• Process for getting waiver so J-1 Resident need not go home after training here; and can change over to work visa (H-1B). Three-step process. Start by filing application with the State. Is discretionary; limited slots available (thirty). If Massachusetts supports, forward to State Department to grant actual waiver (step two). Here, is essentially rubber-stamped, but can take months to get. Once have, file H-1B petition with immigration (step three). Not until approved is physician work-authorized. Can start building/filing these cases each fall. Can take until the following fall, in our experience, for process to conclude.

Chief Requirements
• Agree to take full-time, clinical position in medically underserved or health professional shortage area for period of three years, documented by employment contract. Later work visa and waiver conditioned on three-year commitment. Organization must file brief form with the Commonwealth twice annually over the three years to show person still there.
• Must be organizational applicant. Individuals cannot self-petition.
• Have to take “public payers”, e.g., MassHealth, Medicare, Commonwealth Care, those that cannot pay, etc., with sliding fee scale, and be “clean”, e.g., no Medicare/Medicaid fraud, DEA or criminal investigations; instances of physician discipline, licensure complication or discipline, etc.
• Physician must start within ninety days of getting the waiver.
• Must show/document recruitment difficulties, including with respect to U.S. citizens.
• Must get at least three letters from third-party community agencies and/or practitioner referrers.

Where Preference Accorded
• Jobs in primary care, defined for these purposes as internal medicine, pediatrics, family practice, OB-GYN, psychiatry. These and only these are reviewed first (10/1 to 1/31). From 2/1 to 6/30, can still file these, but specialists can, too.
• Physicians with language skills matching community need.
• Community health centers.
• Hospitals where at least sixty-three percent of patient population receive Medicare, Medicaid, free care, or government payment assistance otherwise.

Other Odds and Ends
• Commonly get more applications than slots available. Never a guarantee.
• Specialist filing window does not even open until February if space remains. With specialists, helpful to show cultural connection, or that would alleviate hardship, e.g., cut significantly distance patients otherwise have to travel.
• If same organization wants to file multiple applications for different physicians, it can, but must prioritize or rank preferentially.
• Will not support if research, teaching, or non-clinical role.  Clinical care only.