For hospitals and health systems seeking to recruit talented physicians, navigating J-1 waiver programs is essential. Foreign physicians who have completed a training program in the U.S. must either return to their home country for two years or obtain a waiver of the foreign residency requirement.
The two key routes for securing this waiver in Michigan are the Conrad-30 program and the federal Health and Human Services (HHS) Clinical-Care waiver. Michigan’s Conrad-30 program opened on Sept. 1 with a limited number of physician waiver slots, while the federal HHS clinical-care waiver is open year-round with no numerical cap. Understanding these programs can help hospitals and health systems plan and compete for top talent in a challenging recruitment environment.
Michigan Conrad-30
Michigan’s Conrad-30 program allows the state to recommend up to 30 J-1 waiver applications each year. Applications for the 2025-2026 cycle opened on Sept. 1, and will remain open through Nov. 1, with a potential second round if slots remain open.
To qualify under Michigan’s Conrad-30 program, physicians must:
- Commit to three years of full-time clinical service at a site located in, or serving, a Health Professional Shortage Area (HPSA) or Medically Underserved Area/Population (MUA/MUP).
- Begin employment within 90 days of receiving the waiver approval.
- Have a valid employment contract. Michigan discourages the use of noncompete clauses and restrictive covenants.
Michigan generally prioritizes primary care specialties such as family medicine, general internal medicine, pediatrics, OB/GYN and psychiatry. However, slots are available for sub-specialists depending on state work-force needs. Because slots can be competitive, early planning is essential.
HHS Clinical-Care Waivers
The federal HHS Clinical-Care waiver offers a year-round alternative with no cap on the number of waivers granted annually, making it especially valuable for hospitals that either miss the state filing window or do not qualify under a specialty restriction.
To qualify under the federal HHS Clinical-Care program, physicians must:
- Complete their residency within the 12 months immediately preceding the commencement of employment under the employment contract.
- Commit to three years of full-time clinical service at a site located in or serving a HPSA with a score of 7 or higher.
- Practice family medicine, general internal medicine, pediatrics, OB/GY or psychiatry.
Because the HHS program runs continuously, it provides greater flexibility for hospitals and health care systems.
The Canadian Advantage
Hospitals hiring Canadian physicians should be aware of one unique advantage: Canadian citizens can enter the U.S. in H-1B status while their J-1 waiver application is pending and without first receiving approval of their J-1 waiver. This allows Canadian physicians to begin serving patients in an underserved area, giving hospitals immediate relief while the waiver process moves forward.
Next Steps for Employers
Employers considering J-1 physician hires should begin by confirming the eligibility of their practice site and drafting contracts that meet state and federal requirements. For Michigan’s Conrad-30 program, packets should be prepared for the Sept. 1 to Nov. 1 window, while eligible primary care and psychiatry candidates can take advantage of an HHS filing.
