The Wisconsin Division of Public Health (DPH) is the designated state agency that can submit State-30 recommendations to the U.S. Department of State (USDOS). The DPH accepts applications for State-30 recommendations from health facilities, or their attorneys, after an offer of employment has been made to the foreign physician.
Starting October 1 each year, Wisconsin begins accepting J1 waiver applications from employers. Applications are reviewed and decisions made (see requirements below) on a first-come basis until all 30 slots are filled. For federal updates and more information on the U.S. Department of State J-1 Visa waiver program, see the USDOS J1 Visa website.
The USDOS reviews state recommendations and submits its recommendation to the U.S. Citizenship and Immigration Services (USCIS), which makes the final J-1 visa waiver decision.
- The applicant physician must provide care at a facility that is physically located in a geographic area federally designated as a Health Professional Shortage Area (primary care or mental health HPSA), Medically Underserved Area (MUA), or Medically Underserved Population (MUP). Wisconsin can make 10 placements (known colloquially as “flex” placements) in areas that are not designated as HPSAs or MUA/Ps, that serve populations from a surrounding shortage area(s) or meet the required extenuating criteria (Flex Placement criteria).
- The applicant physician must agree to provide full-time primary care, general mental health care, or specialty care in this shortage area/service area for three years and 40 hours per week, with at least 32 hours per week spent in direct patient care.
- The applicant physician must have completed a residency or fellowship in the U.S. in the specialty associated with the applicant's employment agreement (e.g., family medicine, internal medicine, pediatrics, obstetrics, psychiatry or other subspecialty).
- The physician and facility must provide care to clients eligible for Medicaid and Medicare and to medically indigent clients.
- The physician must begin working at the facility within 90 days of the effective date of the J-1 visa waiver (after completion of the physician's residency training).
- The employer must provide evidence, over a period of at least 6 months, of unsuccessful efforts to recruit U.S. physicians for the position.
- The employment agreement must demonstrate the employer's commitment to recruit and retain the physician for at least three years.
In order to be recommended for a non-HPSA or non-MUA/P placement (a “flex” placement), at least 30 percent of the physician's primary care or specialty patients must come from surrounding HPSA or MUA/P areas. If a facility cannot meet the percentage requirement, the following is proposed as an alternative consideration method:
Of the following criteria, the first as well as three of the other five criteria must be met:
1. Documentation of the percentage of patients served who reside in a HPSA/ MUA/P (the facility must document some service to patients from these areas), and discussion of how employment of this physician will increase access for the underserved. (This element is required.)
Three of the five following criteria must be met in addition to #1:
2. Facility payer mix that includes 50 percent of patients insured through Medicare and/or Medicaid.
3. Documented difficulty recruiting a physician of the intended specialty (please address all of the following):
a. Documentation showing one year of recruitment efforts.
b. Time it takes or has taken in the past to fill a position for a particular specialty.
c. Retention information for past providers of that specialty. (For example, does the facility have difficulty retaining providers of this type? How does the facility plan to address this?)
d. Other relevant information supporting a case for recruitment difficulty.
4. Need for a physician of that specialty (please address all of the following):
a. Need for this physician's services—How many people in the facility’s service area are waiting for appointments with a physician of that specialty? (For example, how many patients can be documented as needing these services? Will this be the first specialist of this type for the service area?)
b. Documentation regarding physicians leaving or retiring.
c. Long wait times—More than 7 days for returning patients, 14 days for new patients.
d. Documentation that other physicians of this specialty in a reasonable service area are not accepting new patients, or that there are no specialists of this type within the service area.
e. If the specialty is very highly trained and specific, document a statewide shortage of that specialty (and thus having that physician would benefit the entire state).
f. How many full-time employee (FTE) physicians of this specialty does the facility have, and how many does it need to be considered fully staffed?
g. Other relevant information supporting a case for need of a particular physician.
5. Particular barriers unique to the location, including travel time to see an available physician of a particular specialty, geographic barriers, distance from major cities with a variety of services, or other issues regarding location that could support need for a physician.
6. Documentation of population factors, including but not limited to having more than 20 percent of the population with incomes below the federal poverty level, population age distributions or birth rates that cause unusual strain on health care resources, and incidence and/or prevalence of a particular disease burden.
U.S. Department of State: User Fee
The U.S. Department of State (USDOS) requires that J-1 visa waiver applicants (J-1 visa physicians) submit a "user" fee for USDOS to process the application. J-1 visa physicians or their attorneys should submit the fee and the USDOS "J-1 Visa Waiver Review Application" directly to the U.S. Department of State. Please note: A Wisconsin State-30 "slot" will not be assigned until DPH has received, reviewed, and approved a complete application from the employer, including the physician's USDOS case file number. More detailed instructions are included in the Application Information section of this website, or from the Bureau of Consular Affairs, U.S. Department of State, J-1 Visa website.
The lists of federally designated primary care and mental health shortage areas, HPSAs, MUAs, and MUPs are updated on an ongoing basis. The employment offer must include a practice site that is located in a primary care HPSA or MUA or a mental health HPSA for psychiatrists. Wisconsin can consider recommending a J-1 visa waiver in a non-designated service area, when exceptional need and public interest can be demonstrated. See "Shortage Areas" for more information.
Check if street address of the practice site is located within a designated shortage area: Use this link to check if a street address is located within a current HPSA or MUA/MUP and get the designation details.
Wisconsin does not maintain a list of vacancies specifically for J-1 visa physicians or provide a placement service. Many physicians search through private recruiters or employment ads. Internet sites that might be helpful include:
- Federal National Health Service Corps Job Opportunities list (vacancy list used primarily for federal loan repayment for U.S. physicians practicing in HPSAs)
- National Rural Recruitment and Retention Network (a membership-based private non-profit placement service)
State-30 Application Information
See Application Information for detailed information and to view and print a copy of the Wisconsin Guidelines for State-30 Recommendations for J-1 Visa Waivers from this website. Application instructions can also be requested by mail by using the contact information below, or by calling the Primary Care Program at 608-267-7121.
Primary Care Program
Wisconsin Division of Public Health
PO Box 2659
Madison, WI 53701-2659.
Primary Care Program
Wisconsin Division of Public Health
1 W. Wilson St., Room 250
Madison, WI 53703-3445
Requesting an H-1b Work Visa
Once USCIS notifies the foreign physician that the J-1 visa home-residence requirement is waived, the next part of the employment process is for the sponsoring employer to submit an H-1b work visa petition to USCIS. The Wisconsin Division of Public Health does not have a formal role in petitions for H-1b visas or permanent residency.
Information resources related to petitioning for an H1-b visa:
Prevailing Wage Request through the Wisconsin Department of Workforce Development
Temporary Workers through the U.S. Department of State