Conrad 30 Overview by State; J-1 Waivers for physicians

Almost all foreign medical graduates in J-1 status are subject to a requirement that they return to their home country at the completion of the training program for two years. Satisfaction or waiver of this requirement is necessary before moving from J visa status to most any other visa status. Therefore, in most cases a return to the home country for two years or a waiver of this requirement is necessary before a foreign doctor can obtain employment in the United States.

J-1 waivers are sometimes available to foreign medical graduates who have an employment offer that is important to a state department of health, usually if the doctor is working in primary care in a medically underserved area in the state. This waiver option is called the State 30 Program because it is limited to 30 foreign medical graduate waivers per state per year.

The following is a chart our law firm has compiled summarizing which states will sponsor foreign medical graduates for J-1 waivers, and under what conditions. We caution that states change their policies all the time and without warning. The following list is as current as the information provided by each state’s web site, so it is best to check with us for the latest information.

A list of abbreviations is at the end of this document.

State: Alabama

Practice Areas: FP, IM, P, OB/GYN, PSY, Geriatrics

Designation Areas: HPSA, MUA

Flex Slots: No

Fellowship Training Allowed: Up to 20 slots may be available for sub-specialty physicians if the slots are not requested for primary care or psychiatry. Sub-specialty physicians must be board eligible or board certified in the sub-specialty. J-1 physicians who have started or completed fellowship or subspecialty training may apply for a primary care waiver. Must practice direct patient care at least 40 hours per week. Time in sub-specialty does not count towards the 40 hours.

Notable Requirements: Waiver requests must be made through an Alabama licensed medical facility or physician that is physically located in Alabama and is willing to offer the applicant employment for a minimum of three years. Must complete recruitment during six-month time frame immediately before submission of the waiver application. Must provide actual copies of national and in-state advertisements, as well as written acknowledgement of receipt from Alabama medical schools. Must provide certification that the employer is an Alabama licensed medical facility or physician located in the state of Alabama. Submit one original, un-tabbed application for the State Department and one tabbed copy for the Alabama Department of Health.

Application Review Timeline and Process: Awarded based on need, then on a first-come, first-served basis. Primary care applications may be submitted between October 1 and September 30 (until the available 30 slots are filled). Subspecialty applications may be submitted starting the first Monday of the first full week in January of each year. No more than 2 sub-specialty applications may be submitted for the same employer in any given year; if slots remain after April 1, an additional 2 sub-specialty applications may be allowed. Rural hospitals participating in the Medicare Rural Hospital Flexibility Program, and other Alabama employers located in non-Metropolitan Statistical Areas, are allowed to submit subspecialty applications year around, subject to slot availability.

State: Alaska

Practice Areas: Not defined

Designated Areas: HPSA, MUA

Flex Slots: 10

Notable Requirements: Evidence of unsuccessful efforts made to recruit an American physician for the position. Physician must sign a contract with the facility to practice for no less than 40 hours a week for three years. Must supply unsuccessful efforts made to recruit an American physician. For the Flex 10 option, submit evidence that a significant amount of care provided by the J-1 physician will be for people residing in a HPSA or MUA. Director of hiring facility must send a letter, confirming physician’s employment, to Alaska J-1 Visa Coordinator every six months.

Application Review Time and Process: All applications are reviewed on a case-by-case basis.

State: Arizona

Practice Areas: FP, GP, P, OB/GYN, GIM, PSY (in mental health HPSAs)

Designation Areas: HPSA, MHPSA, MUA or MUP

Flex Slots: No

Fellowship Training Allowed: Up to 7 slots reserved for full-time specialists, but primary care physicians or psychiatrists may fill at least 22 of the 30 available slots. Specialists have to show exceptional need for their specialty. The program may use one slot at the discretion of the AZ Health Administration, which may be used for staffing emergencies or the loss of at least two physicians, unless the rural HPSA, MUA, or MUP has only one physician within a rural HPSA, MUA, or MUP within 6 months before the date ADHS receives the request. The discretionary slot will have to meet the HPSA, MUA, MUP requirement.

Notable Requirements: Must provide proof that a good faith effort was made to recruit a U.S. physician in the same salary range, including a description of efforts and copies of ads or announcements, number of U.S. physicians who applied and outcome of any interviews. Sliding discount-to-fee schedules must be based on current federal poverty guidelines and adhere to A.A.C. R9-1-504 sliding fee schedule submission and content. Facility must complete service site application.

Application Review Time and Process: Applications accepted starting October 2 and postmarked on or before November 30; review is 8-12 weeks. Applications are reviewed for completeness, inclusion of all documents, service site eligibility, the J-1 physician’s eligibility, and adherence to the Arizona J-1 Visa Waiver Program state and federal guidelines. If slots remain available at the end of the first application period, the program will begin accepting applications for its second cycle immediately after the first cycle closes. Second cycle application duration, and a possible third application period, will be determined by number of remaining available slots.

State: Arkansas

Practice Areas: PC and any specialty will be considered

Designation Areas: HPSA, MHPSA, MUA, MUP, FQHC, CHC

Flex Slots: Up to 10 Flex spots are available for IMGs practicing in facilities outside of the federally designated areas, but who serve patient populations residing in one or more of the designated areas. Applicants must submit evidence that at least 30% of the patients seen at the practice site are from a HPSA, MUA, or MUP.

Fellowship Training Allowed: No distinction between primary care and specialties.

Notable Requirements: Contract must be 40 hours/week for 3 years; salary stated; no non-compete/non-solicitation clauses. If applicant has received funding from home country a statement of no objection from the home country must be included. Recruitment efforts must be described.

Application Review Time and Process: Reviewed on a first-come-first-served basis beginning October 1 with a final submission date of September 15 unless specific permission is obtained by the Arkansas J-1 Visa Waiver Program. See application checklist. Additional placements can be applied to through the Delta Regional Authority.

State: California

Practice Areas: GIM, FP, P, OB/GYN, PSY

Designation Areas: HPSA, MHPSA, MUA, MUP

Flex Slots: If slots remain vacant.

Fellowship Training Allowed: Applications are prioritized for primary care physicians in federally designated underserved areas, including internist, family practice, pediatrician, psychiatrist, and OB/GYN. Waiver slots will open to all specialists for HPSA, MUA or MUP areas if all 30 waiver slots are not filled by primary care physicians on July 1.

Notable Requirements: Must demonstrate efforts to recruit a U.S. physician and provide long-range plans for retention of foreign physician. Must document the need for a proposed specialty using population-based data relevant to the proposed specialty (morbidity, mortality, population/physician ratio etc.). Must provide services to a caseload that is comprised of at least 30% Medicaid patients or a caseload that includes a combination of at least 30% Medicaid and uninsured patients throughout the three-year contract period.

Application Review Time and Process: Applications are accepted starting October 1st until June 30 for primary care physicians in federally designated underserved areas, and are reviewed in the order received. July 1-September 30, applications are accepted from primary care physicians and specialists. All applications will be held for 30 days and prioritized in the following order: primary care physicians working in a rural clinic located in a HPSA, MUA, MUP, or MHPSA, followed by an urban clinic located in a HPSA, MUA, MUP, or MHPSA; cardiologists, gerontologists, or pediatric sub-specialists working in a HPSA, MUA, or MUP; lastly, other specialists working in a HPSA, MUA, or MUP. Sponsoring employers must document the need for a proposed specialty using population-based data relevant to the proposed specialty (morbidity, mortality, population/physician ratio etc.)

State: Colorado

Practice Areas: FP, GIM, P, OB/GYN, G, PSY, DH

Designation Areas: HPSA, MUA, MUP, MHPSA

Flex Slots: Yes

Fellowship Training Allowed: The program has a preference for outpatient primary care placements, but considers applications for specialists and inpatient assignments if the healthcare facility demonstrates a shortage of that specialty in the area of service. The application must show the entire facility is able and willing to serve the under-served population of the service area (patients on Medicaid, Medicare, and the uninsured).

Notable Requirements: Must show 6 months of recruitment efforts, and there is a $1,000 application fee for a complete application review and waiver determination. Requires application inclusion of steps to improve J-1 physician retention in the community after the service commitment is complete.

Application Review Time and Process: Applications reviewed in the order they are received based on their own merit until 30 recommendations are made to the DOS. Three to four months DOS approval process. Considerations include: completeness of the application, demonstrated need in the community, the healthcare facility’s retention plan, and the degree to which the physician’s training is reflected as matching the community’s needs.

State: Connecticut

Practice Areas: Open to all licensed physicians and surgeons

Designation Areas: HPSA, MUA, MUP

Flex Slots: Yes

Fellowship Training Allowed: Will consider all medical specialties, subspecialties, and surgeons based on need. Up to 5 Flex slots will be available to facilities that document that at least 30% of its patients reside in a designated shortage area, describe the need for the physician’s services, and show how it will benefit the indigent and medically underserved;

Notable Requirements: Demonstrate evidence that required recruitment efforts for an American physician have failed. For Flex spot applications, letters of community support from at least 3 community agencies stating that the J-1 placement is critical to alleviate health care access problems for the underserved. Preference is given to specialties serving an identified and specific need. A maximum of two waivers per health care setting will be recommended in a fiscal year, unless that by April 30, the number of applications approved and recommended from all institutions in that year does not reach 30. Physician must be licensed in Connecticut; the Department will not accept a pending license application as proof of licensure.

Application Review Time and Process: Applications will be accepted starting on October 2 (must be hand-delivered). If slots are left open after April 1, physicians and surgeons serving a federally-designated HPSA or area serving patients from one or more HPSA may apply. Slots fill rapidly.

State: Delaware

Practice Areas: FP, IM, P, OB/GYN

Designation Areas: HPSA, MUA

Flex Slots: Yes

Fellowship Training Allowed: 10 slots are used for areas that are not designated as a shortage area but have been identified by the state as being underserved. Fellowship experience permitted for any specialty with documentation of need in the service area.

Notable Requirements: Site must be pre-approved and include a needs assessment, proof of attempts to hire a U.S. physician, letters from community leaders residing within the site service area, and retention strategy. $200 Site Application fee. Pre-approved sites must also pay a non-refundable $250 waiver processing fee. Sites approved to participate in the J-1 Visa Waiver Program must also participate in state programs designed to increased access to care for the uninsured/under insured such as the Healthcare Connection, Community-based Healthcare Centers, the VIP provider network, and, if appropriate other charitable programs. Site applications must be submitted by June 30. Applications submitted after this time must show “emergent need.”

Application Review Time and Process: Rolling application period.

State: District of Columbia

Practice Areas: GIM, OB/GYN, FP, P, GS, HD, CNC, CRBVD, HIV/AIDS

Designation Areas: HPSA, MUA/P

Flex Slots: Yes

Fellowship Training Allowed: Specialist applications are accepted in practice areas of DC’s leading causes of death (heart disease, cancer, cerebrovascular disease, accidents, HIV/AIDS, and chronic lower respiratory diseases). Other specialties may be considered with letters of support documenting the community’s need of the specific specialty or physician, including any unique qualifications, like language proficiency, that make the applicant suited to serving the patient population. 10 Flex spots held for those to be employed at facilities not located in a HPSA or MUA if the facility serves DC’s underserved, with an insurer-payer mix evidence showing at least 30% Medicaid insured, or 45% Medicaid, Medicare, uninsured, Alliance-insured, and/or reduced fees according to a sliding scale fee policy. The DOH provides National Interest Waiver recommendations for non-Flex slot J-1 waiver physicians after their 3-year commitment, so they may continue another 2 years at the current or other qualifying facility.

Notable Requirements: Contract agreement must be in place for at least 6 months before the application submission and must reference the position for which the J-1 physician is being hired. Facility must show two different forms of documentation of their recruitment efforts for six months before, by national or regional advertisements/postings, which specifically identify the facility, physician type, and the original posting publication date. Other documentation includes agreements with placement services, dated letters to residency programs, recruitment results (e.g. offer letters that have been declined), or other documentation that demonstrates the sponsoring facility has used public or private recruitment efforts in a broad attempt to fill the position. Employer must provide two reports per year to the Health Care Access Bureau until the three-year commitment is complete. Physician must enroll in DC Medicaid and Health Care Alliance. No restrictive covenants; must provide contracts, no offer letters.

Application Review Time and Process: Applications are accepted on rolling basis. Preference is given to PC physicians.

State: Florida

Practice Areas: Not defined

Designation Areas: HPSA, MUA, MUP

Flex Slots: Yes

Fellowship Training Allowed: 10 Flex spots are held for outside of federally-designated shortage areas. The employer must prove that the physician will serve medically underserved patients. National interest waivers are also available.

Notable Requirements: Contract must include 40-hour work week in patient care for 3 years. A complete application packet includes: the J-1 waiver application, practice facility letter, employment contract, evidence of shortage designation status, physician’s curriculum vitae, J-1 visa waiver sponsorship application (DS-3035), and evidence of all previous J-1 status.

Application Review Time and Process: Application packets will be reviewed for completeness.

State: Georgia

Practice Areas: IM, FP, P, OB/GYN, G, PSY

Designation Areas: HPSA, MUA/P

Flex Slots: Yes

Fellowship Training Allowed: Up to 10 slots for specialists in any specialty. 10 Flex spots are held for outside of federally designated shortage areas, but priority is extended to requests within the designated shortage areas. Service time within a non-designated area may be applied to a National Interest Waiver. J-waivers also awarded through the Appalachian Regional Commission.

Notable Requirements: The contract must have must show recruitment efforts for 6 months before application; and a 40-hour work week for 3 years. SORH may make annual site visits to and requires semi-annual reports from the work site. Facilities and physicians must agree to charge patients at the usual and customary rate prevailing in the designated shortage area, unless the patient is indigent, in which case employing a sliding fee schedule based on the federal poverty guideline. Facility and physician must enter agreement with the Georgia Department of Community Health and provide medical assistance under Medicaid, Medicare, and similar programs.

Application Review Time and Process: Applications accepted starting September 1 and accepted year-round, on a first come, first served basis, with priority given to sites in areas with the greatest need for access to medical care, until all slots are filled or the next program cycle. From September to April 1, GA allocates up to 20 PC and up to 10 specialists, taking about one month to decide applications. If slots are remaining from preceding fiscal year, any new applications up to September 30 will be applied to previous year. Starting October 1, new applications will be reviewed. If all slots have been filled before end of program year, new applications are accepted starting September 1 of the fiscal year.

State: Guam

Practice Areas: Does not define primary care.

Application Review Time and Process: Applicants sign a contract with a Guam-based clinic or physician, complete the initial State Department application process, and make a written request for a letter of support from the Department of Public Health and Social Services. There is no separate application.

State: Hawaii

Practice Areas: IM, FP, P, OB/GYN, PSY

Designation Areas: HPSA, MUA, MUP, FQHC

Flex Slots: Yes

Fellowship Training Allowed: Up to 10 Flex slots available with documentation of necessity.

Notable Requirements: The requirements for the program follow the same requirements as the federal application. Must include information about necessity for Flex slots or specialist slots. Contact Rural Health Office for more information.

Application Review Time and Process: The state DOH recruits year round on a first-come, first-served basis. Applications for specialists are accepted year round as are Flex spot applications.

State: Idaho

Practice Areas: FP, IM, P, OB/GYN, PSY,

Designation Areas: HPSA, MUA, MUP, MHPSA

Flex Slots: No

Fellowship Training Allowed: National Interest Waivers are also available for foreign-trained physicians working in health professional shortage areas.

Notable Requirements: Non-refundable application fee to be determined per fiscal year at the discretion of the department director, and will be no less than $1,000. Requirements for recruitment of an American physician includes regional and national print ads, 6 certified letters to area medical schools, show six months of prior efforts, and list of applicants and why they were not selected. Contract must include 40-hour work week in patient care for 3 years; no-compete clause; termination only with cause; “No Objection” statement required if foreign government funding was involved. Application must include recommendation from residency program. Physician must not be in default on any federal or state scholarship or loan repayment. Incomplete applications require an additional re-submission fee.

Application Timeline and Process: Slots awarded on a first-come, first-serve basis, based on completeness. Priority will be given to physicians with language skills appropriate to the facility site community. Preference will be given to applications received from HPSAs having the greatest unmet need for primary care physicians.

State: Illinois

Practice Areas: FP, P, GIM, OB/GYN, PSY, & Combined Medicine/Pediatrics

Designation Areas: HPSA, MUA, MUP, or where 51% of patients come from a HPSA, MUA, or MUP (FLEX waivers only) MHPSA for PSY

Flex Slots: Yes

Fellowship Training Allowed: May grant Flex waivers for an applicant outside of HPSA areas, if facility can show at least 51% of the patients come from a HPSA or MUA/P. In the first calendar quarter of the federal fiscal year, 4 slots reserved for psychiatrists and 6 slots for primary care physicians in rural facilities; 7 slots reserved for primary care and 13 reserved for specialists in urban facilities. Of the 13 slots for specialists, 10 slots may be given to Flex waiver specialists. In the second and third quarters of the federal fiscal year, remaining spots are available to primary care and specialists in rural or urban areas. Site approval required; only 2 waivers per facility.

Notable Requirements: $3000 non-refundable application processing fee must be submitted in order for application to be considered complete. Facility or agency must explain recruitment difficulties in application, the impact on their facility and on patients if the waiver is not approved, and physician’s expected practice arrangement. Employment contract cannot contain a non-compete clause or a liquidated damages clause; must have 40 hour work week minimum; comparable salary to physicians not part of the State 30 program. Facilities must have a Certificate of Good Standing with the Illinois Secretary of State. Facilities can document need for the specialist by providing physician-patient ratios, listings of similar service providers in the area, and wait time comparisons for comparable specialists in underserved areas.

Application Review Time and Process: Applications are processed between October 1 and 31. If slots remain, applications are accepted again between January 1 and 30 and between April 1 and April 30. Applications not accepted after submission deadlines. Application ranked according to the HPSA scoring system, with preference given to the medical facility with the greatest unmet need, defined according to HPSA threshold ratios, and for Flex waiver specialists, based on the greater number of patients served at the facility.

State: Indiana

Note: The Indiana Primary Health Care Association (IPHCA) is under contract with the Indiana State Department of Health (ISDH) to handle the initial processing of J-1 visa waiver applications

Practice Areas: All specialties, with preference to primary care physicians: FP, P, OB/GYN, GIM, (PSY – MHPSA only)

Designation Areas: HPSA, MUA, MUP, (MHPSA – PSY only)

Flex Slots: Yes

Fellowship Training Allowed: All specialties may apply, but first preference given to primary care physicians. Specialists include Hospitalist, Geriatrics, and all other physicians who have received additional Fellowship training. Flex applications are available to sites that show 50% or more of their patients over the last twelve months reside in an underserved area, by unduplicated, de-identified patient records indicating unique patient number and address.

Notable Requirements: Service site must be operational at least 6 months before request. Must show recruitment efforts for 4 months; minimum 40-hour work week; three-year contract; comparable pay; use a sliding fee scale based on ability to pay for all patients at the facility who are uninsured and at or below 200% of federal poverty guidelines; must complete verification of employment within first 30 days and then every 6 months; priority awarded to critical access hospitals. Must have license or show that application for full Indiana medical license has been submitted.

Application Review Time and Process: Applications can be submitted at any time of year, and will be reviewed in the order received until all slots are filled. Items from incomplete applications must be submitted within 5 days. Processing for PC physicians begins October 1 and for specialists on January 1.

State: Iowa

Practice Areas: FP, GS, GIM (includes H), OB/GYN, P, and PSY

Designation Areas: HPSA, MUA, MUP

Flex Slots: Yes,

Fellowship Training Allowed: Up to 10 Flex slots can be used for physicians practicing outside of HPSA, MUA or MUP areas, if the unmet need is clearly demonstrated and submission requirements are met. Priority for PC physicians. Physicians with sub-specialty training must show that their services are essential to the unmet health care needs of the underserved in Iowa.

Notable Requirements: Applicants must notify IDPH of their intent to file a waiver application. Highlight recruitment/retention efforts by the healthcare facility for at least 6 months. Waiver request must be submitted by the health care facility and/or attorney for physician, not from the physician directly. Waiver request must report estimated percentages of Medicaid, Medicare, and uninsured patients to be treated. Annual reporting of the J-1 physician’s number of patients and their insurance status is required.

Application Review Time and Process: Submit 2 copies. Applications accepted from the first Tuesday in September to the last Friday in October for each fiscal year. From these applications, decisions will be sent out by the Iowa Department of Public Health on or by the second Friday in December. Parties must refrain from any contact with the Iowa Department of Public Health until decisions are posted, otherwise possibly disqualifying. Incomplete applications received before the deadline will be returned and can be resubmitted before the due date, otherwise will be considered a new submission. Applications received after the last Friday in October will be considered for the current fiscal year only if the 30 slots are not filled. Applications will be reviewed according to submission requirements and how well the planned practice/ employment meets program requirements, including type of care, location, need, and number of waivers previously granted to the facility and in the location.

State: Kansas

Practice Areas: Priority given to primary care physicians who are board certified in one of the following specialties: Family Practice, General Internal Medicine, General Pediatrics, Obstetrics/ Gynecology, Emergency Medicine and Psychiatry

Designation Areas: HPSA or MUA/MUP designated or updated within the last 4 years. Facilities with automatic HPSA RHC or FQHC also eligible

Flex Slots: Yes

Fellowship Training Allowed: Priority will be given in the following order: (1) primary care: Physicians specializing in FP, GIM, GP, OB/GYM, emergency medicine or psychiatry and will be working in outpatient ambulatory care setting; (2) Specialty: Physicians specializing in a primary care specialty (listed above) and will be serving in the capacity as a hospitalist. Physicians who are board certified in a non-primary care specialty directly related to the management of time critical diagnoses (STEMi, Stroke, and Trauma); (3) Specialty: Physicians specializing in all other specialties, with preference to specialties that directly support the coordination of care for patients with chronic diseases (e.g., diabetes, heart disease). Kansas will use its authority to recommend up to 10 waivers each year for physicians to practice in areas that do not have the required federal shortage area designations, if the need for services can be demonstrated and if patients from designated shortage areas will be served. The employer must demonstrate evidence of unmet need. The employer statement of need must contain documentation that the facility where the physician will practice has sufficient patients who live in designated shortage areas to support at least one full time equivalent physician of the specialty provided by the physician named in the waiver application.

Notable Requirements: Any employer wishing to hire a physician must show that the practice has an open door policy with patients and sign an agreement to accept all patients regardless of ability to pay. Have a written nondiscrimination policy and provide services in a culturally and linguistically appropriate fashion responsive to the needs of the area’s general population. The employer must show evidence of open recruitment and other options for hiring tried over a period of at least the six months. Physician to serve in the clinical practice of his/her profession full time and may be terminated only with cause and cannot be terminated by mutual agreement until the statutorily-required 3 years have expired. Contract must contain a sentence stating what field of medicine the J-1 physician will practice a minimum of 40 hours per week and the practice site address. Include a statement that on-call is not included in the minimum hours. Contracts may not include any clauses that would require the J-1 physician to pay a sum to the employer for experience gained on the job or for the J-1 physician remaining in the area after the contract has ended.

Application Review Time and Process: entities must notify their intention to request J-1 Visa Waiver in an advance of submitting the full application. This notification is made by submitting the “Advance Notification Request for J-1 Visa Waiver” form. Once the Advance Notification Request for J-1 Visa Waiver form has been submitted, entities will have a fixed timeframe to submit the full application as indicated in the guidance document.

State: Kentucky

Program: Kentucky offers J-1 waivers through four programs: the State 30, Appalachian Regional Commission (ARC), HHS Exchange Visitor Program, and Delta Regional Authority (DRA) program. The former two programs are managed by Health Care Access branch of the state’s DPH. J-1 waiver physicians may also extend their service to HPSAs by obtaining a National Interest Waiver.

Practice Areas: FP, P, Medical/Pediatrics, IM, OB/GYN, PSY

Designation Areas: HPSA, MHPSA, MUA/P, FQHC

Flex Slots: Up to 10 slots.

Fellowship Training Allowed: Allowed without restriction in all programs.

Notable Requirements: Must submit detailed summary of recruitment efforts from 3-12 months before the application; 40 hours/week minimum for 3 years; evidence of eligibility for a Kentucky medical license; no objection letter from applicant’s home country. Discounts must be offered by whole facility to all patients with family incomes below 200% of poverty.

Application Review Time and Process: Must apply between 10/1 and 10/31 of fiscal year; 6-month reporting once applicant is approved and working. Kentucky State 30 program will give priority to critical access hospitals and safety net providers including CHCs, local health departments, publicly owned health facilities, and FQHCs.

State: Louisiana

Practice Areas: P, OB/GYN, GIM, FP, GP, PSY
Designation Areas: HPSA and MHPSA

Flex Slots: Yes

Fellowship Training Allowed: Any specialty is permitted, with preference to PCs. For PCs, 80% of services must be PC work, or will otherwise be considered a sub-specialist. Up to 10 Flex slots per year, with 30% patient population in HPSA. Must show dire need for sub-specialty. 6 slots reserved for specialists from October 1 to March 31. On April 1, remaining slots are available on a first-come, first-served basis for completed eligible applicants, no matter the medical specialty. DRA waivers are also available in Louisiana.

Notable Requirements: Must have contract for a minimum of three years at a salary that meets prevailing wage; no non-compete clause or other means for restricting physician from working in the area after the contract period. Must work 40 hours a week; 32 hours must be clinical. Facility must show recruitment efforts for 6 months before contract, including contact with in-state residency directors requesting that this opening be posted; must show posting on www.medjobouisiana.com for PC positions. Facilities must have an active sliding fee scale in place at least 90 days before application approval. Must show 30% of patients are Medicaid, Medicare, or uninsured. Dental HPSAs will not apply. The Bureau may do site visits before and after support for a J-1 waiver physician without notice. Applicants must have completed residency in PC and provide license. Facility must provide the number of patients treated in the previous year and proof of the site’s existence.

Application Review Time and Process: Starts accepting applications on October 1. No deadline for applications. From Oct. 1 to March 31, 80% of 30 slots will be reserved to PCs, and 6 slots for specialists. Slots remaining from April 1 will be processed on a first-come first-served basis, judged by completeness and program guidelines. Priority to applicants who do residency/fellowship training in Louisiana.

State: Maine

Practice Areas: Does not distinguish between primary care and non-primary care applications.

Designation Areas: HPSA, MUA/Ps

Flex Slots: Yes

Notable Requirements: Flex spots for up to 10 specialists outside of HHS designated health shortage areas per cycle. If HPSA/MUA is based on a population group, the physician must increase health care access for that group. Recruitment must be demonstrated for length of time position was vacant, including placement agreements, attendance at recruitment fairs, ads, plans for retaining physician, and needs assessment for increased access. Waiver request must come from the employer and not directly from the applicant. Incomplete applications will be returned. Robust retention documentation expected.

Application Review Time and Process: Applications accepted October 1 until slots full. Request must come from health care facility. Reviewed within 30 days of receipt of application, and assigned a priority number. Once 30 slots have been filled, all further applications between that date and September 30 will be returned and can be processed on or after October 1, providing that the 30 new slots have not been filled.

State: Maryland

Practice Areas: All PCs and specialists

Designation Areas: HPSA and MUA

Flex Slots: Yes

Fellowship Training Allowed: Maryland currently has no clinical specialty restrictions. 10 Flex slots are available.

Notable Requirements: 32 out of 40 hours must be direct patient care; 3-year contract; no non-compete clause. The employer must post vacancy in all in-state medical schools and document recruitment efforts for 6 months before application. Hospitalists are not considered to be patient care.

Application Review Time and Process: Applications are accepted till all slots are filled or till the cycle closes. Applications from PCs (Internal Medicine, Family Medicine, Pediatrics, Geriatrics, Obstetrics and Gynecology, Psychiatry, and General Practice) practicing in underserved areas accepted beginning October 1. All other applications from PCs and specialists, in HPSAs or not, accepted beginning December 1 and evaluated/accepted on a rolling basis. Priority awarded to primary care physicians.

State: Massachusetts

Practice Areas: IM, FP, P, OB/GYN, PSY and Geriatrics (allopathic & osteopathic physicians are also included if trained in one of the aforementioned).

Designation Areas: HPSA, MUA, MUP, MHPSA

FLEX Slots: Yes

Fellowship Training Allowed: Subspecialty practice permitted. Up to 10 Flex waivers granted to facilities that can document that more than 30% of their patients reside in HPSAs or MUA/Ps.

Notable Requirements: Preference given to primary care, greatest level of need, and applicable language skills, and service in the public interest of the Commonwealth. Prioritized areas include community health centers, rural communities, western Massachusetts, and the Islands. Facility must participate in MassHealth. Sponsor must comply with J-1 monitoring; must demonstrate recruitment efforts and long range retention plans beyond the 3-year obligations; include description of how long the position was vacant, how many inquiries were submitted, salary offered, and if position was offered to any U.S. citizens.

Application Review Time and Process: PC and specialist applications will be accepted from October 1 to December 31. Reviews will be conducted in January and notifications sent by or before March 1. If spots remain, the program may open a second round for those eligible applicants that were not supported in the January review.

State: Michigan

Practice Areas: IM, FP, P, OB/GYN, PSY

Designation Areas: HPSA, MUA, MUP

Flex Slots: Yes

Fellowship Training Allowed: All medically essential specialists as well as hospitalists may apply, but limit in place. Will consider up to 10 Flex slots (specialists or PCs) with demonstrated critical need for that service, only if there are slots available after all waiver applications within designated shortage areas have been allocated.

Notable Requirements: Facility must document that a portion of its annual patient caseload resides in a neighboring HPSA and/or MUA/P. No recruitment requirements. Physician must provide clinical services; must have a 3 year contract to work in a MUA or qualifying practice site; must agree to begin employment with 90 days of receiving a waiver; work 40 hours/week; practice 100% in the specialty stated in contract; must have MI license (or pending application); No non-compete contracts or covenants. Prevailing wages must be provided for term of contract. Priority is given to safety net providers. Once placed, the physician’s patients must consist of at least 30% combined Medicaid, discounted sliding fee, and uninsured.

Application Timeline and Process: Applications available on request after June 1, accepted September 1 until November 1. Incomplete applications and those received after deadline will not be accepted.

State: Minnesota

Practice Areas: All

Designation areas: HPSA, MUA

Flex Slots: Yes

Fellowship Training Allowed: Up to 10 Flex slots. Must document that the facility has sufficient patients who live in designated shortage areas to support at least one full time equivalent physician of the specialty provided by physician named in the waiver application. Priority given to PCs. Not all Flex slots will be recommended if there are a high number of primary care applications.

Notable Requirements: Physician must work at the health care facility for a total of at least 3 years and 40 hours per week. Waiver request must come from employer on behalf of the applicant. Must demonstrate that the facility has an in-place sliding fee schedule or similar written indigent care policy for determining discounts, or charity care based on the patient’s ability to pay. The policy must be posted in a place that is accessible to patients and potential patients. Must provide a copy of the charity care policy and describe how it is made available. Must clearly demonstrate that a suitable replacement for the physician cannot be found through recruitment or any other means. Facility director should provide a one to three page letter explaining any issues with the application that will help the review committee select waivers that best meet the needs of the state. The health care facility must detail long-range plans for retention of the physician. Physician may not apply for LPR status until at site for at least 2 years. Applications must be complete to be accepted, otherwise will be returned. No returned or amended applications will be accepted.

Application Timeline and Process: Applications are accepted from September until the last business day in November. Highest program priorities are recruitment for primary care and/or rural location. Also, the length of time that a facility has been recruiting for a position, its past ability to retain physicians, and percentage of Medicare/Medicaid patients being served, will be among priorities under consideration.

State: Mississippi

Practice Areas: FP, GIM, GP, OB/GYN, P, and all specialists including ER

Designation Area: HPSA

Flex Slots: Yes

Fellowship Training Allowed: 10 Flex slots given on a first-come, first-served basis, when serving 30% patient population from HPSAs. Specialists in shortage areas will be considered. ARC waivers are also available through a separate program administered by the MSDH. Facilities within ARC counties may recruit specialists but not PCs under the Conrad State 30 program.

Notable Requirements: Request for site predetermination must precede waiver application. HIV test result and evidence of tuberculosis screening for the applicant required 3 months before site determination application. $1,500 non-refundable waiver processing fee must be submitted with complete application. Recommended 4-year contract; submit weekly work schedule (cannot work less than 4 days a week); transfers must complete 3 years in the new site. Population-to-physician ratio must exceed 3000:1. Must provide evidence of national and regional recruitment efforts conducted in the 3 months before the site predetermination application, including 4 certified letters to medical schools; must show that hiring J-1 is a last resort; copies of CVs received; names of U.S. candidates and reasons for not hiring; must give priority to physicians other than J-1 physicians (such as H-1B) who apply to the waiver job and are qualified. Facility must provide proof it has been operational for at least the 6 months before the application. Applying physician cannot be more than 210 days ‘out of status’ since receiving a visa, and where applicable, must provide a ‘no-objection’ letter. Percentages of Medicaid, Medicare, and indigent, uninsured patients served must be included in application. PCs working within a HPSA, MUA or PSA may also apply for NIWs.

Application Timeline and Process: Applications accepted during the fiscal year. Processing takes up to 180 days after the site pre-determination application is submitted.

State: Missouri

Practice Areas: FP, GP, P, IM, P, OB/GYN, PSY; May accept ER physicians as primary care if substantial amounts of primary care services are provided in the ER.

Designation Areas: HPSA

Flex Slots: No

Fellowship Training Allowed: Yes, sub-specialties accepted if slots are available and facility can show need.

Notable Requirements: Site approval required; must demonstrate recruitment and retention efforts, including a plan to retain physician beyond 3 years; priority given for physicians whose spouses were Missouri residents or were previous J-1 visa waiver participants; IM Physicians selected on basis of geographic areas serviced.

Application Review Time and Process: Applications accepted from October 1 until all slots are filled.

Note: Applications generally begin October 1.

State: Montana

Practice Areas: IM, FP, OB/GYN, P, PSY

Designation Areas: HPSA (Preferred), MUA, MUP, FQHC or special population areas including low income, Medicaid, or Native American populations.

Flex Slots: Up to 10 for practice specialties and non-designated areas. Proof that the area is in need of the applicant is recommended.

Fellowship Training Allowed: Yes, if they fill a proven community health care need.

Notable Requirements: Must submit original and 3 copies of application; must show proof of at least 6 months recruitment; required contract terms include facility contact info, salary, liquidated damages clause, and no non-compete clauses; J-1 salary must be at least equal to local prevailing wage or employer actual wage, whichever is higher; must have or apply for Montana medical license and have completed a residency program in their practice area/specialty.

Application Review Time and Process: Applications accepted throughout the fiscal year, review of applications is 15 to 20 working days.

State: Nebraska

Practice Areas: Not specified

Designation Areas: HPSA, MUA/MUP

Flex Slots: Up to 10; sites must notify the Department of their intent to use a Flex slot before the application is submitted.

Fellowship Training Allowed: Yes. Any applicant will be considered if the facility can show it is in the state’s interest.

Notable Requirements: Must give description of recruitment efforts and long-term plans for retention of physician; physicians in program must accept Medicaid/Medicare patients.

Application Review Time and Process: Reviewed by state within two weeks.

State: Nevada

Practice Areas: FP G, P, IM, OB/GYN, PSY

Designation Areas: HPSA, MHPSA, MUA, MUP

Flex Slots: Considered on a case by case basis; 10 to be used for non-designated areas predominately serving individuals that live in an underserved area. Must provide percentage of population served who are at or below 200% of poverty, wait times for serving the population, next nearest provider for the population, and any other barriers to serving the population.

Fellowship Training Allowed: Yes, will accept sub-specialties on a case-by-case basis at the discretion of the Nevada State Health Division. Must include proof to justify there is a critical need for the specialty.

Notable Requirements: No more than 21 of the 30 slots total can be in Clark County; site approval required; must show proof of 2 months of recruitment & retention efforts, including a plan to retain physician beyond 3 years; physicians must agree to accept Medicare, participate in the Medicaid/Nevada Check-Up program and provide care on a sliding fee scale to low-income, uninsured; must be at least in their last year of residency training; max of 3 waivers per facility per fiscal year; must have or apply for a Nevada medical license; $500 fee for primary care physician employed in a designated shortage area, $800 fee for primary care physician using a Flex slot, $1,100 fee for primary care physician employed by a third-party contracted in a designated shortage area, $1,400 for a primary care physician employed by a third-party contractor using a Flex slot, $800 fee for a specialist employed in a designated shortage area, $1,100 fee for a specialist using a Flex slot, $1,100 fee for a specialist employed by a third-party contractor in a designated shortage area, $1,400 fee for a specialist employed by a third-party contractor using a Flex slot. Department may impose an additional fee, not to exceed $2,000; fee may be refunded if there are no slots available when the application is submitted.

Application Review Time and Process: Applications accepted throughout the year, starting October 1 until slots are filled. Review is 30-45 days.

State: New Hampshire

Practice Areas: FP, P, OB/GYN, IM, PSY

Supporting Specialists for PC: Hospitalists, Geriatrics, General Radiology, General Surgery (who are willing to work at safety net providers)

Designation Areas: HPSA, MHPSA, MUA, MUP, E-MUP

Flex Slots: Up to 10 available in non-designated areas if need can be proved. One slot is held for the discretion of DHHS Commissioner or DPHS Director. Pre-application is required, slot reserved for only 3 months upon approval of pre-application.

Fellowship Training Allowed: Yes. Priority is given for primary care physicians. Specialists will be considered if the facility can demonstrate a shortage of that specialist in the area of service. Criteria based on needs of the community, physician’s specialty, percentage of population being served (must treat Medicaid/Medicare/uninsured patients), use of sliding fee scale, type of facility, distance to nearest CHC.

Notable Requirements: Must meet all Federal and State policy guidelines; work 40 hrs/wk in a clinical outpatient setting (at least 32 hours of direct patient care) for at least 45 weeks per year; must apply or have a NH medical license; physician should have already completed residency training; petitioner must show 6 months prior recruitment/ retention efforts for US physicians; cannot include non-compete clause. Must charge for services at the usual and customary rates prevailing in the service area, except that the service site(s) shall have a policy providing the patients unable to pay the usual and customary rate shall be charged a reduced rate according to the service site’s sliding discount-to-fee-schedule based on poverty level or charged; and not discriminate based on ability to pay or payment source including Medicare and Medicaid. The service site(s) must provide a copy and policy of the sliding-discount-to-fee-schedule with their application for approval. Application must come from facility or its attorney, applications submitted by physicians will not be accepted.

Application Review Time and Process: Applications accepted year round. Review is 3-5 weeks; FLEX applications take longer.

State: New Jersey

Practice Areas: FP, OB/GYN, P, IM, PSY

Designation Areas: HPSA

Flex Slots: 10 Flex slots in which facility can be located in MUA/P.

Fellowship Training Allowed: No; priority for FP and OB/GYN.

Notable Requirements: Short and long-range plan for retention of J-1 physician beyond 3-year obligation required; no non-compete clause recruitment efforts over period of at least 6 months; describe physician’s unique qualifications to serve the proposed patient population; comparable salary to physicians not in the J-waiver program; must treat un-insured/Medicare/Medicaid patients; physicians must have completed residency training and have/apply for a NJ medical license.

Application Review Time and Process: Year-round application process.

State: New Mexico

Practice Areas: FP, OB/GYN, P, GIM, PSY no preference for PC over specialists.

Designation Areas: HPSA for primary care physicians; MUA and MUP for sub-specialists. FQHCs are eligible regardless of their location.

Flex Slots: 10 Flex slots available for non-designated areas with a majority patient population from designated areas; physicians must provide direct patient services.

Fellowship Training Allowed: Yes; facility must show significant shortage of the specialty and a need for this specialty among its patients consistent with NMDOH findings

Notable Requirements: Physician must have NM license; contract must contain provision that physician will pay penalty of up to $250,000 in case of default and must not include non-compete clause; facility must have policy to accept all patients regardless of ability to pay; application must identify physician’s supervisor; must provide summary of 6 months recruitment; must sign & notarize affidavit, Candidate Site Location & Report Agreement & Candidate Data Sheet.

Application Review Time and Process: Applications accepted starting September 1 until all slots are full.

State: New York

Practice Areas: IM, FP, P, All specialties considered

Designation Areas: HPSA, MUA, MUP (preference for HPSA)

Flex Slots: Up to 10 for non-designated areas where patients reside in HPSAs or MUA/Ps (must be documented).

Fellowship Training Allowed: Must demonstrate need for specialist.

Notable Requirements: Physician must try to use other eligible IGA programs first; physician may not be out of status for more than 6 months; physician must possess or qualify for a NY medical license; contract must state that physician agrees to treat all patients regardless of ability to pay; and must document all recruitment efforts for 6 months before application. The employer letter requesting the J-1 waiver and describing the need for the physician, must be signed by the CEO or Chief Medical Officer of the facility/organization submitting the application(s) on behalf of the physician(s). The contract should not contain any termination without cause or non-compete clauses.

Application Review Time and Process: Application deadline is at the end of November each year. Decisions are made by March.

State: North Carolina

Practice Areas: FP, IM, P, OB/GYN; hospitalists will be considered

Designation Areas: HPSA

Flex Slots: A highly selective process. Contact Department before submitting the application. To use one of 10 Flex slots, sponsoring facility must draw from a large HPSA patient pool.

Fellowship Training Allowed: No.

Notable Requirements: 3 year minimum contract; no non-compete clause; INA statement signed by physician; no required recruitment effort documentation; physician must try to obtain other IGA waivers first.

Application Review Time and Process: Rolling through fiscal year.

State: North Dakota

Practice Areas: FP, IM, PSY, P, OB/GYN

Designation Areas: HPSA or MUA/P

Flex Slots: 10 Flex slots for non-designated areas; limit of one submitted Flex slot waiver per organization per month from October 1 to April 1. After this time, all applications will be reviewed in the order received.

Fellowship Training Allowed: Considered on a case-by-case basis.

Notable Requirements: Facility must show evidence of recruitment efforts USDOS case number must appear on all documents filed with the application. Application must consist of two copies of requested documents in a single package, in checklist order.

Application Review Time and Process: Applications accepted October 1 to September 30 (entire fiscal year) until slots are filled.

State: Ohio

Practice Areas: Primary care (preferred) including: AM, OB/GYN, FP, P, GIM, Combined GIM/P, GER, PSY, Child/Adol PSY or GER PSY

Designation Areas: HPSA and select MUA/MUPs.

Flex Slots: Up to 10 flexible slots for non-designated areas; serving HPSA population(s). Facility must have been operating and have implemented a sliding fee scale for at least a year to qualify for a Flex slot application. Must complete the application Non-HPSA (Flexible) supplement form. Must show a minimum 30% patients come from HPSAs &/or Governor’s Certified Shortage Areas OR minimum 20% patients come from HPSAs &/or Governor’s Certified Shortage Areas and there are no barriers for patients to obtain care.

Fellowship Training Allowed: Preference for PC; non-primary care applications accepted without limit pending availability of slots (see application Non-Primary Care supplement). Hospitalists and ER physicians are considered sub-specialists.

Notable Requirements: Non-refundable application fee of $3,571 detailed recruitment evidence by facility within prior 12 months; contract must include binding arbitration; physician must try to use other eligible IGA programs first; contract cannot include a non-compete clause or termination without cause. Contracts must state that changes must adhere to Ohio Department of Health J-1 Visa Waiver requirements. Contracts made while physician has O-1 status must be terminated before waiver obligation start date.

Application Review Time and Process: Applications accepted beginning October 1 on first come first served and rolling basis. FLEX and sub-specialist applications accepted January 1 to May 31. Primary care application review is 45 days, others reviewed within 90 days.

State: Oklahoma

Practice Areas: IM, FP, P, OB/GYN

Designation Areas: HPSA, MUA

Flex Slots: Up to 10 slots available. Will be reviewed in the same manner as other applications.

Fellowship Training Allowed: Yes, accepted on a case-by-case basis, must show need and submit physician’s CV before submission of application. Psychiatry is considered to be a specialty placement due to the low number of psychiatry applications. Emergency Room physicians are not accepted.

Notable Requirements: Physician contract must not contain a non-compete clause. More than 2 slots per county per fiscal year may be allowed only on a case-by-case basis, 1 slot allowed per employer per year. Must submit regional and national recruitment efforts.

Application Review Time and Process: Rolling applications throughout the fiscal year.

State: Oregon

Practice Areas: FP, General PSY, GIM, P, OB/GYN. Priority for Family Practice and Psychiatry.

Designation Areas: HPSA (preferred), MUA, MUP. MUAs and MUPs that are not also HPSAs need to receive approval before applying;

Flex Slots: Up to 10 considered for non-designated areas with prior approval; must meet all federal requirements.

Fellowship Training Allowed: Number of slots reserved for specialists is flexible based on community needs.

Notable Requirements: Wages and conditions must be equal to those of U.S. physicians; must provide 6 months of general recruitment documentation. At least 40% of patients must be Medicaid, Medicare, or other low income patients. 26% of 40% must be Medicaid eligible. $2000 application fee.

Application Review Time and Process: Accepted throughout the fiscal year until all slots are filled; review in 15 business days.

State: Pennsylvania

Practice Areas: FP, P, OB/GYN, IM, PSY

Designation Areas: HPSA, MUA, MUP, MHPSA

Flex Slots: Facility must state intent to apply for the slot in a letter of need and document the need; must document that 20% of patients are from primary care HPSA or MUA/P; must provide EIN; one request per facility per fiscal year.

Fellowship Training Allowed: Subspecialties considered for 10 Flex slots. Physicians with sub-specialty training won’t be considered for primary care except geriatrics in place of family practice or internal medicine.

Notable Requirements: Facility must include sliding fee scale showing discounts up to 200% of the federal poverty level and a statement from the physician that he/she does not have an approved waiver or one pending (including hardship waivers); recruitment efforts for at least 6 months within the prior year; must be documented in chronological order, contract must not include non-compete clause.

Application Review Time and Process: Initial Application Period: September 30 – December 15; Second Application Period: January 1 – June 15; Final Application Period: July 1 – September 15. Rejected applicants may request in writing to be reconsidered in the next application period.

State: Rhode Island

Practice Areas: FP, IM, P/Pediatric Neurology, OB/GYN, Anesthesiology, Radiology, Child or General PSY

Designation Areas: HPSA, MHPSA, MUA, MUP

Flex Slots: Will evaluate on a case-by-case basis. $4,000 application fee for all Flex slots.

Fellowship Training Allowed: Yes. $4,000 application fee for all specialists.

Notable Requirements: Preference given to physicians who have completed residencies in Rhode Island; contract must not include non-compete clause; Applicant physician must show evidence of two of three: (1) Must have volunteered in a professional capacity at least 4 hours per month; (2) MAT certification; or (3) CLAS training

Application Review Time and Process: Primary care applications are reviewed October – December.

State: South Carolina

Practice Areas: FP, P, IM, OB/GYN, PSY

Designation Areas: HPSA or MUP

Flex Slots: Yes.

Fellowship Training Allowed: Yes, all specialties and sub-specialties; must prove public interest.

Notable Requirements: Must have site approval and show treatment of indigent or uninsured patients; must submit proof of unsuccessful recruitment efforts; facility must have been providing care for at least one year in South Carolina; physicians must establish a case number before submitting applications to the South Carolina Department of Health and Environmental Control.

Application Review Time and Process: Applications accepted at any time. Initial review done within 10 working days of submission. Slots awarded on first come first served basis. Applicants must reserve slot with contact below.

State: South Dakota

Practice Areas: FP, GP, IM, OB/GYN, P

Designation Areas: HPSA, MUA

Flex Slots: 5 reserved for urban areas and 5 reserved for non-urban areas before April 1 of each year; on April 1, the department may approve any application until all 10 slots are filled.

Fellowship Training Allowed: Yes, primary care and all specialties are eligible (no limitation on number of each).

Notable Requirements: Program fee of $200; contract must not include non-compete clause; average of 40 hours per week (4 week minimum of 128 hours seeing patients on ambulatory or in-patient basis and 32 hours administrative work) for at least 48 weeks per year for a minimum of 3 years; though no time frame is outlined.

Application Review Time and Process: Reviewed in order of receipt. One written request may be sent for incomplete applications; response must be received within 30 days.

State: Tennessee

Practice Areas: FP, P, OB/GYN, GIM

Designation Areas: HPSA, MUA, and Health Resource Shortage Areas

Flex Slots: 5 Flex slots may be used in affiliation with hospitals in non-designated areas that can show that 50% or more patients reside in a HPSA or MUA.

Fellowship Training Allowed: Yes, 9 slots for sub-specialties. See website for list of sub-specialties accepted until June 30. Will accept any sub-specialty from July 1 if slots remain.

Notable Requirements: Placement of primary care physicians only in rural areas of the state; placement of physician specialists will be in association with hospitals; must show recruitment efforts for past six months directly before application. Applications must be sent via certified mail.

Application Review Time and Process: Through March 31, sub-specialists accepted only in hospitals in the top 20 non-psychiatric hospitals with the highest percentage of total adjusted patient days for TennCare patients, Rural Referral Center hospitals, Sole Community hospitals, Medicare dependent hospitals, or rural hospitals located in a HPSA/MUA. From April 1 to June 30, will accept applications from facilities that already received sub-specialists slots and Critical Access Hospitals located in a HPSA/MUA. From July 1, will accept any sub-specialty.

State: Texas

Practice Areas: IM, FP, P, OB/GYN, PSY

Designation Areas: Geographic HPSA, FQHCs and Rural Health Clinics with “automatic” facility HPSA designation. Geographic MUAs may be used for specialists. Not all HPSAs and MUAs meet Texas Conrad 30 requirements.

Flex Slots: No.

Fellowship Training Allowed: Yes, specialists considered with additional evidence documenting need in any HPSA or MUA.

Notable Requirements: $3,000 fee; need 4-6 letters of community support; contract must list benefits, state that any amendments will adhere to federal and state visa waiver regulations, must include schedule of hours; must include amount of leave; no recruitment requirements.

Application Review Time and Process: Applications are generally accepted beginning in September.

State: Utah

Practice Areas: FP, IM, P, OB/GYN, PSY

Designation Area: HPSA or MUA

Flex Slots: Yes.

Fellowship Training Allowed: Yes, must demonstrate public interest.

Notable Requirements: Must provide evidence of unsuccessful recruitment efforts for at least one year before application.

Application Review Time and Process: Applications accepted October 1 to September 30 (entire FY) on a first-come, first-served basis.

State: Vermont

Practice Areas: FP, GIM, P, OB/GYN, Geriatrics, H

Designation Areas: HPSA, MHPSA, MUA, MUP

Flex Slots: Up to 10 for non-designated areas if employer can document professional need and service to patients living in designated areas.

Fellowship Training Allowed: Yes. After Primary Care, Geriatrics and Hospitalists, priority given to Surgery, Anesthesiology, Neurology, Pathology, Specialty Internal Medicine, and Psychiatry, then to Ophthalmology, Radiology, Emergency Medicine, and Urology. Others considered if can show need and serve patients living in designated shortage areas.

Notable Requirements: Must have valid Vermont medical license or proof of complete application.

Application Review Time and Process: Rolling application process throughout fiscal year.

State: Virginia

Practice Areas: IM, FP, P, OB/GYN, PSY; priority for physicians with residency in PC or PSY

Designation Areas: HPSA (priority), MHPSA, MUA, MUP

Flex Slots: 5 slots available from February 1; facility must document extreme need.

Fellowship Training Allowed: All specialties are eligible, must show need; priority for primary care.

Notable Requirements: Prioritizes submissions based on the following criteria: (1) physicians trained in Virginia; (2) HPSA; (3) MUA; (4) Virginia MUA; (5) MUP. Must show proof of 6 months of unsuccessful recruitment; include one original and one copy of contract in application; include copy of Medicaid and Medicare Provider Agreements; contract for physicians must not contain non-compete clauses, must state type and amount of leave, state medical field of practice, list or benefits and insurance, termination only for cause, no at will policy physician must agree to abide by INA and a fixed salary. Physician must provide three letters of recommendation. Only five applicants per practice site.

Application Review Time and Process: Review is 12-15 weeks; accepted September 1 – August 31 (entire FY).

State: Washington

Practice Areas: FP (can include OB), OB/GYN, IM, P, G, and PSY

Designation Areas: HPSA

Flex Slots: Up to 10 Flex slots beginning January 15 of each year; Must describe percentage of expected Medicaid and Medicare patients, how employer will ensure access to the physician for low-income or uninsured patients, if there is a unique practice area or substantial referral network making the physician a statewide resource for certain medical conditions, and if the physician has language skills that will benefit patients at the practice site.

Fellowship Training Allowed: Yes, up to 10 slots for specialty physicians; if still has PC slots available after April 1, will accept additional sub-specialty applications.

Notable Requirements: 3-year contract. Submit 2 copies of contract with original signatures. Must show proof of 6 months of active recruitment efforts in the 6 months before employment contract; physician must be finished with training or in the final year of a training program. Physician must have active Washington medical license or proof of a pending application. Employer must be licensed to do business in Washington and must have provided healthcare services in Washington for the 12 months before the application. Must submit both the main application package and the secondary application package.

Application Review Time and Process: Applications accepted October 1 to September 30 (entire FY); initial review is 10 business days; full review is up to 2 weeks.

State: West Virginia

Practice Areas: FP, IM, P, OB/GYN, PSY

Designation Areas: HPSA, MHPSA, MUA, MUP

Flex Slots: Up to 10 slots.

Fellowship Training Allowed: Yes, evaluated on a case-by-case basis.

Notable Requirements: 4-year contract; Signed INA statement required and no non-compete clauses; site approval required; failure to comply with the program will result in default and penalties; documentation of prior six months recruitment efforts required.

Application Review Time and Process: Applications accepted October 1 to September 30 (entire FY).

State: Wisconsin

Practice Areas: FP, P, GIM, OB/GYN, PSY,

Designation Areas: HPSA or MUA/P

Flex Slots: Up to 10 for non-designated areas; 30% of patients must come from nearby HPSA/MUA/Ps. If don’t have 30%, can show: Percent of patients who reside in HPSA/MUA/P and how physician will increase access for underserved PLUS 3 of the following: 1. Facility payer mix including 50% of patients insured through Medicare and/or Medicaid; 2. Document difficulty recruiting a physician; 3. Need for physician’s specialty; 4. Barriers unique to the site; 5. Population factors.

Fellowship Training Allowed: Yes; must demonstrate exceptional need and public interest (no preference between PC and specialists); must have completed residency in area of specialty.

Notable Requirements: Employer must provide evidence of 6 months unsuccessful recruitment efforts; physician must work at least 32 hours per week of direct patient care in an out-patient setting; benefits must be equal to those of similar physicians. Must have completed U.S. residency program.

Application Review Time and Process: Applications accepted throughout the fiscal year on first come first served basis until slots are filled.

State: Wyoming

Practice Areas: GIM, FP, P, OB/GYN, PSY

Designation Areas: HPSA, MHPSA, MUA or state-designated shortage area

Flex Slots: Up to 10 Flex slots available for non-designated areas.

Fellowship Training Allowed: Yes, must demonstrate need for full time specialty physician by shortage area patients

Notable Requirements: Site approval required; proof of recruitment efforts required; Facility’s long-range plans for retention of physician beyond 3-year period must be noted; before employment the physician must meet all medical licensure requirements for the state of Wyoming.

Application Review Time and Process: Applications accepted throughout fiscal year.

Abbreviations:

SS: Sub-specialist (specialist) physician

AM: Adolescent Medicine

AN : Anesthesiology

ARC: Appalachian Regional Commission

CNC: Cancer (specialists related to)
CHC: Community Health Center

CRBVD: Cerebrovascular disease (specialists related to)

DH: Dental Health

DO: Doctor of Osteopathy

DOS: Department of State

E-MUP: Governor’s Medically Undeserved Population

ER: Emergency Room/Medicine

FMG: Foreign Medical Graduate

FQHC: Federally Qualified Health Centers

FP: Family Practice/Family Medicine

FY: Fiscal Year

GIM: General Internal Medicine

GP: General Practice

GS: Doctor of General Surgery

H: Hospitalist

HD: Heart disease (specialists related to)

HPSA: Health Physician Shortage Area
HR: Hour

IGA: Interested Government Agency

IM: Internal Medicine

IMG: International Medical Graduate

LPR: Lawful Permanent Resident

MHPSA: Mental Health Physician Shortage Area

MUA: Medically Underserved Area
MUP: Medically Underserved Population

NIW: National Interest Waiver

OB/GYN: Obstetrics/Gynecology

OD: Optometry

P: Pediatrics

PC: Primary care physician

PSA: Physician Scarcity Area

PSY: Psychiatry

RHC: Rural Health Clinics

TOEFL: Test of English as a Foreign Language

USDA: U.S. Department of Agriculture

WK: Week

YR: Year