What Should be in a J-1 Physician Contract?

Attention new physicians fresh out of medical school—especially those aiming to practice in the U.S. on a J-1 visa: securing a J-1 waiver job should be your top priority. But just as important is understanding the terms of your first employment contract. Let’s break it down in simple terms. An employment contract is a formal agreement between you and your future employer that outlines how your professional relationship will function—everything from duties and compensation to how and when the agreement can end. While contract laws vary slightly from state to state, the core elements are generally consistent. Why keep reading? Because knowing what to look for in your first contract can help you avoid costly mistakes and set you up for long-term success in your medical career.

In this guide, What Should be in a J-1 Physician Contract is explained with clear steps and tips.

How to Get Started in the Program — What Should be in a J-1 Physician Contract

Some states either require or don’t require many things. I’m going through what everyone will have and a few things that vary from state to state. First, the J-1 contract must contain sites where the J-1 physician will be working and the services they’ll be providing. It must state that the J-1 physician must start within 90 days of receiving the J-1 visa waiver. Since I’m in Arizona, I’m going through the Arizona department of health services. The requirements for the contract, and get into what varies from state to state. It must be for three years—that goes for any state. It must express that the J-1 physician will work a minimum of 40 hours on average. 

That must be in every contract in every state. Then the employer and J-1 physician must both sign the agreement. Those are just the bare-bones things that must be in every J-1 contract. 

Things That Change From State to State 

Some of the things that change from state to state. And this might help a J-1 physician looking in multiple states for different opportunities. Arizona, for instance, prohibits any non-compete in the agreement. Arizona does allow and enforce reasonable non-competes for J-1 physicians in the state, but they prohibit them in a J-1 contract. Which can change from state to state whether it needs to be in there or not. If the contract changes in some way, if there’s an amendment, it must still reach those basic amendment requirements. If they amend it, they must run it through the state’s health department or whoever oversees the contract.

When drafting a J-1 physician contract, it’s essential to understand the requirements of the Conrad 30 Waiver Program. The U.S. Citizenship and Immigration Services (USCIS) outlines that the contract must include a full-time employment commitment of at least three years in a designated underserved area. For more detailed information, refer to USCIS’s Conrad 30 Waiver Program overview.

Additionally, the Educational Commission for Foreign Medical Graduates (ECFMG) provides a comprehensive reference guide for J-1 physicians. This guide details the necessary components of a J-1 physician contract, including the requirement for a signed contract or official letter of offer for a position in an approved clinical training program. Learn more by visiting ECFMG’s reference guide for J-1 physicians.

Visa Petition Approved Medical Contract

Regarding negotiating a J-1 contract, I mean, every contract negotiation is based upon leverage. A J-1 physician probably has less leverage because they need to be in that position. But different specialties always have different leverages than others. Then if you’re willing to go into certain places. The entire point of the J-1 visitor program is to bring physicians to health service shortage areas or under-served communities. So, you’re likely going somewhere that’s more rural, not in a large city, and is probably harder to recruit to. The visitor program intends to bring good J-1 physicians into these areas where recruiting is harder. Then after three years, they can go through the process and get their green card. So that’s the basics of what needs to go into a J-1 employment contract.

Other Blogs of Interest

• Is a Physician an Independent Contractor?
• When Should a Resident Physician Start Looking for a Job?

J-1 Visa Waiver Program

The J-1 Visa Waiver Program is designed to bring in physicians from abroad for a temporary period. J-1 physicians are required to work full-time at their assigned location and have an employment contract that includes those requirements. J-1 Physician Contract Requirements list all the criteria J-1 Physicians must meet before being approved for the J-1 waiver program. A visitor program granting entry into the United States of America. Here is a breakdown of what you must know about getting your J physician contract set up ready for approval!

International Medical Graduates

The US Citizen and Immigration Services provides valuable information for those interested in the J-1 process. The J-1 classification is for those who want to participate in an approved program. A program allowing them the opportunity to teach, instruct, lecture, study and observe, consult with others, or demonstrate special skills. You can also receive J-1 training while you are there!

Visa

The United States Department of State has named public and private entities to act as exchange sponsors. These visitor programs are designed to promote the interchange of persons, knowledge, and skills in fields like education, arts, or science.

The US Secretary appoints a designated sponsor for each J-1 Exchange Visitor program. They have goals set out on behalf of those visiting America from their home country. Those who will bring back new ideas and unique perspectives when they return home at the end of their stay. And attaining this through cultural exchanges that help broaden international understanding of different cultures. Which we can all learn something about during this experience.

Visa Application Process for J-1 Visitor Program

The US Department of State plays the primary role in administering the J-1 exchange visitor program. So, you want to get a visa for this J-1 trip. But your sponsoring agency is not helping. Then it’s time to start getting creative. You will need Form DS-2019: Certificate of Eligibility for Exchange Visitor Status (formerly known as an IAP-66). This means working closely with officials at your sponsoring embassy or organization who are assisting through this whole ordeal. But don’t worry, they’re there every step along the way!

A responsible officer has the power to grant a student their Form DS-2019, otherwise known as an I-20. Your RO will be your point of contact for any questions you may have during this process. And can help answer any questions. They’re also in charge of issuing documents like letters or transcripts if needed before we issue them our coveted document!

The US Department of State provides Form DS-2019 to those interested in going abroad for educational purposes. And receiving the J-1 visa after acquiring it through their school’s sponsor. Which is typically an American university or college with international programs on an F, M, or Q status. The waiting time for your interview appointment can vary, so submitting as early as possible is strongly encouraged. Though you may not enter the United States more than 30 days before your program starts.

Physicians

A J-1 physician should not enter into a contract without having the agreement reviewed by legal counsel first. You need someone to protect your interests. You need a firm grasp of the key terms and their implications. When we do a thorough review of your J-1 physician employment contract, you will receive:

• Available in any state where that J-1 physician is
• Flat-rate pricing, with no hidden costs
• Review of your proposed employment agreement
• Phone consultation with Attorney Robert Chelle reviewing the contract term by term
• Follow up with a review of the needed clarifications

Knowing you have professional and experienced help with an employment contract will enable you to take the stress out of trying to do a vital business transaction. You can then focus on what is important — your patients.

J-1 Waiver Visa Contract Requirements

The employment agreement between the J-1 physician and the employer must contain a number of terms. Each state where the J-1 physician will practice will have its requirements. But all states require the following in the Employment Agreement:

• The contract must specify the name of the service site(s). And the address where the J-1 physician will provide their services. (A separate service site application must be completed and submitted.  Where? For each site where the J-1 physician will perform their required full-time hours per week.)
• J-1 waiver program contract must be for at least full-time (at least 40 hours per week). And specify the approved primary care/specialty services the site will provide.
• The contract must be for at least 3 years.
• J-1 physician must agree to begin employment at the approved service site(s) within 90 days of receiving J-1 waiver. (must state in the contract)
• Until the J-1 physician completes the three-year commitment, the J-1 physician must provide services:

• At the service site(s) specified in the employment contract,
• To the patients specified in the employment contract, and
• In the manner specified in the employment contract

GME Programs and Medical Schools

Alien physicians must, to be eligible for a work permit. J-1 applicants must have completed the appropriate educational requirements and training in their home country before coming to America. Successful candidates will need at least an associate degree in accounting from American universities. Or equivalent experience working as an accountant abroad.

Foreign Medical Graduates

The requirements for an international student vary from program to program. J-1 applicants must be able to adapt to the educational and cultural environment they will experience in their visitor programs. And have the necessary background, needs, and experiences suitable for the fields of study offered at university or college-level institutions. Also, competency with oral communication. Such as speaking English fluently so that one can easily comprehend what is being said without any difficulty whatsoever.

Some universities desire international students because it allows them more diversity on campus, giving intellectual stimulation through new perspectives. Also allowing those who may not especially enjoy interacting with people outside of their own culture might create less stress. Worry-free during school days if they had someone close enough culturally similar around them all day.

Looking for the most comprehensive and rigorous medical exam? Look no further than The National Board of Medical Examiners. There are three different ways to pass this examination: Part I & II from either an American or Foreign school. Step 1&2 passing with ECFMG (Educational Commission For Foreign Medical Graduates) and a Visa Qualifying Exam(VQE). One must pass all parts before their education begins, as some US schools require it even after graduation!

The National Board of Medical Exams

The National Board of Medical Exams exists so J-1 physicians can ensure they have the best training available. They do this by offering multiple options for completing your certification process.

The country’s government required a physician with the skills to provide care. The alien had filed an offer, along with a written assurance that he would return after training was complete. And they issued permission for him to train.

The passage begins by stating their need to be physicians who are needed within the area first. Before further assessing any individual’s qualifications or willingness to serve. Alongside providing documentation, ensuring their Willingness, educational background, and proficiency must also reflect what’s required. Once they meet these requirements, if approved, it will permit them to enter this new opportunity.

The agreement includes a contract from the US accredited medical school, an affiliated hospital, or a scientific institution. In order to provide accreditation graduate medical education for the alien physician. Both parties sign it:

The United States has strict requirements for granting citizenship status that one can meet with various documents. Documents such as diplomas, transcripts, degrees, etc. One of these additional documents required is one detailing how you will receive your training in medicine. That is, via affiliation agreements between institutions like colleges/universities that offer this type of training. And hospitals where physicians train after graduating too called “accredited” schools. Meaning their credits towards certification are recognized nationally (or internationally). This document must detail what year(s) you plan on studying at the said institution.

t you are fully protected. And assist you in the contract process so that we fairly represent your interests.

Every physician contract is unique. However, nearly All contracts for health care providers should contain several essential terms. If the contract doesn’t spell out these essential terms, disputes can arise when there is a disagreement between the parties. For instance, if the physician expects to work  Monday through Thursday and the employer expects the provider to work Monday through Friday. Still, the particular workdays are absent from the agreement. Who prevails?

Physician Agreement Checklist

Spelling out the details of your job is crucial to avoid contract conflicts during the term of your employment. Below is a checklist of essential terms that contracts should contain (and a brief explanation of each term):

Contract Basics

1. Practice Services Offered: What is the clinical patient care duties? Are you given time to review administrative tasks? How many patients are you expected to see (like in pediatrics)?
2. Patient Care Schedule: What days and hours per week are you expected to provide patient care? What is the surgery schedule? Are you involved in the planning of your schedule?
3. Locations: Which facilities will they schedule you to provide care at (outpatient clinic, surgical sites, in-patient services, etc.)?
4. Outside Activities: Are you permitted to pursue moonlighting or locum tenens opportunities? Do you need permission from the employer before you accept those practice medicine-related positions?
5. Practice Call Schedule: How often are you on call (after-hours office call, hospital call (if applicable))?
6. Electronic Medical Records (EMR): What EMR system do they use in the practice of medicine? Will you receive training or time to review the system before providing care?
7. Practice Assignment: Can the employer assign the Agreement?
8. Term: What is the length of the initial term? Does the Agreement automatically renew after the initial term?
9. Without Cause Termination: How much notice is required for either party to terminate the Agreement without-cause?
10. For Cause Termination: What are the grounds for immediate termination for-cause? Is a review provided to dispute the termination?
11. Non-Compete: How long does the non-compete last, and what is the prohibited geographic scope?
12. Non-Solicitation: How long does it last and covers employees, patients, and business associates?
13. Notice: How is the notice given? Via hand delivery, email, US mail, etc.? Does it have to be provided to the employer’s attorney?
14. Alternative Dispute Resolution: If there is a conflict regarding the contract, will mediation or arbitration process be utilized? What is the standard attorney review process for conflict? Who decides which attorney oversees the process?

Monetary Considerations

1. Medical License:  Will the medical practice offer expense repayment for your license? Will an advisor be provided?
2. Base Compensation: What is the annual base salary? What is the pay period frequency? Does the base compensation increase over the term of the Agreement? Is there a yearly review or quarterly review of compensation?
3. Productivity Compensation: If there is productivity compensation, how is it calculated (wRVU, net-collections, patient encounters, etc.)? Is there an annual review?
4. Practice Benefits Summary: Are standard benefits offered: health, vision, dental, life, retirement, etc.? Who is the advisor of human resource benefits?
5. Paid Time Off: How much time off does the job offer? What is the split between vacation, sick days, CME attendance, and holidays? Is there an HR guide?
6. Continuing Medical Education (CME): What is the annual allowance for CME expenses, and how much time off are they offering?
7. Dues and Fees: Which financial expenses are covered (board licensing, DEA registration, privileging, AMA membership, Board review)?
8. Relocation Assistance: Is relocation assistance offered? What are the repayment obligations if the Agreement terminates before the expiration of the initial term?
9. Signing Bonus: Is an employee signing bonus offered? When is it paid? Do you have to pay it back if you leave before you complete the initial term? Are student loans paid back? Is there a forgiveness period for student loans?
10. Professional Liability Insurance: What type of liability insurance (malpractice) do they offer: claims-made, occurrence, self-insurance?
11. Tail insurance Insurance: If tail insurance is necessary, who is responsible for paying for it when the Agreement terminates?
12. Disability Insurance: Is disability insurance provided (short-term and long-term)?
13. Financial Retirement:  Is a financial retirement plan offered?
14. Practice Post-Termination Payment Obligations: Will you receive production bonuses after the Agreement terminates?

Hire A Contract Attorney

If you have questions about claims-made or occurrence coverage and your current malpractice insurance. Contact Chelle Law today if you are interested in having your employment agreement reviewed.

MGMA Numbers

Now, as far as the MGMA numbers go, they are kind of hard to find. I mean, you can Google around and find, I would say, data from maybe a year or two old. I found that people are relying on 2020 numbers. They’re completely screwed up due to COVID. Some of the RVU compensation factor numbers are way out of whack. Some of the comps are just way out of whack.

I would not use 2020 data to compare the contract offer. 2019 is probably the safest and most reliable number that we have right now. 2021 hasn’t been released, at least at this point while I’m making this video yet. So, Google and read around. You can try and find some numbers to help you with negotiations. I’d say the best tactic is to go out, find multiple job offers and see what you’re being offered initially.

Summary

Those are tips on getting a better salary and where to start. Contacting an attorney and trying to maybe get a feel for the area certainly might be helpful. It’s fairly specialized in people that just focus on physician contracts. It’s possible you won’t find somebody in the area you’re looking at, so maybe do a wider search for that. But anyway, the last point is that some employers simply will not negotiate. They’ll say it’s A take-it-or-leave-it offer, you’ll then have to be willing to walk if you’re unhappy with your salary. 

But some people say, no, we’re not negotiating. This is what we’re offering, and I wouldn’t be offended by that. That’s just kind of the tech that they’re taking as far as employing somebody. So, don’t be surprised if you have an employer that says no. But if you’re unhappy with an offer, you need to be willing to walk as well. Accepting a deal that you think is well below your value is never a good feeling. Don’t just accept that because you need a job. Find the right job.

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