The Conrad 30 Waiver Program Explained

Conrad 30 is the most common route for J-1 physicians to remove the two-year home-country requirement and stay in the US. A state health department recommends you for a waiver, you work full time for at least three years at a qualifying facility, and you do it in H-1B status. This page explains how that works and what to check, including a status question that every applicant now has to ask. For the rule itself, see the two-year home residency requirement.

How the program works #

Conrad 30 comes from section 214(l) of the Immigration and Nationality Act. A foreign medical graduate on a J-1 who is subject to the two-year rule can get it waived if a state agency (or a federal agency) asks for the waiver to support H-1B employment in a federally designated shortage area. According to the USCIS Policy Manual, the main conditions are:

The Policy Manual also describes "flex" slots: a state may use a limited number of its waivers for physicians who work outside a designated area if they serve patients who live in one. How a state uses flex slots, and which of them it allows, is its own decision.

Step by step #

1. Finish or near the end of training on the J-1. Waiver timing is tied to your DS-2019 dates and to each state's cycle, so start months ahead.
2. Find an employer in a state that participates. The employer must offer a full-time contract at an eligible facility. Many employers advertise Conrad positions.
3. Apply to the state. Each state publishes its own process. Some open an application window once a year and use a lottery or ranking when demand is high. For example, one state's public page lists a short application window in early October and a lottery date in November for its fiscal year, which shows how tight timing can be. That same page says it keeps accepting applications after the window if its slots are not filled, but do not assume every state does.
4. State recommendation to the State Department. The state sends its recommendation, and the State Department's Waiver Review Division reviews it.
5. Employer files the H-1B. The petitioner files Form I-129 with the favorable State Department recommendation to change you from J-1 to H-1B. Family members on J-2 file to change to H-4.
6. Serve the contract. After the three years you can move toward permanent residence. See green card paths for physicians.

What varies by state #

State programs differ more than most applicants expect:

• Which specialties are welcome. Many states favor primary care, psychiatry or other specialties in short supply, and some reserve a few slots for others.
• Whether the state limits facility types, requires the employer to show recruitment efforts or restricts how the contract is written.
• How and when applications are accepted, how the state ranks competing applications and what it charges, if anything.
• Whether employers must cover the cost, and what happens if a job falls through.

Do not use a ranking article or a forum post from another year. Open the health department page for each state you might work in.

Risks to plan around #

• The sunset. If the authority lapses at a date when you have not yet been recommended, you may lose the option or have to wait for Congress. Have a second plan, such as another waiver route in J-1 waiver options, or a different visa.
• Leaving the contract. USCIS says a physician who does not complete the three-year commitment can become subject to the home-country requirement again, with limited exceptions for extenuating circumstances. Read the contract for what happens if the facility closes, changes the job or lets you go.
• Your own timing. Most states have deadlines that sit within your final residency or fellowship year. Missing one can cost a year.
• Policy changes. H-1B rules, including the 2025 and 2026 payment proclamation, may affect the employer's filing. See the visa policy changes tracker.

Questions to ask in residency #

• Does our program have a history of residents who got Conrad 30 waivers, and in which states?
• Which states in my target region still have unused slots by the time most residents apply?
• Is my specialty one the state prioritizes?
• If the program ends before the sunset date, do I still have a path?

This information is general and not legal advice. USMLE Wise does not provide immigration advice; use the program's international office and a qualified attorney for your case.