Under U.S. immigration law, international medical graduates (IMGs) who train in the United States are generally required to return to their home country for two years before they can apply to reenter. The Conrad 30 Visa Waiver program provides an exception for physicians who meet specific criteria and commit to practicing for at least three years in rural or medically underserved areas. For more than three decades, the Conrad 30 program has been a cornerstone of rural healthcare, helping communities that struggle to attract and retain doctors.
Recent Niskanen Center polling highlights both the program’s obscurity and its broad appeal. Most voters reported knowing little or nothing about Conrad 30. Yet, once informed, strong bipartisan support emerged for expanding it. After learning that Conrad 30 helps address physician shortages by allowing foreign doctors to serve in underserved communities, 76% of voters—including 71% of Republicans and members of the Trump coalition—said they somewhat or strongly support the program.
These findings are consistent with previous polling. A 2024 survey by Americans for Prosperity showed similar support for programs addressing healthcare workforce shortages, with 9 out of 10 respondents saying we should make it easier for the U.S.-trained foreign doctors to remain in the country if they practice in an underserved area.
According to the latest data from the Health Resources and Services Administration, the U.S. has more than 7,000 primary care Health Professional Shortage Areas (HPSAs)–two-thirds of them in rural areas.1 Yet a 2023 survey found that only four percent of graduating medical residents prefer to practice in towns of 25,000 people or fewer.
This mismatch between acute need and limited domestic supply underscores the importance of programs like Conrad 30. But despite broad public support for strengthening the program, Congressional gridlock on immigration continues to stall reforms that could expand its reach and effectiveness.
Polling also identified several reforms that would make voters even more supportive of Conrad 30. These include: pathways for permanent residency tied to service requirements, requiring visa holders to stay longer in areas with shortages, stronger provisions for tracking visa holders, and pairing the program with border security measures to address broader immigration concerns.
Momentum for reform is already visible in Congress. Several bipartisan bills have been introduced to reauthorize, reform, or expand the program–including the Conrad State 30 and Physician Access Reauthorization Act, the DOCTORS Act, and the Doctors in our Borders Act.
In the last fiscal year, only 26 states used all 30 of their available Conrad waivers, leaving roughly 330 slots unused, according to Niskanen analysis.2 The DOCTORS Act, for example, would allow one-third of the unused waivers to be distributed equally among states that had fully used their allotment. Niksanen estimates this reform would retain over 100 U.S. trained physicians–an average of about four additional doctors per state–to serve in underserved communities.
With physician shortages projected to deepen in the coming decades, particularly in non-metro regions, Congress has a clear opportunity. Improving and expanding the Conrad 30 program would not only prevent wasted capacity but also strengthen access to quality care in the rural and underserved areas that need it most.
- Health Resources and Services Administration (HRSA), Designated Health Professional Shortage Areas Statistics: Second Quarter of Fiscal Year 2025, Designated HPSA Quarterly Summary (Washington, DC: U.S. Department of Health and Human Services, September 8, 2025).
↩︎ - Niskanen’s analysis relies on data from 3RNET in addition to data obtained directly from the state-level offices managing Conrad-30 programs in Delaware, Illinois, New Jersey, Texas, and Virginia, and using five-year 3RNET averages for Florida and Vermont.
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