Foreign Medical Graduates/Physicians Conrad 30 Program

If a foreign national physician is subject to 212(e) due to having entered the U.S. for the purpose of obtaining graduate medical education or training, an IGA waiver (what is known as a Conrad 30 program) may be the only option.

The first question to ask is whether the proposed employer qualifies as part of a Medically Underserved Area and Medically Underserved Population (“MUA/MUP”) or Health Professional Shortage Area (“HPSA”).

MUA/MUPs have shortages of primary medical care, dental or mental health providers and may be geographic (a county or service area), demographic (low income, Medicaid-eligible populations, cultural and/or linguistic access barriers to primary medical care services). They are each assigned an Index of Medical Underservice (IMU) score, which is used to determine the eligibility of an area or population for MUA/MUP status. The Score is 0 to 100, with 0 being completely underserved, and 100 being completely served. The database to determine MUAs and MUPs is located at

The NC Conrad 30 program (and Appalachian Regional Commission) does not grant waivers for MUAs/MUPs. If the institution is an MUA but not a HPSA, the requirements for HHS or other IGA waivers should be reviewed to see if that program accepts MUAs/MUPs.

Health Professional Shortage Areas (HPSAs) have shortages of primary medical care, dental or mental health providers and may be geographic (a county or service area), demographic (low income population) or institutional (comprehensive health center, federally qualified health center or other public facility). They are scored from 2 to 26, with 2 being the highest need. The database to determine HPSAs is located at:

To determine in what Census Tract an employer is located, go to:

Places that are at one point designated HPSA/MUAs can become saturated markets. The current HPSA/MUA designation of the site should be double-checked before proceeding by contacting the Shortage Designation Branch.

The next question is whether the foreign national received funding from his/her home government to pursue training? If not, s/he can proceed with the IGA Waiver. If yes, the foreign national will have to obtain a no-objection statement from his/her home country before filing the IGA waiver. (The no-objection statement must conform with requirements found at 22 CFR 41.63(d) with the added notation that it is being furnished pursuant to Public Law 103-416. See 22 CFR 41.63(e).)

To initiate the Conrad 30 Waiver Process, a DS-3035 must be filed with Department of State. For Interested Government Agencies like the Appalachian Regional Commission (“ARC”), North Carolina can request these federal agency waivers for some counties in western North Carolina. If the hiring medical facility is in one of these counties, it must apply for the ARC waiver first.

Requirements include:

  1. Three (3) year minimum contract;
  2. Liquidated damages agreement for $250,000;
  3. Letter from the sponsoring employer; and
  4. Affidavit and Agreement from the foreign national physician.

In connection with the North Carolina Conrad 30 Program, it is not a requirement to apply for other IGA waivers first unless the county is covered by the ARC, but HHS waivers should be considered as a possible option. North Carolina has one of the more restrictive Conrad 30 programs in the country. North Carolina requires foreign-educated primary care physicians seeking a waiver to the J-1 visa to sign a four-year contract to work in a non-profit clinic (accepting Medicaid and Medicare) in a HPSA. Upon completion of the contract, the Office of Rural Health will recommend the waivers approval to the US Information Agency (USIA) who then recommends approval to immigration. North Carolina is the only state participating in this program with these additional regulations.

Requirements include:

  • Four (4) year minimum commitment;
  • Applications from HPSA designated areas only, not MUAs. If a specialist, then the employer must prove a critical shortage in that specialty;
  • No apparent liquidated damages agreement;
  • Letter from sponsoring institution describing the health care facility, location, and existing nature/extent of medical services, summarizing how the health care facility has attempted to locate qualified US physicians, describing the foreign medical graduate’s qualifications, proposed responsibilities, and how his/her employment will satisfy important unmet health care needs of the community of service area;
  • Employment contract that meets specifications. Non-compete clauses are not allowed for IGA waivers;
  • Copies of all IAP-66/DS-2019 forms;
  • Copy of Waiver Review Divisions instruction letter with Case Number;
  • Copy of candidate curriculum vitae;
  • Completed USIA Data Sheet;
  • No-objection letter from Candidate’s home government (if required); The no-objection letter must be sought in accordance with regulations at 22 CFR 41.63(d) and transmitted to the US State Department via ‘diplomatic channels’. Only a copy of the letter needs to be submitted with the NC Conrad 30 application. If not required, must include statement from physician stating such.
  • Copy of letter of reference from physician’s Residency Director;
  • Copy of tri-party agreement between physician, employing practice, and NC Office of Rural Health and Community Care;
  • Signed statement regarding promise to not have pending J-1 waiver nor a future request to obtain one from another IGA.

The effect of the IGA Waiver for physicians is to temporarily waive the two (2-year home residency requirement so that the individual can apply for an H-1B for employment for the employer who sponsored the waiver. Failure to complete the contract will result in the 212(e) requirement being reinstated. A foreign medical graduate who is granted a waiver under Pub. L. 103-416 and who does not fulfill the requisite three (3) year employment contract or otherwise comply with the terms and conditions imposed on the waiver is ineligible to apply for change of status to any other nonimmigrant classification. The conditions imposed by the NC Conrad 30 waiver impose a four (4) year rather than a three (3) year contract.