This latest iteration of Conrad 30 includes needed protections for physicians who are at risk of exploitation—for example, concerning on-call hours—in the limited choice of placements available to them. “Provisions in this bill that would make improvements to the program by requiring more transparency in employment contract terms, creating additional waivers per states, and protecting spouses and children of physicians in the program” all have the AMA’s support, Dr. Madara’s letter states.
The last authorization expired on April 28, but in practical terms lawmakers may take some time to vote without disrupting patient care. If not enacted, eventually the waiver process—initiated by states on behalf of doctors—will break down. The “30” in the Conrad program is shorthand for the per-state limit on waivers. At current levels, about 1,500 physician placements could be affected in the immediate wake of an end to new applications.
With a J-1 waiver in hand, the next step is the transition to an HB-1 visa that allows for six years of employment. On April 3 came the disappointing news that an expedited HB-1 approval program is on hold for up to six months. The “premium processing” program can secure a HB-1 decision within 15 days, instead of the months it could take otherwise. That speed is critically important. All this plays out in the last year of residency and the HB-1 processes can’t even start until the state obtains the waiver. Once no longer covered by a J-1 visa, there is only limited time for HB-1 approval so those physicians can begin their new jobs on schedule or even stay in the country.
U.S. Citizenship and Immigration Services says the suspension allows it time to clear out its HB-1 backlog. That has happened before, but six months is an unusually long period. The situation concerning Conrad 30 physicians is too close for comfort for patients in underserved communities, the physicians who serve them and states seeking to keep Conrad 30 running smoothly. All of them have benefited from a successful, well-focused program, designed to place critically needed doctors in settings where others are not rushing in to practice.