January 29, 2024

A New J-1 Waiver Program for International Medical Graduates Is Here

What You Need to Know About the Northern Border Regional Commission
Holland & Knight Alert
Elvira Jeanethe Rodriguez | Vinh Duong


  • In response to American Medical Association studies showing shortages in access to primary care physicians for 83 million people in the U.S., as well as severely limited availability of OB-GYN and other critical services in many parts of the country, the Northern Border Regional Commission (NBRC) announced the launch of a new J-1 waiver program for international medical graduates (IMGs) trained in the U.S.
  • The program, which was announced in December 2023, enables the NBRC to request that the J-1 visa requirement for IMGs to return to their home countries be waived in exchange for their agreeing to practice in a Health Professional Shortage Area or Medically Underserved Area.
  • The NBRC program currently covers select counties in Maine, New Hampshire, New York and Vermont.

The American Medical Association (AMA) recently addressed the national physician shortage in the U.S. and the alarming gaps in access to medical care caused by this shortage across the country. According to the AMA, it's estimated that more than 83 million people in the U.S. currently live in areas without sufficient access to a primary care physician. In large parts of Idaho and Mississippi, pregnant women can't find OB-GYNs to care for them, 90 percent of counties in the U.S. are without a pediatric ophthalmologist and 80 percent are without an infectious disease specialist. More than one-third of Black Americans live in "cardiology deserts" – communities where there are no available cardiologists.

The shortage of physicians is hitting every corner of the U.S., urban and rural alike, and has created significant disparities in healthcare access, with the most direct and disproportionate impact on vulnerable populations with high needs and limited means. Both rural and urban areas are grappling with limited availability of healthcare providers, resulting in delayed treatments, extended wait and travel times, and, in some cases, inadequate medical care. The effects of this shortage have been particularly pronounced in primary care fields, where patient demand continues to outpace the supply of qualified physicians.

Against this backdrop, states and federal agencies have turned to international medical graduates (IMGs) who have completed their graduate medical training in the U.S. under J-1 visas to help address the pressing physician shortages and healthcare disparities in underserved areas. Ordinarily, IMGs are required to return to their home countries after completing their graduate medical education in the U.S., but this requirement can be waived at the request of a state health agency or a federal agency for IMGs who agree to practice in a Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA).

Previously, there were four federal agencies that support J-1 waiver applications to allow physicians to work in underserved areas: the Appalachian Regional Commission, Delta Regional Authority, U.S. Department of Health and Human Services (HHS) and Southeast Crescent Regional Commission.

In December 2023, the Northern Border Regional Commission (NBRC) announced the launch of its J-1 waiver program, making it the fifth federal program of its kind. The NBRC's footprint will cover select counties in Maine, New Hampshire, New York and Vermont. In contrast with state health agency J-1 waiver programs, the NBRC, similar to its federal counterparts, offers an unlimited number of J-1 waiver slots, supports applications for both primary care and subspecialties (subspecialist applications will be accepted during phase two of the agency's rollout plan) and accepts applications year-round. The arrival of the NBRC creates an additional pathway for employers to staff IMGs in medically underserved areas across parts of the Northeastern U.S., particularly for those physicians who do not qualify to apply through the State Conrad-30 programs due to oversubscription, filing deadlines and other factors.

The NBRC's J-1 waiver program is modeled after the Appalachian Regional Commission program and is currently open to primary or mental health physicians who will practice in a qualifying, federally designated HPSA or MUA within the covered regions for at least three years and 40 hours per week.

The launch of the NBRC's J-1 Visa waiver program is welcomed by many as an important addition to existing federal J-1 waiver programs. The NBRC will help increase primary care access and bolster specialization in high-need areas, thereby helping alleviate the chronic physician shortage for residents in Maine, New Hampshire, New York and Vermont.

For additional information, please contact the authors.

Information contained in this alert is for the general education and knowledge of our readers. It is not designed to be, and should not be used as, the sole source of information when analyzing and resolving a legal problem, and it should not be substituted for legal advice, which relies on a specific factual analysis. Moreover, the laws of each jurisdiction are different and are constantly changing. This information is not intended to create, and receipt of it does not constitute, an attorney-client relationship. If you have specific questions regarding a particular fact situation, we urge you to consult the authors of this publication, your Holland & Knight representative or other competent legal counsel.

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