30 Years of Conrad 30: A Prescription for Progress in US Healthcare

The Conrad 30 J-1 waiver program turns 30 years old in 2024. Yet, throughout the program's history and despite bipartisan support, very little legislation has passed to ensure that it reflects the intent of its original sponsor, Senator Kent Conrad (D-ND), which is explored in the following blog.

History of the Conrad Program

In 1976, the United States Congress, concerned with the large numbers of International Medical Graduates (IMGs) in the country, passed the Health Professions Educational Assistance Act (HPEAA).

Through this legislation, IMGs who trained in the U.S. in J-1 status became subject to section 212(e) of the Immigration and Nationality Act, requiring physicians to return to their home country for two years after undergoing graduate medical education in the U.S.

Over time, and due to a variety of factors, medical programs where IMGs trained increasingly began to require IMGs to train in J-1 status, as opposed to sponsoring them for H-1B status. Coincidently, the U.S. was experiencing a downward shift in the number of U.S. physicians being trained, which resulted in a significant need for IMGs to fill the gap of physicians in the country. However, most IMGs were now subject to the two-year home residency requirement.

In 1994, Senator Conrad championed bipartisan legislation that significantly changed a physician’s ability to remain in the U.S. after undergoing U.S. medical training by creating J-1 waivers. Originally known as the “Conrad State 20” J-1 waiver legislation, Senator Conrad’s proposal for these state programs was an effort to address the demands in healthcare spreading across the U.S. as physician shortages grew, particularly in rural and underserved areas.

The program allowed each of the 50 state Departments of Health to sponsor up to 20 IMGs every year to obtain a waiver of the two-year residency requirement if they would be working at a worksite located in rural and urban areas designated as health professional shortage areas or medically underserved areas.

As physician shortages continued to grow across the U.S., the Conrad program was a welcome solution to boosting access to healthcare.

Expansion and Increased Program Demands

As the program approaches its 30^thyear, it is, unfortunately, rapidly falling behind demands.

In the early years of the program, waiver numbers were often available year-round, and IMGs were able to readily obtain waivers of the two-year residency requirement. However, over time as more IMGs were subject to completing U.S. medical training in J-1 status and the demand for physicians grew, the programs became more competitive.

In its 30 years, the only modernization of the program was an increase in 2002 from 20 waivers per state to 30 waivers per state. Today, this number is no longer enough to meet J-1 waiver demands, and many states find themselves with many more physicians seeking to work in underserved communities than there are waiver numbers to grant.

Legislative Proposals: How to Meet Rising Demands Across the U.S.

It is no secret that the U.S. population is rapidly increasing and aging, and the projected shortage of physicians is only expected to continue to rise in tandem. In a study by the Association of American Medical Colleges (AAMC), the U.S. faces a projected shortage of up to 124,000 physicians by 2034. Multiple factors contribute to this shortage, with studies showing increasing levels of burnout due to the COVID-19 pandemic and more physicians reaching the age of retirement.

The need for smart immigration reform to address the growing healthcare crisis has never been more urgent. For many years, states have been forced to determine the best way to allocate their 30 waivers amongst IMGs, and they are not always administered based on need but rather through administratively-neutral means such as a first-come, first-served basis.

In line with Senator Conrad’s original reason to create the Conrad program, the need to build on and expand the Conrad legislation is a short-term solution to ensure access to healthcare for all Americans. Retaining IMGs who train in the U.S. is of vital importance in addressing physician shortages.

There are a variety of legislative reforms that could make the immigration journey easier to navigate for IMGs and employers while addressing the shortage of healthcare workers. Two pending bills that have strong bi-partisan support are the Conrad State 30 and Physician Access Reauthorization Act (Conrad 30) and the Healthcare Workforce Resilience Act.

The Conrad Reauthorization Bill is a bipartisan effort that provides overdue reforms by permitting states to vary on the 30-waiver limit based on state-by-state need, rather than limiting each state to only 30. This legislation also permits IMGs who timely and unsuccessfully applied for a Conrad waiver to extend their status to remain in the U.S. and reapply for the next fiscal year. The Healthcare Workforce Resilience Act, another bipartisan effort, would recapture 40,000 unused employment-based visas from previous years and reallocate 15,000 to physicians and 25,000 to nurses.

As September approaches and the Conrad 30 program officially turns 30, the U.S. is facing the critical need to modernize the program to keep up with quickly rising healthcare demands. While the two aforementioned bills provide welcome relief to the physician shortage, more can be done by Congress on this front.

In the absence of Congressional action, more and more states are stepping in to help fill shortages by expanding licensing eligibility for IMGs, creating a patchwork of licensure requirements nationwide in an attempt to address the U.S. physician shortage. Modernizing the program in a way that helps ensure states can employ U.S.-trained physicians to meet their rising healthcare shortage needs has never been more important. Constituents are encouraged to contact their elected officials to encourage them to push these two bills toward passing.

Need to Know More?

For further information or if you have questions about the State Conrad 30 program, please reach out to Partner Sarah K. Peterson at [email protected] and Associate Nicole Bennett at [email protected].

This blog was published on February 27, 2024, and due to the circumstances, there are frequent changes. To keep up to date with all the latest updates on global immigration, please subscribe to our alerts and follow us on LinkedIn, X, Facebook and Instagram.