Delta Regional Authority Waiver

The Delta Regional Authority (DRA) is a federal-state partnership serving a 240-county/parish area in an eight-state region. Led by a Federal Co-Chairman and the governors of each participating state, the DRA is designed to remedy severe and chronic economic distress by stimulating economic development and fostering partnerships that will have a positive impact on the region's economy. The DRA waiver requires the foreign born physician to practice at least 40 hours per week as a clinical care physician for a minimum period of three years at a health professional shortage area (HPSA) or medically underserved area (MUA) facility located in the Delta region.  The eight states included in the region are Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee (counties/parishes covered by DRA can be found at http://www.dra.gov/dra_coverage_map.html).

The DRA will sponsor primary care and specialist physicians and charges a $3000 application fee to process waiver applications.

The Conrad 30 Waiver

The Conrad 30 Waiver is by far the most widely-used waiver program for J-1 physicians. Under this program, named after Senator Kent Conrad who sponsored the 1994 law that created it, each state (including Washington, D.C., Puerto Rico, Guam, and the U.S. Virgin Islands) can sponsor up to 30 physicians for J-1 waivers each year.  To be eligible for a Conrad 30 waiver, a foreign physician must agree to work for three years in a facility located in a health professional shortage area (HPSA) or medically underserved area (MUA) (unless applying for a FLEX location) and agree to begin work within 90 days of the USCIS approval of the waiver.

Each state administers its allotment of waivers and has its own requirements for waiver requests. Generally, a foreign physician is required to sign a three-year employment contract (usually without a non-compete clause). Also, evidence must be provided that the employer attempted in good faith to recruit U.S. citizen physicians, and that the facility is viable and located in a HPSA or MUA or qualifies for a FLEX waiver. In general, the proposed practice must be located within a designated health care shortage area. Federal law permits up to 10 of the state's 30 annual waiver slots to be used for practice locations outside of designated shortage areas, when the employer can demonstrate that it serves patients who live in shortage areas. These waivers are generally referred to as “Flex 10” or “Flex” waivers. Each state may have its own criteria for the documentation needed for a facility and physician to qualify for a FLEX waiver.

Most states limit waiver requests to physicians who will practice primary care.  Like the ARC and HHS clinical care waivers, primary care is usually defined as practice in internal medicine, pediatrics, family practice or obstetrics/gynecology, or general psychiatry.  However, many states will also grant waiver requests for specialty physicians, provided the HPSA or MUA has a sufficient need for such specialists.

Nearly all states begin to accept J-1 waiver applications for their programs on October 1. Because of the limited number of slots available (30) for each state, an early application filed on October 1 or soon after stands a better chance of approval, especially in states where the demand for waiver slots is highly competitive. What's more, the typical timeline to obtain a waiver approval is three to six months, depending upon the state. Therefore, it is critical for a J-1 physician to find employment as early as possible in the last year of residency or fellowship.  For example, a J-1 physician in her third year of an internal medicine residency and graduating on June 30, 2013 should have an employment contract by September 1, 2012, allowing sufficient time to prepare and file a waiver application on October 1.  While it is possible to apply later and obtain approval, delay in filing can limit the job choices for J-1 physicians.