H-1B for Doctors and Nurses: Cap-Exempt, Conrad 30, Limits

What doctors need

If you will treat patients, you need any license the state requires. You also need a full foreign license or a medical degree.

Next, one of two paths applies. The first is a job mainly teaching or doing research at a public or nonprofit institution.

In that case, patient care must be only incidental to the teaching or research.

The second path covers clinical work. You must pass a licensing exam that HHS accepts, or be a US medical graduate.

On that path, you must also show English skills through the ECFMG test or an accredited medical school.

Physicians of national or international renown are exempt from these extra steps.

Which hospitals are cap-exempt

A hospital is not cap-exempt just because it is a hospital. Cap-exempt employers include universities and nonprofits related to or affiliated with them.

Nonprofit research groups and government research groups are also exempt.

A nonprofit hospital can qualify through a university link. It might share a board, be run by the university, or be a branch or member.

A formal affiliation agreement for research or education can also count. Supporting that mission must be a fundamental activity of the hospital.

You can also be exempt if you spend at least half your time working at a qualifying institution and support its mission.

Search H-1B sponsors to see which hospitals and health systems filed H-1B petitions in 2025.

Leaving or adding a job

If your cap-exempt job ends and no new cap-exempt petition follows, you may face the cap. That applies if you were not counted earlier.

While you keep a cap-exempt job, a second cap-subject employer can file a concurrent petition. That does not subject you to the cap.

Conrad 30 for J-1 doctors

Many foreign doctors train in the US on J-1 visas and face a two-year home residence requirement. Conrad 30 lets them seek a waiver.

Each state may recommend up to 30 waivers a year. States may use up to 10 flexible slots outside formal shortage areas.

In return, you work full time in H-1B status for at least 3 years. The facility must be in or serve a shortage or underserved area.

Full time means 40 hours a week. You must start within 90 days of the waiver.

Conrad 30 doctors are exempt from the H-1B cap, so no lottery is needed.

Is Conrad 30 still open?

This point is unsettled. On October 1, 2025, USCIS said the program had lapsed for new J-1 doctors unless Congress extended it.

Doctors who held J-1 status on or before September 30, 2025 remained eligible.

Bills to extend it were introduced in 2025. As of October 2026, we could not confirm an extension, so check with your state health office.

Nurses: most RN jobs do not qualify

USCIS guidance from 2014 says the standard registered nurse job is generally not a specialty occupation.

Advanced practice nurse jobs generally qualify. These include nurse practitioners, nurse-midwives, clinical nurse specialists and nurse anesthetists.

Some specialized RN roles, such as critical care or oncology, may qualify case by case.

If a state required a bachelor's degree for RN licensure, USCIS would treat RN jobs there as specialty occupations. As of 2015, no state did.

The main path for nurses: an EB-3 green card

Most foreign-trained registered nurses come on a green card, not an H-1B. The usual category is EB-3.

Registered nurses are on the Labor Department's Schedule A shortage list. The employer skips the PERM recruitment test and files the I-140 directly with USCIS.

For Schedule A, you need one of these: a CGFNS certificate, a full and unrestricted license in the state where you will work, or a passing NCLEX-RN score.

The catch is the visa line. In the October 2026 Visa Bulletin, EB-3 final action dates were May 15, 2024 for most countries, August 15, 2023 for the Philippines, and January 1, 2014 for India. Your priority date must be earlier than the date for your country.

TN for Canadian and Mexican nurses

Registered nurse is on the USMCA list of TN professions. Only citizens of Canada and Mexico qualify, not permanent residents.

You need a job offer from a US employer, a nursing license for the state where you will work, and a VisaScreen certificate.

TN status is granted for up to three years at a time and can be renewed. It does not cover licensed practical nurses, and you cannot be self-employed.

Canadians usually apply at the border or at a preclearance airport. Mexicans first get a TN visa at a US consulate. TN nurses can work in any state where they hold a license.

NCLEX and VisaScreen come first

You cannot work as a registered nurse in any US state without that state's license. Every state requires a passing NCLEX-RN score.

NCSBN runs the exam. Each state board sets its own rules for foreign-educated nurses, such as credential reviews and English tests.

Federal law also requires a health care worker certificate before nurses and several other health workers get a visa or green card. For nurses this is usually CGFNS's VisaScreen, which checks your education, licenses and English.

Without the NCLEX, you will not get an RN job. Unlicensed health roles generally do not qualify for H-1B, TN or Schedule A.

Which hospitals sponsor nurses?

Foreign nurses are sponsored by hospital systems and by nurse staffing agencies that act as the employer.

Before you sign, check the employer's green card (PERM) and H-1B record, and read any repayment terms in the contract.

Find sponsors hiring now to see which hospitals and health systems filed H-1B petitions in 2025.

Fees in 2026

The $100,000 proclamation payment targets petitions for workers outside the US. As of October 2026, a court order has paused collection. See our $100,000 fee guide.

DHS has also proposed a separate $103,265 fee for cap-subject petitions. It would not apply to cap-exempt petitions. As of October 2026, it is only a proposal.

Not legal advice

This is general information, not legal advice, so confirm your situation with an immigration attorney.

Questions

Sources

• 8 CFR 214.2: Special requirements for nonimmigrant classes (Cornell LII)
• USCIS: H-1B Specialty Occupations
• USCIS: Conrad 30 Waiver Program
• Greenberg Traurig: J-1 visa waiver options for physicians (2023)
• RN Law Group: Understanding the Conrad 30 waiver (Nov. 2025)
• Faegre Drinker: USCIS issues new guidance on H-1B status for nurses (2014)
• Siskind Susser: USCIS issues final memo on H-1Bs for nurses
• USCIS: Presidential Proclamation on Restriction on Entry of Certain Nonimmigrant Workers
• Federal Register: Fee for Certain H-1B Petitions, proposed rule (Aug. 25, 2026)
• 20 CFR 656.5 (Schedule A occupations), Cornell LII
• 20 CFR 656.15 (Schedule A filing), Cornell LII
• 8 CFR 212.15 (health care worker certification), Cornell LII
• 8 CFR 214.6 (TN status), Cornell LII
• CGFNS: VisaScreen
• NCSBN: NCLEX exams
• Miller Mayer: TN visa requirements for registered nurses
• Samper Law: October 2026 Visa Bulletin (final action and filing dates)

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