The Pennsylvania Department of Health (PA DOH) announced on September 12, 2013, that with the start of the new fiscal year on October 1, 2013, it will begin accepting J-1 Waiver applications under the Appalachian Regional Commission (ARC) Waiver Program.

The waiver programs were established to waive the 2-year home-presence requirement of foreign medical graduates who complete their graduate medical education and training in the US under the J-1 Exchange Visitor visa.  The home-presence requirement can be waived if the foreign physician contracts to work for 3 years providing care to medically underserved patient populations.

For years, DOH had only accepted J-1 Waiver applications for physicians under the Conrad 30 Program.  And for years, that was enough to meet demand.  Recently, however, there has been an increase in the number of J-1 Waiver applications filed by health care employers, resulting in an insufficient number of J-1 Waiver spots for applicants.

Traditionally, DOH has given priority to primary care (i.e., Family Practice, Internal Medicine, Pediatrics, Psychiatry and Obstetrics/Gynecology) waiver applications.  With demand outstripping the availability of J-1 Waiver number spots, many waiver sponsors and beneficiaries in the medical specialty fields were left with a great deal of uncertainty.  Employers wanted some degree of assurance that they would ultimately be able to employ much-needed specialists whom they sponsored for J-1 waivers to work in designated medical shortage areas.  Foreign specialist physicians wanted confidence that if they waited out DOH’s J-1 Waiver processing phases, they would have a reasonable chance of waiver approval so that they could obtain status to begin working for their waiver sponsors (rather than finding themselves without a job after the lengthy wait).  It is speculated that this questionability may have caused specialists to focus their job searches in other states.  With much of the Commonwealth being rural and in need of specialist physicians, that was not a favorable situation.  Of course, even with the acceptance of ARC J-1 Waiver applications, there is no guarantee that each and every specialist waiver application will be approved.

Physician employers looking to hire primary care physicians should be aware of the ARC recruitment requirements, which are specific.  It would be prudent to try to comply with the ARC requirements just in case no US physician can be found for hire.

A few details about the ARC J-1 Waiver Program:

  • Only applications sponsoring primary care physicians are eligible.
  • The physician must work in an HHS-designated Health Professional Shortage Area (52 of Pennsylvania’s 67 counties are within the Appalachian Region).

Of course there are more details regarding the program, and DOH has indicated that it will soon publish additional information and guidelines.

Ms. Wadhwani is a partner in Fox Rothschild’s Immigration Practice Group.  She may be reached at