According to the Association of American Medical Colleges (AAMC), the United States could face a shortage of between 37,800 and 124,000 physicians by 2036. This shortfall, described as an “urgent crisis” by the president of the American Medical Association (AMA), is expected to disproportionately affect rural areas, where access to healthcare is already limited.
Both the AAMC and AMA have identified U.S. immigration policy as a critical strategy for strengthening the physician workforce and mitigating the impact of the physician shortage on the nation’s health. The J-1 and H-1B visa programs, which help attract international physicians to fill gaps in primary care and specialty services, are central to these efforts.
As the incoming administration brings a renewed focus on immigration policy, we explore the visa programs that make it possible for foreign-national physicians to work in the United States.
J-1 Visa Program for Foreign Physicians
Foreign physicians pursuing residencies or fellowships in the United States enter the country under J-1 visas. The U.S. Department of State has designated the Educational Commission for Foreign Medical Graduates (ECFMG) as the sole sponsor for J-1 physicians participating in graduate medical education programs. The ECFMG also facilitates J-2 visas for the spouses and unmarried minor children of J-1 physicians.
According to the ECFMG, the number of J-1 physicians training and serving patients in U.S. teaching hospitals increased by 58% over the past decade, highlighting the growing role of foreign nationals in addressing U.S. healthcare needs. The State Department notes that the leading countries of origin for J-1 physicians are Canada, India, Pakistan, and Nepal.
Conrad 30 J-1 Visa Waiver Program
Under U.S. immigration law, physicians on J-1 visas are required to return to their country of most recent permanent residence for at least two years after completing their U.S. training. They are only eligible to change their visa status or apply for permanent residency after fulfilling this requirement. However, the Conrad 30 J-1 Visa Waiver Program offers exceptions to this requirement to address physician shortages in underserved areas.
The Conrad 30 program waives the two-year return requirement for qualifying J-1 physicians. In exchange, participants must commit to practicing medicine for at least three years in designated Health Professional Shortage Areas (HPSAs) or Medically Underserved Areas/Populations (MUAs/MUPs).
To qualify, J-1 physicians must secure sponsorship from a state public health department or equivalent entity, sign a full-time employment contract with an approved healthcare facility, and meet federal and state-specific criteria. Under the program, each state can sponsor up to 30 physicians annually and tailor the program to meet specific healthcare needs.
Applying for a Conrad waiver entails multiple steps, including completing State Department paperwork and compliance with state-specific requirements. For example, in Virginia, the Conrad 30 program is managed by the Virginia Department of Health to “enhance access to primary and specialty care in underserved regions.” Virginia prioritizes physicians whose work aligns with public health goals, ensuring maximum impact in addressing healthcare disparities. Similarly, Alabama’s Conrad 30 program focuses on bridging gaps in healthcare access within its underserved communities. Although program details differ slightly, the core objective remains the same: attracting skilled international medical graduates to bolster the healthcare workforce in regions where it is most needed.
In a 2023 letter to the Senate Committee on Health, Education, Labor, and Pensions, the AAMC stressed the value of the Conrad 30 program, noting that it had “brought more than 15,000 physicians to underserved areas—comparable to (if not more than) the [National Health Services Corps]—at no cost to the federal government” over a 15-year period. However, the program’s utilization varies by state, and some states opt not to fully use their allotted slots. To address this, the bipartisan Directing Our Country’s Transfer of Residency Slots (DOCTORS) Act proposes reallocating unused Conrad 30 slots to states that have already filled their annual allotment. This would allow them to bring in more than 30 physicians each year. There is also bipartisan support for the Conrad State 30 and Physician Access Reauthorization Act, which would allow states to have up to 35 waivers based on their usage.
H-1B Visas for Physicians
Some non-national physicians work under H-1B visas, which allow U.S. employers to hire foreign workers in specialty occupations requiring advanced knowledge. To qualify, physicians must hold a Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree from an accredited institution and possess an unrestricted medical license in the state where they intend to practice. Additionally, the sponsoring employer must demonstrate the necessity of hiring a foreign worker the role.
As part of the application process, the employer must file a Labor Condition Application (LCA) with the U.S. Department of Labor, attesting to fair wages and working conditions. H-1B visas are subject to an annual cap of 85,000, including 20,000 reserved for individuals with advanced degrees from U.S. institutions. However, cap exemptions are available for qualifying institutions, including nonprofit organizations, institutions of higher education, and affiliated teaching hospitals.
H-1B visas are initially valid for three years and can be extended for up to six years. Additional extensions may be made for specified circumstances, including being in the process of obtaining permanent residency.
On December 18, 2024, the Department of Homeland Security (DHS) published a final rule titled “Modernizing H-1B Requirements, Providing Flexibility in the F-1 Program, and Program Improvements.” DHS stated that the rule would enhance the efficiency and integrity of the H-1B program by refining eligibility criteria, streamlining application processes, and introducing safeguards to prevent misuse. These updates could be particularly relevant to physicians navigating the complexities of U.S. immigration and employment systems.
Political Context and Future Considerations
While immigration reform was a cornerstone of President-elect Trump’s campaign, there is uncertainty about whether it will include changes in visa programs for highly-skilled workers. High-profile debates among conservatives have recently highlighted divisions over immigration policy specific to skilled workers. For example, when Elon Musk, who is slated to lead the advisory Department of Government Efficiency, advocated for an expansion of the H-1B visa program, former Trump adviser Steve Bannon countered that “one hundred percent of the workers that are here on H-1B visas should be deported.” Opposition has not been limited to conservatives; Senator Bernie Sanders also criticized Musk’s stance, underscoring the broader debate on the role of foreign labor in the U.S. workforce.
As the new administration’s policies unfold, stakeholders in the healthcare and immigration sectors will be closely monitoring potential reforms that could affect the recruitment and retention of international medical professionals in the United States.