H-1B vs J-1 Visas and Locum Tenens Work: The Complete Doctor’s Guide
/H-1B vs J-1 Visas and Locum Tenens Work: The Complete Doctor’s Guide
Important note: Immigration rules are high-stakes and fact-specific. This is educational information, not legal advice. Before you accept any locums arrangement (especially across multiple facilities/states), review the exact plan with an immigration attorney who regularly handles physician H-1B/J-1 cases.
Understanding the Core Problem: Why Visas and Locums Don’t Naturally “Fit”
Locum tenens is designed for flexibility—multiple sites, short assignments, changing schedules, and often independent-contractor (1099) relationships. U.S. work visas for physicians are designed for control and specificity—employer-specific, location-specific, and tightly documented job terms.
That mismatch is the central theme:
H-1B can sometimes be structured to support locums-style work, but only if the sponsoring employer relationship and worksite rules are handled correctly.
J-1 (ECFMG-sponsored for training) generally cannot be used for moonlighting/locums the way people imagine, and the “two-year home residence” rule (INA 212(e)) changes the timeline unless you obtain a waiver.
If you’re on a visa and you want locums, you need a plan that aligns immigration compliance with how locums assignments actually operate.
Part 1 — Locum Tenens Basics (What Staffing Agencies Typically Do)
Locum tenens staffing agencies commonly place physicians as 1099 independent contractors—meaning you’re not a traditional employee of the hospital you’re covering, and the agency may treat you as a contractor rather than W-2 staff.
That matters because many visa frameworks assume:
a clear employer-employee relationship, and
a specific worksite arrangement.
So, if your agency says “it’s 1099,” your next question should be: “How will my visa allow me to do this work, at this site, for this sponsor?”
Part 2 — J-1 Visas for Physicians (What They Are and What They Usually Permit)
What the Physician J-1 Is (and Who Controls It)
For most international physicians in U.S. graduate medical education, the J-1 physician visa is administered through the U.S. Department of State (Exchange Visitor Program) and sponsored by ECFMG, which issues the DS-2019 after confirming eligibility.
This J-1 is for clinical training (residency/fellowship), not for general “any job you want as a doctor.”
The 212(e) Two-Year Home Residence Requirement
ECFMG states that all J-1 physicians sponsored by ECFMG for clinical training are subject to the two-year home-country physical presence requirement (INA §212(e)).
Practically, that means after training you may be required to spend two years in your home country before you can obtain certain U.S. immigration benefits/status changes—unless you obtain a waiver.
Can You Do Locum Tenens While on a Training J-1?
In most real-world cases: no in the way people mean it.
Your J-1 work/training is tied to the approved program and sites.
“Extra” clinical work outside that framework is generally not allowed unless explicitly authorized under J-1 rules (and for physicians, the system is strict and program-controlled).
Even if someone offers you shifts, that does not make it permissible.
If you’re a J-1 physician and you want to do locums after training, the conversation usually shifts to J-1 waiver pathways and then to an H-1B (or another status) that can support employment in the U.S.
Part 3 — J-1 Waivers (The Bridge Between Training and Working in the U.S.)
Conrad 30 Waiver Program (Most Common Physician Path)
USCIS explains the Conrad 30 waiver program as a pathway for certain J-1 foreign medical graduates to seek a waiver of the 2-year home residence requirement, typically tied to work serving medically underserved areas/populations.
Key practical points:
Each state can recommend up to 30 waivers per year (hence “Conrad 30”).
The waiver is usually linked to a specific job commitment (commonly multi-year) at an approved employer/site in a shortage area.
“But I Want Locums, Not a 3-Year Commitment”
This is the most common friction.
A typical J-1 waiver job is structured as:
Full-time work
For a specific employer
At specific locations
For a defined term
That is not the same thing as hopping between assignments.
In other words: the waiver job is often the opposite of locums. Some physicians do “locums-like” work only aftercompleting their waiver obligation (depending on their subsequent status and approvals).
What Happens If You Need to Change Employers During a Waiver?
USCIS has policy guidance about obligations and notifications for J-1 physicians who have received waivers (including Conrad 30), underscoring that changes are not casual and must be handled properly.
Part 4 — H-1B for Physicians (Why It’s Usually the Better Fit for Work Flexibility)
What H-1B Is (In This Context)
H-1B is a work-authorized status for specialty occupations and is employer-sponsored. For doctors, it’s commonly used:
after a J-1 waiver
or by programs/employers able to sponsor physicians directly
USCIS provides guidance that an H-1B worker changing employers may begin working for the new employer once the new employer files an H-1B petition (the portability concept).
The U.S. Department of Labor also explains “portability” as enabling certain H-1B workers to change jobs without falling out of status, assuming requirements are met.
Why this matters for locums: if you need to switch who you work for, the paperwork and timing rules become central.
The Big H-1B Locums Question: “Can I Work Multiple Assignments?”
Potentially, but only if structured correctly.
Your H-1B permission is typically tied to:
the petitioning employer
the specific job terms
the approved work locations/worksites
If your locums assignments will take you to multiple hospitals/clinics, the arrangement must respect how H-1B worksite and employer control are documented.
Key concept: Employer-Employee Relationship
USCIS guidance emphasizes the idea of an employer petitioning for the worker and the worker being authorized under that petition.
Translation: “I found shifts” is not the same as “I’m authorized to work those shifts under my H-1B.”
Part 5 — Pros and Cons: H-1B vs J-1 for a Locums-Minded Physician
J-1 (ECFMG training) — Pros
Well-established pipeline for residency/fellowship through ECFMG sponsorship
Clear training framework
Often the most accessible visa path for IMGs entering U.S. GME
J-1 — Cons (for locums goals)
Typically subject to the 2-year home residence requirement
Limited flexibility; work is tied tightly to the training program
To stay and work after training, most need a waiver path (e.g., Conrad 30) that often requires a multi-year commitment
H-1B — Pros (for locums goals)
Can be compatible with physician employment outside training
Portability framework exists for changing employers under qualifying conditions
More plausible pathway to structure multi-site work if worksite and sponsorship rules are satisfied
H-1B — Cons (for locums goals)
Still employer-specific; not “work anywhere”
Multi-site locums adds compliance complexity
Some staffing models (especially pure 1099 independent contractor setups) can be hard to reconcile with how H-1B petitions typically demonstrate control and worksite details (you must structure this carefully)
Part 6 — “Everything You Need to Know” Before You Accept Locums on H-1B or J-1
1) Your Immigration Status Must Match the Exact Work You’ll Perform
Before signing anything, you should be able to answer:
Who is my sponsoring employer?
What sites am I authorized to work at?
What happens if the facility changes my schedule or adds a new site?
Is travel between sites expected, and is that covered in the petition strategy?
2) Avoid “Handshake Locums”
Never rely on “the recruiter said it’s fine.” You want:
the worksite list and structure confirmed by immigration counsel
written clarity from the sponsoring entity
3) Understand the “Visa vs. Credentialing” Timelines
Even U.S. citizen physicians can wait weeks to months for credentialing. Visa-linked physicians can have an additional layer:
petition filings
approvals/amendments (as needed)
site additions
4) Pay Structures and How They Interact With Visa Reality
Typical locums pay models:
hourly
daily/shift rate
call stipends + callback pay
sometimes productivity incentives
However, your visa constraints may mean:
you can’t simply “pick up extra shifts elsewhere”
you may need all work routed through the authorized employer/sponsor and authorized locations
This can affect your ability to chase the highest rate in the market week-to-week.
5) Taxes and Classification
If an agency pushes 1099, remember: immigration compliance is not the same as tax classification. A structure that is “normal” for locums financially may be incompatible with your visa unless designed properly.
6) Malpractice
Most locums assignments include arranged malpractice (often through the agency), but you still need to confirm:
occurrence vs claims-made
who pays tail (if applicable)
whether you’re covered for telemedicine, multiple sites, etc.
Part 7 — Practical Pathways Doctors Commonly Use
Pathway A: J-1 Training → Waiver Job (Conrad 30 or other) → H-1B → More Flexibility Later
This is common because:
J-1 training is standardized through ECFMG
waiver programs are established through USCIS/state processes
after waiver obligations and status progression, a physician may pursue more flexible arrangements
Pathway B: H-1B Through an Employer That Can Support Multi-Site Practice
This is the “locums-friendly H-1B strategy” conceptually, but it requires:
a legitimate employer structure
careful documentation of worksites
clean compliance execution
If you hear phrases like “we’ll just add sites later,” translate that into: amendments/filings, time, and risk.
Part 8 — The Contract Checklist (Visa-Sensitive Version)
When evaluating a locums assignment, add visa-specific questions to the usual checklist.
Usual locums checklist (still matters)
volume and case mix
call schedule and callback definition
EMR and training
staffing support
schedule guarantees and cancellation terms
Visa-specific checklist (non-negotiable)
Who is the petitioner/sponsor?
Are all worksites listed/covered?
What is the process to add a new site?
Can the facility “float” you to another clinic/hospital? (This is common operationally—and dangerous if not pre-cleared.)
Are you allowed to moonlight? (If you’re in a J-1 training program, assume “no” unless explicitly authorized; after training, your status controls.)
What happens if the assignment ends early? (Status risk if you suddenly have no authorized work—talk to counsel.)
Part 9 — Common Mistakes and How to Avoid Them
Mistake 1: Treating “locums” like Uber shifts
For visa holders, you generally cannot just pick up shifts at will. Your authorization is structured, not “gig based.”
Mistake 2: Signing a contract before immigration review
Even if the clinical job is perfect, if the worksite plan doesn’t fit your petition strategy, you can end up unable to work.
Mistake 3: Underestimating how fast facilities change details
Hospitals change clinic locations, add outreach sites, rearrange schedules—often without considering immigration consequences.
Mistake 4: Assuming “telemedicine locums” avoids the problem
Telemedicine can still require state licensure and a compliant employment arrangement; visa rules still apply to who employs you and under what terms.
Part 10 — Bottom Line Guidance
J-1 (training) is usually a structured pathway into U.S. training but is not designed for locums, and the 212(e) requirement + waiver obligations are the main hurdles for a locums-first plan.
H-1B is typically the more viable status for a physician who wants flexible work, but locums across multiple sites requires careful sponsorship and worksite compliance planning.
The winning strategy is usually: optimize immigration stability first, then optimize locums flexibility second.
FAQ: H-1B, J-1, and Locum Tenens for Physicians
1) Can I do locum tenens on a J-1 visa during residency or fellowship?
Usually, not in the way people mean “locums.” J-1 physician status through ECFMG is tied to the approved training program and requirements, and physicians are subject to strict program/site rules.
2) What is the 212(e) requirement and why does it matter?
ECFMG states J-1 physicians sponsored for clinical training are subject to the two-year home-country physical presence requirement under INA §212(e). This requirement affects eligibility for certain U.S. status changes unless you obtain a waiver.
3) What is the Conrad 30 waiver?
USCIS describes Conrad 30 as a waiver program allowing certain J-1 foreign medical graduates to apply for a waiver of the 2-year home residence requirement, typically connected to service in medically underserved areas.
4) Does every state have Conrad 30 slots?
States can recommend up to 30 waivers per year, and state timelines/fill rates vary.
5) If I get a J-1 waiver job, can I still do locums on the side?
Don’t assume you can. Your post-waiver status, employer, and work authorization terms control what you can do. Many waiver roles are structured as full-time commitments at specific sites; side work can create immigration issues unless clearly authorized.
6) Can I work for multiple hospitals on H-1B?
Potentially, but it depends on how employment is structured and how worksites are handled in the H-1B petition strategy. H-1B is employer-sponsored, and portability exists under certain conditions when changing employers.
7) What is H-1B portability?
USCIS notes an H-1B employee changing employers may begin working for the new employer as soon as the new employer files Form I-129 on their behalf (when portability requirements are met). DOL also explains portability as enabling job changes without being out of status when requirements are satisfied.
8) Is locum tenens typically 1099?
Many locums roles are structured as 1099 independent contractor arrangements.
But immigration compliance may require a different structure or a more carefully designed employer relationship.
9) If the agency wants to pay me 1099, is that automatically a problem for H-1B?
Not “automatically,” but it is a major red flag to review carefully. Visa compliance is about the petitioning employer and approved work terms—not just how the agency pays you. Treat any 1099 locums plan on H-1B as “needs attorney review.”
10) What’s the safest “first locums” approach for visa holders?
A conservative approach is:
one sponsoring employer
one (or a very limited number of) pre-approved worksites
a longer assignment with stable schedule
This minimizes changes that could trigger amendments or compliance issues.
11) What if the hospital asks me to cover a second clinic “just this week”?
For visa holders, “just this week” can be a serious problem if the additional site isn’t covered by the authorization strategy. This is one of the most common real-world pitfalls.
12) Can I do telemedicine locums on H-1B?
Possibly, but you still need:
a compliant employer relationship
authorization consistent with how/where the work is performed
state licensure where patients are located
Telemedicine does not remove immigration requirements.
13) What documents should I prepare to move faster with visa-sensitive locums?
Keep a ready credentialing packet:
CV, licenses, board cert, DEA, NPI
training certificates
references
immunizations, background checks
Also keep copies of immigration approvals, I-94, and any relevant notices for your counsel and credentialing teams.
14) What should I ask a recruiter right away?
Ask:
“Do you place physicians on H-1B or post-J-1 waiver statuses regularly?”
“Who is the petitioner/sponsor?”
“What are the exact worksites?”
“Is the role W-2 or 1099—and has immigration counsel approved the structure?”
15) What if my recruiter says, “We do this all the time”?
That might be true—but you still need your specific facts reviewed. Immigration is not “industry standard.” It is document-and-facts standard.
16) Are there special issues if I’m on a J-1 waiver obligation and want to change employers?
Yes. USCIS provides policy guidance regarding Conrad 30 and waiver physician obligations and notifications, which signals that changing jobs during waiver periods is not casual and must be handled carefully.
17) Does AMA have a simple overview of J-1 requirements?
The AMA provides a physician/IMG-oriented overview of J-1 pathways and typical requirements such as ECFMG certification and training offer letters.
18) How do I compare H-1B and J-1 if my main goal is locums flexibility?
J-1 is primarily a training pathway with post-training constraints (212(e) and waiver processes).
H-1B is a work pathway but is employer- and worksite-specific; locums requires careful multi-site planning and sometimes employer changes (portability rules matter).
19) What are the most common reasons visa-holder locums plans fail?
The worksite list changes mid-assignment
The physician is asked to “help out” at another location
The employment relationship is poorly documented
The physician stops working unexpectedly due to cancellation and doesn’t have a compliant status plan
The plan relies on assumptions rather than attorney-reviewed filings
20) What contract clause matters most for visa holders?
Two categories:
Worksite/assignment scope clarity: where you will work and what happens if location changes
Cancellation/guaranteed pay: because loss of work can create immediate practical status anxiety
21) What about travel reimbursements, housing, and per diems—any visa-specific issues?
Usually these are financial/contract terms, but anything that changes where you’re actually working can intersect with compliance. Keep the focus on: “work location and authorized employer relationship.”
22) Should I prioritize fewer states and fewer sites?
Often yes—at least initially. Complexity is the enemy of compliance. One stable site with a stable schedule is often the best starting point.
23) Can I build a long-term career doing locums on H-1B?
Some physicians do—usually by stabilizing a compliant structure with consistent sites and predictable scheduling, then expanding cautiously. The feasibility depends on your specialty demand, employer support, and how well your team manages amendments/filings when needed.
24) What if I want to go from locums to a permanent job?
That can be a strong strategy: a longer “locums-to-perm” assignment can reduce uncertainty, stabilize your worksite, and make sponsorship cleaner.
25) What’s the single most practical piece of advice?
Don’t treat visa-sensitive locums as “gig work.” Treat it like a regulated professional arrangement that must be engineered correctly—employer, worksite, schedule, and documentation all aligned.