The HHS waiver was previously restricted to researchers; however, in June 2003, the HHS began to sponsor clinical practitioners as well.  We will discuss both waiver tracks here.

HHS Research Waiver

This waiver is difficult to obtain because the HHS will only sponsor foreign born physicians under “stringent and restrictive criteria.”  For instance, HHS must determine that the physician is an “integral” part of a program “of high priority and of national or international significance” and that they “possesses outstanding qualifications, training and experience well beyond the usually expected accomplishments at the graduate, postgraduate and residency levels.”  In general, this waiver is only granted for physicians who can document their leadership in research.  Also, usually these physicians are employed by distinguished universities or research facilities, who must provide extensive documentation, including unsuccessful recruitment efforts to find a U.S. citizen or permanent resident of comparable qualifications.  If the waiver is approved by the HHS, the physician must work with the sponsoring research facility for a minimum of three years.

The HHS Clinical Care Waiver

In June 2003, HHS began acting as an IGA to sponsor primary care physicians to work in health professional shortage areas (HPSA) or medically underserved areas (MUAs), as determined by the HHS' Bureau of Primary Health Care.  This policy was in response to the closure of the U.S. Department of Agriculture's (USDA) waiver program in 2002.  For HHS purposes, “primary care physicians” are defined as physicians practicing general internal medicine, pediatrics, family practice or obstetrics/gynecology.

Although Congress passed legislation in late 2004 which allows federal agencies to sponsor waivers for specialists, the HHS Clinical Care Waiver is available only to primary care physicians and general psychiatrists who have completed their primary care or psychiatric residency training programs within the past 12 months.  For example, an internist enters into an employment agreement to work for a facility located in No Man's Land, Texas, a HPSA.  The agreement requires him to start work on July 1, 2010.  In order to apply for a HHS waiver, he must have completed his residency training no earlier than June 30, 2009.  According to the HHS, this 12-month eligibility limitation ensures that the physicians' primary care training is current.  It also ensures that the physician is not engaged in subspecialty training.

As with other IGA waivers, sponsoring facilities must provide proof of recent recruitment efforts to find qualified physicians who are U.S. citizens or permanent residents.  Also, the sponsored J-1 physician must commit to a three year period of service with the sponsoring employer and agree to begin work within 90 days of the USCIS approval of the waiver.