The U.S. Department of Health and Human Services (HHS) recently modified its application guidelines for institutions to request waivers of the two-year foreign residency requirement for physicians with J-1 visas who wish to engage in clinical care. The J-1 visa, which is an exchange visitor visa, is normally granted to a foreign national with the understanding that at the conclusion of the visa period, the foreign national will return to his or her last country of residence.

HHS had announced in December 2002 that the agency would begin to accept applications to sponsor J-1 visa physicians as an interested government agency (IGA) for the purpose of waiving the foreign residency requirement for both clinical care and research programs. This requirement may be waived at the request of an IGA and the approval of the U.S. Department of State if the physician agrees to deliver health care services for three years in primary care or mental health professional shortage areas (HPSAs) or medically underserved areas (MUAs). In recent years, the U.S. Department of Housing and Urban Development and the U.S. Department of Agriculture had withdrawn from participation as IGAs for the purpose of sponsoring J-1 visa physicians for waivers of the return-home requirement. In the meantime, the limit that each state is allowed to request as an IGA through its Department of Health or similar agency each year was raised from 20 to 30.

In June 2003, HHS had issued guidelines for applying to the agency to act as an IGA for the purpose of a waiver prior to October 1, 2003, the beginning of the new Federal fiscal year (FFY). These guidelines limited the program to those physicians who had completed a residency in primary care or psychiatry and were willing to work in an HPSA or MUA. The modified application guidelines are effective for the current FFY, which ends September 30, 2004. During this period, HHS will only process applications from a facility located in an HPSA with a score of 14 or higher, and which is one of the following:

• a health center as defined within the Public Health Service Act;
• a rural health clinic within the Social Security Act; or
• a Native American/Alaskan Native tribal medical facility.