The number of aged adults in the United States will almost double between 2005 and 2030, and by some conservative estimates we will have a 200,000 physician shortage as early as the year 2020. The prospect of healthcare reform could mean that up to 30 million Americans would have access to doctors where they previously did not, which would also create a significant physician shortage.

In an attempt to remedy this problem, there is a host of immigration visas available to international medical graduates (IMGs) who are willing to treat this expanding population and who can show that their foreign degree equates to the appropriate US medical degree. International medical graduates are typically admitted on a J-1 exchange visa which gives them the opportunity to pursue graduate medical education unavailable anywhere else. Although there are 12 categories for J-1 international medical graduates we have seen the same four reoccur with disproportionately more frequency: Professors and research scholars, Teachers, Specialists, and Alien Physicians.

Although vitally important, navigating the field of "medical immigration" as it has come to be called, is fraught with (unnecessary) complications, inter-agency crossover issues, and worst of all an incorrect fear that there are a limited number of medical jobs which should be reserved for those lucky enough to have been born here.

IMGs can come here on a J-1 visa for 7 years (in rare cases they can get an extension) and then transfer over to an H1-B visa while working in an Medically Underserved Area (MUA) or serving a Medically Underserved Population (MUP), or working in a Health Professional Shortage Area. under a Conrad 30 waiver. Without the Conrad 30 waiver, the international medical graduate will be subject to the two-year home rule which obligates the IMG to leave the United States for a minimum of two years without the possibility of even applying for a visa at the American embassy. There are many other federal parameters which the IMG must meet in order to waive the two-year home rule requirement, which is why it is so important to have a knowledgeable lawyer working on the process.

Since the federal government has delegated the Conrad 30 waivers to only 30 per state, the states have introduced their own additional requirements. The prudent IMG must work with immigration counsel who has experience dealing with each particular state’s department of health. Two anecdotal examples are that Florida gives 8 points of extra preference (on their own sliding scale) to general medical practitioners who speak Spanish, while Ohio is notorious for charging a record $3,571 per application.

Joseph R. Lackey has spent considerable time investigating both the federal law and the corresponding state departments of health to navigate the particular federal and state requirements so that an IMG can practice in the United States in the area of his or her preference.