J-1 physicians are international medical graduates who have been given a J-1 Visa to complete a medical residency or fellowship in the U.S. A stipulation of the J-1 Visa is that upon completion of training, the physicians must return to their home country for two years. This requirement is “waived” under the Conrad 30 program, named for Senator Kent Conrad who sponsored the bill to help address the shortage of healthcare professionals throughout the U.S. The physician must be willing to work in a shortage area, in a position for which recruitment of a U.S. physician has been unsuccessful. This federal program allocates 30 slots to each state, per year, with up to 10 “flex” slots available outside of designated Health Professional Shortage Areas (HPSA), provided other program requirements are met. A popular method for linking J-1 physicians with employers is the 3Rnet website operated by a non-profit organization that helps place healthcare professionals in rural and underserved areas all over the country.
Follow these steps:
1. Rural sites may post your open positions on 3Rnet website or refer interested physicians to register on this site.
2. When a physician registers on the 3Rnet site, if they identify Nevada as a state of interest, an automatic notice comes to the NV Primary Care Office (PCO). Staff in the PCO will then contact the physician to request a curriculum vitae (CV). If the physician submits a CV within a few days, it will be distributed, via listserv, with the automated notice from 3Rnet. If no CV is received within a few days of the notice, the notice is forwarded to the listserv without a CV, which may reflect a lower level of interest in coming to Nevada. Many physicians broadcast to multiple states upon initial registration.
3. If you would like to be added to our listserv for notification, or if you have specific or urgent staffing needs, please contact NV PCO at firstname.lastname@example.org so that we can forward physician referrals to you.
4. Verify that your site is either in a Health Professional Shortage Area (HPSA) or Medically Underserved Area/Population (MUA/P) by entering the address of your practice site at this link.
5. If your facility is not in a HPSA or MUA, you may not qualify to host a J-1 physician, but you should contact the PCO to determine any possible options.
6. In anticipation of hiring a J-1 Visa physician, always keep track of all physician job postings. Our application requires proof that you have made a good faith effort to recruit a U.S. physician at the prevailing wage rate for at least two months before considering a J-1 Visa physician.
7. Also track the number of patients you see monthly and their payer source. Conrad 30 physicians are required to work in practices that accept Medicaid, Medicare, and Nevada Check-Up patients. In addition, they must provide care to uninsured, low-income patients by offering a sliding fee scale to all of the patients of the practice. Our application requires you to provide payer-source statistics for the previous three months and the totals for the last twelve months, to document your eligibility.
8. Develop a comprehensive Recruitment and Retention plan. The goal of the program isn’t just to fill your clinic’s open physician position, but to retain that physician in the community. So, you need to have a plan to ensure the physician is a good fit for your practice and for your community.
9. Be prepared to “sell” your open position to physician candidates interested in coming to Nevada. Develop a job description that clearly defines the position requirements (location, hours, on-call hours, number of patients to be seen each day, etc.), the practice make-up (number and types of patients seen and type of support staff they will be working with), and the salary and benefits package. Also be prepared to provide information about the community and the surrounding areas. Keep in mind that they may be bringing a family with them, so have information and contacts available regarding housing, schools and community centers so the physician can easily determine if the community will meet their family’s needs.
10. If a qualified physician referral is sent to you by the PCO, you should contact the physician either by phone or email, as soon as possible. At this point, it is up to you to screen the candidate and possibly make an offer of employment, pending all of the necessary interviews, references and background checks that are part of your normal hiring process. It is important to make sure this is a good fit, because you will be obligated to continue employment of this physician for three years.
11. Once you find a J-1 Visa physician you are interested in hiring, the PCO recommends both you and the physician review the “Responsibilities and Rights” presentation of the Nevada Conrad 30 program, to be clear about expectations of the program and the corresponding commitments you are making to each other.
12. At this point, the physician should find an immigration attorney who will draft an employment contract that meets the Nevada Conrad 30 contract requirements. Though the attorney works for the physician, the employer can choose to off-set some of the cost (estimated cost: $10,000), by supplementing the physician’s salary. Please discuss this issue with an immigration attorney before proceeding. The PCO does not endorse any immigration attorney; however, a list of attorneys who have submitted successful applications is available upon request from the PCO. Further, the dual representation of a single attorney for both parties can result in a conflict of interest with regard to the employment contract. Consequently, physicians may elect to engage a separate attorney to review the employment contract.
13. Typically, once the contract is signed, the attorney will request information from the practice, including your recruitment history and practice payer source data, in order to complete the Nevada Conrad 30 Visa Waiver Application.
14. As soon as possible, the physician should start their application for the Nevada State Board of Medical Examiners license. Though the license will not be issued until the physician’s H-1B Visa is approved, the application process takes some time, so they should start it as soon as possible.
15. Once the Conrad 30 application is complete, it is submitted to the PCO with a copy and a check as defined in the J-1 Visa Waiver Instructions. The PCO will review the application and notify the attorney of any missing requirements, within 14 days of receipt. Once the application meets all the program requirements, the attorney will be notified of the date the application will be submitted for review to the Primary Care Advisory Council (PCAC), whose meetings are open to the public in accordance with the Nevada Open Meeting Law.
16. The PCAC will review the waiver application and provide a recommendation either supporting or not supporting the application to the Administrator of the State of Nevada Division of Public and Behavioral Health. The Administrator will then evaluate the application and issue a letter of support pursuant to requirements set within NRS 439A.175. After the letter of support is signed by the Administrator, the waiver application will be sent to the Department of State.
17. The PCO always encourages attorneys, employers and physicians to contact our office if you need clarification on any of the program requirements prior to submitting an application to expedite the review process.