For health care employers recruiting residents and fellows in J-1 status, and for physicians hoping to remain in the United States after completing their training, the J-1 waiver process is often the critical next step. Physicians who receive graduate medical education or training in J-1 status are generally required to return to their home country for two years before they may obtain H-1B status or permanent residence. A waiver removes that requirement, typically in exchange for the physician’s commitment to provide at least three years of full-time clinical service in an underserved community.
The Conrad 30 program is a national program, but it is administered through individual state health departments. Each state may recommend up to 30 physicians for waivers during each federal fiscal year. Although certain federal requirements apply nationwide, each state establishes its own application process, filing deadlines, specialty priorities, selection criteria and supporting documentation requirements. As a result, an application that qualifies in Michigan may be evaluated differently in another state. Employers recruiting physicians outside Michigan should review the requirements of the state in which the physician will practice.
For Michigan employers and physicians, the two principal employer-sponsored options for clinical service are the Michigan Conrad 30 program and the U.S. Department of Health and Human Services (HHS) Clinical Care Waiver Program.
Michigan Conrad 30 Program
The Michigan Department of Health and Human Services (MDHHS) may recommend up to 30 J-1 physician waivers during each annual cycle. Michigan’s published schedule provides that the application window opens on the first business day of September and closes on the first business day of November. Accordingly, the upcoming filing period opens September 1, 2026, and closes November 1, 2026. If fewer than 30 qualifying applications are received, MDHHS may announce an additional filing period.
Michigan’s program is available to primary care physicians, hospitalists and many specialists, although MDHHS applies its own eligibility requirements and preference criteria when selecting applicants. A typical application includes a compliant three-year employment agreement, documentation regarding the proposed practice locations, evidence of the employer’s recruitment efforts and information demonstrating the physician’s qualifications and the need for the physician’s services. Applications are evaluated under Michigan’s published criteria and are not approved simply on a first-come, first-served basis.
HHS Clinical Care Waiver Program
The HHS Clinical Care Waiver Program is a separate federal waiver option and does not use one of Michigan’s 30 Conrad slots. HHS accepts applications on a rolling basis, but its program is more limited than Michigan’s Conrad 30 program. It generally applies only to physicians practicing:
- Family medicine
- General internal medicine
- General pediatrics
- Obstetrics and gynecology
- General psychiatry
The physician must practice at a qualifying location with a Health Professional Shortage Area score of at least seven. Michigan directs physicians who satisfy the HHS eligibility requirements to pursue the HHS program rather than use one of the state’s limited Conrad 30 slots.
The HHS application is submitted by the employer or health care facility on behalf of the physician. The employment agreement must provide for at least three years of full-time clinical service, generally 40 hours per week, and may not contain a noncompete or other restrictive covenant. The employer must also obtain a supporting letter from the applicable state health department and provide documentation regarding the practice site, recruitment efforts and community need.
How the Waiver Process Works
Although each state maintains its own rules and HHS has separate requirements, most employer-sponsored physician waiver cases follow the same general sequence:
- Confirm that the physician’s specialty, proposed work locations and anticipated start date qualify under the selected waiver program.
- Prepare and execute an employment agreement containing the required three-year service commitment and other program-specific provisions.
- Open a waiver case with the U.S. Department of State and obtain a waiver case number.
- Submit the employer’s sponsorship request to the applicable state health department or HHS.
- After a favorable recommendation, complete Department of State and U.S. Citizenship and Immigration Services waiver processing, followed by the employer’s H-1B petition.
Selecting the appropriate waiver route should occur before the employment agreement is finalized. Michigan employers considering a Conrad 30 filing should act promptly during the September 1 through November 1 application window. Although HHS applications may be submitted throughout the year, the program’s narrower specialty, location and contract requirements still make early review important.
Warner’s Immigration Practice Group can assist health care employers and physicians with evaluating the available waiver programs, preparing compliant employment agreements, submitting the waiver request and managing the subsequent H-1B process.
