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All J-1 Waiver Pathways for Physicians

Conrad 30 is the most common, but it's not the only option. There are 5 additional pathways — several with unlimited slots and no state cap. If Conrad is full in your state, one of these may work.

Last verified: May 2026· Sources: USCIS, HHS OGA, ARC, DRA, SCRC, Congress.gov
PathwaySlotsFeeSpecialtiesProcessing
Conrad 3030 per state (+ up to 10 flex in most states)Varies by state ($0-500 state fee)All specialties accepted (primary care prioritized)State: 2-10 weeks → DOS: 8-12 weeks → USCIS: 1-3 months
HHSUnlimitedNo HHS fee (standard DOS $120 fee applies)Primary care only6-8 weeks at HHS level, plus DOS and USCIS (total 6-9 months)
ARCUnlimitedNo application fee (eliminated June 2021)Primary care, psychiatry, AND subspecialists acceptedTypically faster than HHS
DRAUnlimitedNo fee (eliminated October 2022)Primary care prioritized; specialists accepted with documentation of community needVaries by state
SCRCUnlimited$3,000 non-refundable processing feePrimary care, psychiatry, and subspecialists acceptedApproximately 60 days for review
VACase-by-caseNo application feeBased on VA facility needs — all specialties possibleVaries significantly

Conrad State 30 Program

30 per state (+ up to 10 flex in most states)Varies by state ($0-500 state fee)State: 2-10 weeks → DOS: 8-12 weeks → USCIS: 1-3 months
Official site

Eligible Specialties

All specialties accepted (primary care prioritized)

Geographic Coverage

All 50 states + DC

Requirements

  • Must work in a HPSA, MUA, or serve a MUP for 3 years
  • Full-time (40+ hours/week) at the sponsoring facility
  • Full unrestricted state medical license required
  • Employer must demonstrate failed US physician recruitment
  • No non-compete clauses allowed in federal waiver contracts
  • Work in H-1B status after waiver approval

Advantages

  • Most common and well-understood pathway
  • All specialties eligible (not just primary care)
  • Every state participates
  • Flex slots available in most states for non-HPSA sites

Limitations

  • Only 30 slots per state — competitive states fill in days
  • 19 states filled all 30 slots in FY 2024
  • Some states (TX, AZ, IN) have no flex slots
  • Potential sunset risk — reauthorization pending in Congress

HHS Clinical Care Waiver (Supplement B)

UnlimitedNo HHS fee (standard DOS $120 fee applies)6-8 weeks at HHS level, plus DOS and USCIS (total 6-9 months)
Official site

Eligible Specialties

Primary care only: Family Medicine, General Internal Medicine, General Pediatrics, OB/GYN, General Psychiatry

Geographic Coverage

Nationwide — any facility in a HPSA with score 7+ (expanded from FQHCs-only in 2020)

Requirements

  • Facility must be in a HPSA with score of 7 or higher
  • Limited to primary care specialties and general psychiatry
  • 3-year full-time service commitment
  • Expanded in 2020 beyond FQHCs to any qualifying facility
  • Facilities in HPSAs marked 'Proposed for Withdrawal' on HRSA website are NOT eligible (since Oct 2023)

Advantages

  • Unlimited slots — no state cap
  • No application fee
  • Good backup when Conrad slots are full
  • Available nationwide, not limited by state programs

Limitations

  • Total timeline 6-9 months (HHS 6-8 weeks + DOS + USCIS)
  • Limited to primary care and psychiatry only (no subspecialists)
  • Requires HPSA score 7+ (not all HPSA sites qualify)
  • Long wait makes planning difficult

Appalachian Regional Commission (ARC)

UnlimitedNo application fee (eliminated June 2021)Typically faster than HHS
Official site

Eligible Specialties

Primary care, psychiatry, AND subspecialists accepted

Geographic Coverage

423 Appalachian counties across 13 states: AL, GA, KY, MD, MS, NY, NC, OH, PA, SC, TN, VA, WV (all of WV is covered)

Requirements

  • Must be in an Appalachian county designated as HPSA
  • Employer must demonstrate 6 months of failed US physician recruitment
  • 3-year full-time service commitment
  • Accepts subspecialists — not limited to primary care
  • Facility must be in an ARC-eligible county

Advantages

  • Unlimited slots with no application fee
  • Accepts subspecialists (unlike HHS)
  • Faster processing than HHS
  • Covers parts of 13 states including NY, PA, OH, NC
  • Effectively gives eligible states more than 30 total waiver slots

Limitations

  • Geographic limitation — only Appalachian counties qualify
  • Must demonstrate 6 months failed recruitment (documentation burden)
  • Not all counties in covered states are ARC-eligible
  • Less well-known — some employers unfamiliar with the process

Delta Regional Authority (DRA)

UnlimitedNo fee (eliminated October 2022)Varies by state
Official site

Eligible Specialties

Primary care prioritized; specialists accepted with documentation of community need

Geographic Coverage

240 counties/parishes across 8 states: AL, AR, IL, KY, LA, MS, MO, TN

Requirements

  • Must be in a DRA-eligible county
  • Accepts primary care and specialists if need is demonstrated
  • 3-year full-time service commitment
  • Employer must demonstrate community need for the specialty

Advantages

  • Unlimited slots
  • Rolling applications — no fiscal year deadline pressure
  • Accepts specialists beyond primary care
  • Covers parts of 8 southern/midwestern states

Limitations

  • Limited to 252 counties in 8 states (mostly Mississippi Delta region)
  • Less documented process — harder to find guidance
  • Not all employers know about this pathway
  • Geographic limitation to Delta region

Southeast Crescent Regional Commission (SCRC)

Unlimited$3,000 non-refundable processing feeApproximately 60 days for review
Official site

Eligible Specialties

Primary care, psychiatry, and subspecialists accepted

Geographic Coverage

428 counties across 7 states: AL, FL (entire state covered), GA (122 counties), MS, NC (69 counties), SC, VA

Requirements

  • Must be in an SCRC-eligible county
  • Accepts primary care, psychiatry, and subspecialists
  • 3-year full-time service commitment
  • $3,000 application processing fee required

Advantages

  • Unlimited slots — newest pathway with growing capacity
  • ALL of Florida is covered — every county in the state qualifies
  • Also covers 122 GA counties, 69 NC counties, parts of AL/MS/SC/VA
  • Accepts subspecialists, not just primary care

Limitations

  • $3,000 non-refundable fee — highest of any pathway
  • Newer program (launched 2022) — less track record than ARC or DRA
  • Limited to southeastern states only
  • Uses patient-to-physician ratio (minimum 2,000:1) for decisions

Department of Veterans Affairs (VA)

Case-by-caseNo application feeVaries significantly
Official site

Eligible Specialties

Based on VA facility needs — all specialties possible

Geographic Coverage

VA facilities nationwide

Requirements

  • Must be employed at a VA medical center
  • Not subject to standard HPSA/MUA requirements
  • Justification based on VA-specific staffing needs
  • Must be eligible for VA employment

Advantages

  • Not limited by shortage-area designations
  • Federal employment benefits (PSLF-eligible, federal retirement)
  • Can be in any specialty the VA needs
  • Research and teaching positions also eligible

Limitations

  • Must work at a VA facility specifically
  • VA is NOT currently H-1B cap-exempt (legislation pending — verify before choosing)
  • VA hiring process can be slow and bureaucratic
  • Salary may be lower than private sector

Not Sure Which Pathway Is Right for You?

Start with our state-by-state intelligence. Each state page includes which pathways are available, slot fill data, and specific guidance.

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