When a foreign-national physician on a J-1 exchange visitor visa seeks to remain in the U.S. beyond the two-year home-residence requirement under INA §212(e), the Conrad 30 Waiver Program offers a viable path — provided they agree to serve for at least three years in a medically underserved area or population. Here’s how it works, and how it interacts with the H-1B status change.

What is the Conrad 30 Waiver Program?

 Under INA §214(l), each U.S. state (plus D.C., Guam, Puerto Rico, and the U.S. Virgin Islands) may recommend up to 30 J-1 physician waiver requests per federal fiscal year (Oct 1 – Sept 30) for physicians who commit to at least three years of service in a Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), or Medically Underserved Population (MUP). The physician must work full-time (generally at least 40 hours per week) in the approved underserved location consistent with the state’s approved waiver. The state health department reviews the application, forwards a recommendation to the U.S. Department of State Waiver Review Division, which in turn notifies U.S. Citizenship and Immigration Services (USCIS) once the waiver is approved.

Key Steps in the Conrad 30 Process

 Identify an eligible service site and employer in an HPSA, MUA, or MUP. Note that some larger states with high demand for waivers (e.g. NY, TX, FL, CA) may provide online updates or a tracker showing how many of their 30 slots remain for the current fiscal year — others require contacting the state coordinator directly. Ensure the site is properly designated (HPSA/MUA/MUP) and the employer is willing to support the full 3-year service term in its employment contract.

1. File the DS-3035 and pay the fee online with the Department of State, and obtain the barcode confirmation page and DOS fee receipt.
2. Prepare the state waiver application. Each state’s health department has its own forms, deadlines, and checklists that should be carefully consulted.
3. Submit the complete waiver package (including the DS-3035 materials and the employment contract) to the state health department.
4. If recommended, the state transmits the case to DOS.
5. DOS adjudicates the waiver request and forwards to USCIS, which adjudicates the waiver by issuing an I-612 approval notice with an addendum listing the specific approved worksite(s).
6. The physician must begin their 3-year service within 90 days of the I-612 approval, so the employer should be ready to file the I-129 petition requesting a change of status from J-1 to H-1B soon after USCIS approves the waiver. Premium processing will likely be needed to authorize the physician to begin work within the required 90-day window. The waiver process also needs to be initiated early enough so that the H-1B change of status application can be filed before the expiration of the physician’s J-1 status.

During the government shutdown: the DOS processing stage (step 6) is currently on hold; however, most states are still continuing to accept and review Conrad 30 waiver applications and can still issue state-level recommendations. This means physicians/employers can still be advancing steps 1-5 in the meantime.

Implications When Changing to H-1B Status

 Cap exemption

One of the major benefits of the Conrad 30 waiver is that the physician is exempt from the H-1B annual numerical cap for the initial H-1B petition, and does not need to be registered and selected in the annual lottery process. In effect, this means the employer files the H-1B petition and marks the beneficiary as “cap-exempt” because of the waiver.
Because the physician is individually cap-exempt via the waiver, the employer does not necessarily have to be a classic cap-exempt employer (like a university or nonprofit research institution). The beneficiary’s waiver status carries the exemption.

Portability and transfers

Once the physician has changed to H-1B status and the petition is approved under the cap-exempt basis, the standard H-1B portability rules apply. During the three-year service obligation, any change of employer or location must still comply with the terms of the waiver (i.e., the employer is in the approved underserved site or successor site approved by the state, etc.). If the physician remains in service at the approved location for the full three years, after completion they may change employers or sites more freely, including moving to a location not in an underserved area.

After completing the service obligation

After the full three years of service are fulfilled, the physician is treated as having been “counted against” the H-1B cap at the time of the initial waiver‐based H-1B. That means for future H-1B petitions or transfers (including to cap-subject employers in non-shortage areas) the physician will not need to go through the lottery again — they are already counted. Completion of the full service obligation is therefore key to the physician’s employment options afterward.

Risk considerations

 If the physician leaves the approved site prematurely (without state approval or without qualifying for an “extenuating circumstances” exception), the waiver may be revoked and the physician may lose cap-exemption or face other adverse consequences. The H-1B petition must therefore correctly reflect the terms of the waiver and service location. Any change of employer or site must be analyzed in light of the original waiver commitment and state/federal regulations. Records of employment at the approved site should also be maintained for audit or enforcement purposes.

Conclusion

The Conrad 30 waiver offers a powerful avenue for J-1 physicians to bypass the home‐residence requirement, transition to H-1B status, and benefit from cap-exemption — but only if the conditions are handled precisely. From securing a valid placement in an underserved area, to preparing the waiver application, to structuring the H-1B petition and tracking service completion, each step matters. For employers and attorneys supporting these cases, integrating the waiver process with H-1B strategy early on will help minimize risk and maximize flexibility.

If you’re considering a J-1 physician waiver or changing to H-1B status and want tailored guidance on strategy, eligibility, or documentation, we’re here to help.

By: Rebecca Chen

Rebecca Chen is a Partner at Reddy & Neumann. Her representation includes advising clients throughout the non-immigrant and immigrant visa application process, from initial filing, responding to various requests for evidence, and processing at overseas consulates. Her years of experience in the immigration field have made her a knowledgeable resource for complex business immigration matters.