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One of the required steps to transform from medical training to professional medical practice is obtaining a J-1 waiver.
A J-1 visa is a temporary, non-immigrant visa status which is specifically utilized in order to empower foreign physicians to engage in residency and clinical fellowships in the United States. The problem is that once a physician enters the United States under a J-1 visa, the physician is obligated to go back for two years to their home country. And as long as they have this two year home residence obligation, they are ineligible to get an H-1B visa or permanent residence. In short, they are ineligible to transform from a trainee to a practicing physician in the United States.
In order to work as a physician in the U.S., you need to get a waiver or the alternative is to go back to the home country. What U.S. law says is that it is possible to get a waiver of your home residence obligation if a government agency in particular, if a state department of health, recommends a waiver to a foreign physician in the belief that it is more important for the physician to stay in the United States than it is to go back to the home country.
A state's Department of Health will consider several factors in making a waiver determination. First, the physician needs to be working in a position that will benefit the indigent and the medically underserved. Secondly, in most instances, a physician has to be working in a facility that is physically located in a designated medically underserved area. It is best to focus your job search into either a medically underserved area or in some instances into states that have a low volume of J-1 waiver applicants. This gives the state's Department of Health significantly more flexibility in determining waiver eligibility for physicians who will benefit the indigent and the medically underserved.
Specialists can certainly get waivers as well as primary care physicians. But once you get a waiver, you have an obligation to work at the medical practice for three years, specifically in H-1B status. It will only be at the conclusion of this three year H-1B service obligation that you will gain eligibility for permanent residency. The waiver simply removes a major barrier in your journey from training to professional medical practice.
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