Julia Mattingly is a staff writer and first-year Ph.D. student.

The United States grapples with an enduring and formidable challenge: the persistent shortage of physicians, particularly in rural and underserved parts of the country. To combat this dire situation, the Conrad 30 Waiver program has emerged as a significant legal pathway for noncitizen international medical graduates (IMGs) to reinforce the U.S. physician workforce. This program plays a pivotal role in addressing the physician shortage by providing opportunities for noncitizen IMGs to serve in underserved areas. As physician shortages in the U.S. continue to worsen, it is imperative that Congress indefinitely reauthorize the Conrad 30 program. 

The Conrad 30 Program 

The Conrad 30 Program, established under the 1994 Immigration and Nationality Technical Corrections Act, represents an indispensable initiative to alleviate the shortage of health care providers in the nation. Noncitizen IMGs often embark on their journey into U.S. medical residency programs through the H-1B and J-1 visa pathways, with a significant majority entering via the J-1 route. The Immigration and Nationality Act generally necessitates trainees return to their home countries for two years upon completing their training. Nevertheless, the Conrad program offers an essential waiver that allows them to convert their J-1 visas to H-1B nonimmigrant status. This conversion, contingent on a three-year, full-time commitment to practice medicine in underserved areas, effectively bypasses the return requirement, serving as a pivotal legal path for noncitizen IMGs to contribute to the U.S. health care workforce. 

Conrad 30 initially empowered each state’s health department to sponsor 20 IMGs annually for a “J-1 Waiver” to exempt them from the two-year home residency requirement. These IMGs would then be required to serve in federally-designated shortage areas, targeting physicians who had completed U.S. residency programs, predominantly in primary care and general practices. In 2003, Congress reauthorized the program, increasing the number of waiver spots to a generous 30 per state annually. This expansion led to the birth of the Conrad 30 Waiver Program, broadening the scope of health care providers it could assist. This initiative collectively enables states to recruit between 800 to 1,000 IMGs every year, and ultimately, it has facilitated the entry of over 15,000 IMGs into the U.S. health care workforce. As of 2021, foreign born providers accounted for 26%of the 987,000 physicians and surgeons practicing in the United States. 

Thirteen states have collected data on physician retention in shortage areas beyond the initial three-year obligation period. These findings, mostly via exit surveys, indicate that approximately 55 to 80% of physicians participating in the Conrad 30 program said they intend to remain in the communities they were initially assigned. Studies tracking actual retention in a few states after obligated service offer promising results, with nearly 40% of physicians remaining with their original employer five years post-obligation. Consequently, the program plays an instrumental role in ensuring that underserved communities have access to quality health care services. 

Conrad 30 Reauthorization 

While the Conrad 30 Program has made significant strides in alleviating the physician shortage, its temporary authorization by Congress presents a significant challenge. Over the summer, Reps. Brad Schneider (D-Ill.), Don Bacon (R-Neb.), David Valadao (R-Calif.) and Sylvia Garcia (D-Texas) reintroduced the bipartisan Conrad State 30 and Physician Access Reauthorization Act (H.R. 4942). The Senate companion bill (S. 665) was introduced in March by Sens. Amy Klobuchar (D-Minn.), Susan Collins (R-Maine), Jacky Rosen (D-Nev.) and Thom Tillis (R-N.C.). However, respective committees have yet to consider both bills. 

The time has come for Congress to indefinitely reauthorize Conrad 30 for several compelling reasons. First, the physician shortage is not a fleeting issue; it is a chronic challenge that requires a sustained, long-term solution. Indefinite reauthorization would provide the program with the stability and longevity needed to make a lasting impact. Second, it would send a clear message that the commitment to addressing the physician shortage is unwavering and enduring. Lastly, the uncertainty of periodic reauthorization may deter potential noncitizen IMGs from pursuing this critical path to serve in underserved areas. Indefinite reauthorization would provide the assurance that the program will continue to be available, making it an attractive option for future participants and further expanding the pool of health care providers. 

Conclusion 

The Conrad 30 Program is a beacon of hope in the battle against the persistent U.S. physician shortage. It offers noncitizen IMGs a legal path to contribute to the domestic health care workforce, particularly in underserved areas. The time is ripe for Congress to take decisive action by indefinitely reauthorizing the program. The program’s significance, impact and critical role in addressing the physician shortage demand nothing less than enduring commitment. With indefinite reauthorization, the Conrad 30 Program will remain a vital solution by providing a steady supply of physicians to rural and underserved areas, fostering a more robust and equitable health care system for all and ensuring that the United States stands strong in the face of its most pressing health care challenges.

This piece was edited by Deputy Editor Kathleen Bever and Executive Editor Nathan Varnell.

Photo by Abdulai Sayni on Unsplash.