Why are J1-waiver jobs tougher after fellowships ?

Although we have discussed before why fellowships are easier and at better programs on J1 visa than on H1b visas - this advantage can be a double-edged weapon when it comes to landing J1-waiver jobs, coz' that ain't easy for IMGs who do fellowships after J1 residency. In a previous post about J1-waiver sponsoring agencies and specialties - we saw that most J1-waiver jobs are taken up by the primary care specialties and "Primary care" for these waiver jobs implies - Family Medicine, Internal Medicine, Ob-Gyn, Pediatrics and Psychiatry. Many states consider fellowships in Geriatrics and Ob-Gyn (after FP) also in this category, making J1-waiver jobs are easier for IMGs who apply with this training.

Here is why J1-waiver positions are tougher for fellowship-training IMGs


A. State Restrictions:

The United states of America are not so united when it comes to implementing a federal policy since they are allowed some leeway in implementing them. The same applies to the J1-waiver jobs rules sponsored by government agencies like the Conrad 30 program.

1. In some states IMGs with fellowship training are not eligible to apply for J1-waiver positions

2. Some states accept IMG with fellowships, but they gotta still work as primary care physicians - e.g. Virginia. Even in these states, it is the primary care physicians with no specialty training that are preferred. Like the Indiana Department of Health says:

"The Indiana State Health Department of Health J-1 Visa Wavier Program gives first preference to primary care physicians (family or general practice, pediatrics, obstetrics/gynecology and general internal medicine) and psychiatrists. ISDH will consider J-1 wavier specialists who practice in these areas"

3. Whereas in states like Pennsylvania, IMGs with fellowships maybe accepted only as per need - but they cannot work in primary care positions, even if there are vacancies. Here's what the Pennsylvania Department of Health J1-waiver document says :

"Sub specialties may be considered based on need; however requests for primary care physicians are given priority. Physicians who are fellowship trained will not be considered for primary care vacancies" (*...sigh...*)

or as the New Jersey J1-waiver program says:

"Physicians with sub specialties or fellowship experience are not considered to be primary care physicians for the purpose of this program, and are generally not eligible for participation. Under exceptional circumstances, e.g. a documented continuous and pervasive lack of access by the indigent population to a specific sub specialty, applications from subspecialists will be considered. Physicians must also be trained in the specialty in which they are practicing."


4. And finally, as a saving grace somewhat, some states reserve some slots for specialists who can work as specialists in their respective field, provided the employer can demonstrate a lack of the particular specialty. For example the Washington State Conran-30 program sets aside 10 position for specialists out of a total of 30

But note that even in these states - not all specialty areas may have vacancies at a given time....Huh.



B. Longer J1-waiver job contract time

Since the above vagaries were not troublesome enough ;-) , in most states which accept specialists into J1-waiver specialist positions, the J1-waiver job term is required to be a five-year contract instead of a three-year contract that primary care specialties enjoy- Arrgh ! Not only is this too long to get stuck in if the job area is a sad place to live, holding 5 years in a specialty position only makes it tougher for newer batch of IMGs to find positions, since specialty position vacancies will have a longer turnover time.


Saving the best for the last : Its good to know that VA (Veteran Affairs) Hospitals are free from restrictions on the number , location and the specialty of IMGs hired on J1-waiver jobs - the only bottleneck is finding a vacancy, which again may not be easy. Many opine that VA hospitals are the location of choice for specialists searching for J1-waiver specialist positions.

One tip - It might be advantageous for J1 guys to do their fellowships at programs which have rotations with attached VA hospitals, since that could potentially improve chances of landing a job in a VA facility by making the right internal contacts :-)




So..does all this smell like a subtle tactic to force more IMGs into primary care positions rather than specialist positions ? Eat and Ruminate the thought and while you are at it - read this informative article: Health Departments’ Use Of International Medical Graduates In Physician Shortage Areas


Sometime in the near future I shall compile a list of state that accept specialists and their criteria- though th R3Net website I have mentioned a few times before has a rough guide on this - click here




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