Conrad Waiver – Extenuating Circumstances Permitting Employer Change

The Conrad 30 program allows a physician who is subject to the two-year home residency requirement (HRR) to waive the HRR by completing a three-year term of employment in H1B status in a federally designated health professional shortage or underserved area. Ordinarily, an employer change is not permissible during the three-year term of employment. If the physician fails to complete the full three-year term, the individual becomes re-subject to the entire two-year HRR. However, in certain situations, the physician may be permitted to move to a different H1B employer to complete the three-year period based on certain extenuating circumstances.

Background on HRR

An international medical graduate (IMG) who receives graduate medical training in the United States via the J-1 exchange visitor program typically becomes subject to a two-year home-residence requirement (HRR). There are several potential methods of receiving a waiver to the HRR, the most common of which is the Conrad 30 waiver.

More details on the HRR and Conrad 30 waiver are available in the MurthyDotCom NewsBrief, H1B Cap Exemptions for Physicians (25.Jan.2018).

Extenuating Circumstances

As noted above, the physician typically must work the full three years for the same employer in order to satisfy the Conrad 30 waiver requirement. However, if certain requirements are satisfied, the U.S. Citizenship and Immigration Services (USCIS) has the discretion to approve an H1B change of employer for the physician based on extenuating circumstances.

According to the applicable regulations, extenuating circumstance may include, but are not be limited to, the closure of the sponsoring health care facility or hardship to the foreign physician. The broad wording of the regulation allows the USCIS to evaluate various situations that arise in the professional and personal lives of the physician on a case-by-case basis and then determine whether the change of employment should be recognized for waiver purposes.

Filing Requirements

In order for the H1B change-of-employer petition to be approvable, all of the following must be included:

  • An employment contract with a health care facility located in a federally-designated shortage area for the balance of the required 3-year period
  • Evidence of the extenuating circumstance necessitating the request for change of employer
  • Evidence of the approval of the H1B status with the existing (or previous) employer
  • Evidence that the geographic area/s of intended employment is/are in a federally-designated shortage area

Additionally, depending upon the circumstances, it may be advisable to submit evidence that the initial J-1 waiver sponsor is supportive of the change-of-employer request.


The Conrad 30 program offers a helpful means for physicians to avoid having to comply with the HRR, while simultaneously benefitting communities in need of doctors. Physicians who have questions about moving to a new Conrad 30 sponsor are welcome to contact a Murthy Law Firm attorney by eMailing


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Disclaimer: The information provided here is of a general nature and may not apply to any specific or particular circumstance. It is not to be construed as legal advice nor presumed indefinitely up to date.