Physician H-1B Jobs After Residency: Cap-Exempt Hospitals, Conrad 30 and the 2026 Fee Status

Your first attending contract decides whether you need the H-1B lottery. See which employers are cap-exempt, how the exemption is lost, and where the fee and Conrad 30 stand.

Part of our guide to cap-exempt H-1B employers.

Physician H-1B jobs after residency fall into two groups. Cap-exempt jobs, at a university hospital, a nonprofit hospital related to or affiliated with a university, or a nonprofit or government research organization, can be filed in any month with no lottery, and so can a J-1 physician's Conrad 30 waiver job. Cap-subject jobs, at most private practices, for-profit groups and unaffiliated hospitals, need an H-1B lottery selection and usually cannot start before October 1, unless you were already counted against the cap. As of November 1, 2026, the $100,000 H-1B payment is not being collected, and Conrad 30 is in effect through December 11, 2026.

Status as of 2026-11-01

• $100,000 payment: blocked, not collected. Proclamation 11069 keeps the restriction in effect on paper until 2027-09-21, but courts have vacated or blocked the agency policies that carry it out. Both rulings are on appeal: California v. Mullin (1st Cir. No. 26-1699; states' brief due 2026-11-04) and Global Nurse Force v. Trump (9th Cir. No. 26-6667; opening brief due 2026-11-06). A brief is not a ruling.
• Conrad 30: in effect through 2026-12-11, carried by the continuing resolution, P.L. 119-103.
• Cap-exemption rules: in effect, as amended effective 2025-01-17. A USCIS H-1B reform proposal (RIN 1615-AD00) whose agenda abstract mentions cap exemptions is under OIRA review, with no published text.

Which physician H-1B jobs after residency skip the lottery?

An attending job skips the H-1B lottery when the employer is cap-exempt: a university or its hospital, a nonprofit hospital related to or affiliated with a university, or a nonprofit or government research organization. A J-1 physician's Conrad 30 waiver job skips it too. A private practice or for-profit group is cap-subject, with narrow exceptions covered below.

Under 8 U.S.C. 1184(g)(5), the cap does not apply to a worker who "is employed (or has received an offer of employment) at an institution of higher education," at "a related or affiliated nonprofit entity," or at "a nonprofit research organization or a governmental research organization." Under 8 CFR 214.2(h)(8)(iii)(F), a nonprofit hospital qualifies through shared ownership or control with a university, by being operated by or attached to one, or through a written affiliation agreement where "a fundamental activity" of the hospital is to directly contribute to the university's research or education mission. A nonprofit whose fundamental activities include research can qualify as a research organization (8 CFR 214.2(h)(19)(iii)(C)). Our guide to cap-exempt university hospitals covers the employer side; this is the attending-job version.

Attending-job employers and H-1B cap status (as of 2026-11)

A hospitalist job at a university hospital is cap-exempt; the same job with a for-profit group at an unaffiliated community hospital is not. Our explainer on cap-exempt third-party placements covers the half-time rule for groups that staff academic hospitals.

How do you check whether a hospital is really cap-exempt?

Ask which legal basis the employer will use, then check its filing history. The entity that signs your contract and files the petition decides the answer, not the hospital's brand name.

1. Ask the employer's medical staff office or HR, in writing, whether it will file your Form I-129 as cap-exempt and on which basis: university, affiliated nonprofit, research organization or Conrad 30 waiver.
2. Search the employer's legal name on the USCIS H-1B Employer Data Hub (fiscal years 2009 through 2026, quarter 4) and read several years of approvals.
3. Download the latest LCA disclosure file (FY2026 Q3, through 2026-06-30) from the DOL OFLC performance data page and filter by employer and physician job titles to see specialties, worksites and wages.
4. Pull your I-797 approval notices and your latest I-94 to count the H-1B time you have already used.
5. Apply early to the state medical board. For direct patient care, 8 CFR 214.2(h)(4)(viii) requires "a license or other authorization required by the state of intended employment to practice medicine" and, for foreign medical graduates, a passed Federation Licensing Examination or an HHS-recognized equivalent. A J-1 resident who has not finished them should check before relying on an H-1B offer.
6. Confirm with the employer's immigration attorney the filing type (change of employer inside the US or consular notification) and the start date before you sign.

Can a doctor on H-1B change jobs after residency?

Yes. Your new employer files its own Form I-129, and USCIS's H-1B specialty occupations page says an H-1B worker "may begin working for the new employer as soon as they properly file a non-frivolous Form I-129 petition on your behalf." What changes is the cap question: cap-exempt to cap-exempt needs no lottery, while cap-exempt to cap-subject generally does.

If you leave cap-exempt employment for a cap-subject employer, USCIS says "your new employer's H-1B petition will be subject to the H-1B cap." The same page says you stay outside the cap for that validity period "as long as you continue your cap-exempt employment, were previously counted toward the cap, or otherwise remain cap exempt." Many residents trained on cap-exempt H-1Bs at university hospitals never entered a lottery, so they have never been counted. That one fact can undo a private-practice offer. Your program's GME office or its immigration counsel can tell you how your residency petition was filed.

How physicians lose cap exemption without noticing

• Signing a cap-subject contract with a July 1 start when you have never been counted.
• Letting the cap-exempt job end while a concurrent cap-subject job continues. You then become cap-subject unless previously counted, and USCIS "may revoke" the concurrent petition.
• Drifting below half time at the qualifying site in a group or staffing placement.
• Leaving a Conrad 30 job early. Unless USCIS accepts extenuating circumstances, such as the facility closing or hardship, the physician and family "will once again become subject to the 2-year foreign residence requirement," according to its Conrad 30 page.

The six-year clock starts mattering now

USCIS describes an initial stay of up to three years, extendable "for a total period of admission of 6 years." Residency and fellowship years on H-1B count; J-1 years do not. A physician who did a three-year residency and a two-year fellowship on H-1B has about one year left (our arithmetic). Going past six years usually needs a PERM or I-140 filed at least 365 days before the extension would take effect, or, in some cases, an approved I-140, under 8 CFR 214.2(h)(13)(iii)(D)-(E). See our AC21 extensions guide, and plan the timing with an immigration attorney before you accept an offer.

Can a physician work for a private practice on H-1B?

Yes, but a private practice is normally cap-subject, so it needs a lottery selection first and the job usually cannot start before October 1. The exceptions are a physician already counted against the cap, a Conrad 30 waiver job, or concurrent employment added to a cap-exempt job that continues.

For the lottery route, three facts set the timing as of 2026-11-01:

• Weighted selection is in effect (since 2026-02-27): a Level IV wage offer gets four entries and Level I one, so the wage level the practice offers changes your odds. The weighted selection rule has the full scale.
• The FY2028 registration is not announced. The FY2027 window ran March 4-19 with a $215 fee; March 2027 is an expectation, not a date. Under 8 CFR 214.2(h)(8)(iii)(A)(3), USCIS must announce the start at least 30 calendar days ahead; watch its registration page.
• A separate $103,265 fee for certain cap-subject petitions is only proposed (RIN 1615-AD20). Comments closed 2026-09-24 and no final rule exists as of 2026-11-01.

Concurrent employment is the other route. USCIS says a worker in a cap-exempt job "may engage in concurrent employment in a cap-subject position" while the cap-exempt employment continues. For physicians, that usually means part-time practice or moonlighting alongside an academic appointment. Each employer files its own I-129 and LCA; the cap-subject work can start once that petition is properly filed (or on its requested start date, if later). See our concurrent H-1B guide for how the two petitions interact.

Worked timeline: one resident, two offers

Take Dr. A, a PGY-3 internal medicine resident on a cap-exempt H-1B at a university hospital since July 2024, never counted against the cap, finishing on 2027-06-30. In December 2026 she is weighing two offers: a hospitalist job at a university-affiliated nonprofit hospital, and a job with a private multispecialty group.

Her clock matters too. Three residency years leave three H-1B years, roughly to mid-2030, so a PERM or I-140 would need to be filed by about mid-2029 to support a one-year extension past six years (our arithmetic). How to handle the July-to-October gap is a question for an immigration attorney, not a recruiter. One more date: the CR that funds DOL runs to 2026-12-11, and practitioners report, based on past shutdowns, that LCA processing could stop if Congress does not pass funding by then.

Does the $100,000 H-1B fee apply to physicians?

Not right now, and not because of specialty. As of 2026-11-01 USCIS is not collecting the $100,000 payment from any employer, because courts vacated or blocked the agency policies that implement it. If collection resumed, the petition type would matter, not your specialty.

The USCIS I-129 page says a court "vacated agency guidance implementing the $100,000 payment requirement," and adds: "If this order is later lifted, DHS still plans to collect the payment." Under USCIS's 2026-09-21 description, change-of-status, amendment and extension requests granted inside the US were never covered, while a denied change of status or a consular-notification petition would be. So a resident whose change-of-employer petition is granted inside the US would sit outside it; a physician recruited from abroad, or finishing a home-residency requirement overseas, would not.

The text of Proclamation 11069 does not mention physicians, doctors or health care. Section 1(c) lets the DHS Secretary exempt an individual, a company's workers or "all aliens working in an industry" when their hiring "is in the national interest," at the Secretary's discretion; do not assume it covers you.

The fee's effect on hiring from abroad is measurable. The Congressional Research Service (Insight IN12747, 2026-10-14) reports that "during the first eight months that the fee was in effect, the number of initial H-1B petitions that DHS received for consular processing from cap-exempt employers dropped 91% from the same period the year before." Our $100,000 fee status check tracks the appeals.

Is Conrad 30 still running in 2026?

Yes. As of 2026-11-01 Conrad 30 is in effect, but only through 2026-12-11. Its authority rides on the continuing resolution, P.L. 119-103, which the Congressional Research Service (R49353) says carries it "for the duration of the CR." What happens after that depends on whether Congress passes funding or another extension by 2026-12-11.

For a J-1 resident, the Conrad job is often the attending job search. The statute, 8 U.S.C. 1184(l)(2)(A), reads: "The numerical limitations contained in subsection (g)(1)(A) shall not apply to any alien whose status is changed" to H-1B, if the waiver came "upon a request by an interested Federal agency or an interested State agency." That makes a private clinic in a shortage area a lottery-free employer for you. Per USCIS's Conrad 30 page, the contract must be for full-time work of at least three years at a facility in, or serving patients from, an HHS-designated shortage area, and the State Department treats full time as 40 hours a week. Graduate medical training still triggers the two-year home-residency rule even though the 2024-12-09 Skills List revision removed India and China.

Waiver mechanics and state windows are in our IMG physician visa guide and the Conrad 30 December 11 deadline explainer.

What changed in 2026, and what has not (as of 2026-11-01)

Sources: Central Florida Public Media, the Texas governor's letter, the RIN 1615-AD00 entry, the grace-period and deference proposals.

Common mistakes

• Asking "do you sponsor?" instead of "do you file cap-exempt, and on what basis?" A hospital can sponsor H-1B and still be a cap-subject employer that needs a lottery selection.
• Reading the $100,000 line on the USCIS fee schedule as proof it is collected. The G-1055 still prints it; the I-129 page notes the vacatur.
• Treating the 91% CRS drop as proof that hospitals stopped sponsoring. It measures initial petitions for consular processing from all cap-exempt employers, universities and research groups included, not changes of employer inside the US.
• Ignoring the six-year clock until PERM timing is already tight.
• Assuming cap-exemption rules have changed. They have not; the OIRA item has no public text.

Frequently asked questions

Can a doctor on H-1B change jobs after residency?

Yes. The new employer files its own Form I-129, and USCIS says you may begin working for it as soon as it properly files a non-frivolous petition. Moving from a cap-exempt residency to another cap-exempt employer needs no lottery; moving to a cap-subject employer generally does unless you were previously counted against the cap. This is the rule as of 2026-11-01.

Which hospitals are cap-exempt for H-1B?

Hospitals that are part of a university, nonprofit hospitals related to or affiliated with a university under 8 CFR 214.2(h)(8)(iii)(F), and nonprofit or government research organizations are cap-exempt, under rules in effect since 2025-01-17. A physician group can also file cap-exempt if you spend at least half your time at a qualifying site on work that furthers its mission. An unaffiliated nonprofit community hospital is usually cap-subject unless research is one of its fundamental activities, so ask each employer which basis it uses.

Does the $100,000 H-1B fee apply to physicians?

Not right now. As of 2026-11-01 USCIS is not collecting it from any employer, because courts vacated or blocked the implementing policies; Proclamation 11069 stays in effect on paper until 2027-09-21 and appeals are pending. If collection resumed, petition type would matter, not specialty: inside-US change-of-status, extension and amendment approvals were never covered, while a denied change of status or a consular-notification petition for a doctor abroad would be.

Is Conrad 30 still running in 2026?

Yes. As of 2026-11-01 Conrad 30 is in effect through 2026-12-11, because the continuing resolution (P.L. 119-103) carries it for as long as the CR lasts. What happens after that depends on whether Congress passes funding or another extension by 2026-12-11. Physicians who change from J-1 to H-1B with a Conrad waiver are not counted against the cap under 8 U.S.C. 1184(l)(2)(A).

Can a physician work for a private practice on H-1B?

Yes, but a private practice is normally cap-subject, so it needs a lottery selection first and the job usually cannot start before October 1. The main exceptions are a physician already counted against the cap within the past six years, a Conrad 30 waiver job, or concurrent employment added to a cap-exempt job that continues. The FY2028 registration has not been announced as of 2026-11-01.

Sources

• USCIS, H-1B Specialty Occupations
• USCIS, Form I-129
• USCIS, Conrad 30 Waiver Program
• USCIS, H-1B Employer Data Hub
• USCIS, H-1B Electronic Registration Process
• DOL OFLC, Performance Data
• 8 U.S.C. 1184 and 8 CFR 214.2
• Proclamation 11069, 91 FR 60497
• CRS Insight IN12747, H-1B Executive Actions in 2026
• CRS R49353, continuing appropriations for FY2027
• California v. Mullin docket and Global Nurse Force order, 2026-09-30
• RIN 1615-AD00 agenda entry
• Proposed rules: $103,265 fee for certain H-1B petitions, eliminating the 60-day grace period and removing deference; final weighted selection rule
• Texas Governor's H-1B letter to state agency heads, 2026-01-27

How we checked this: we read the USCIS H-1B, I-129, registration and Conrad 30 pages, 8 U.S.C. 1184, 8 CFR 214.2(h), the text of Proclamation 11069, CRS IN12747 and R49353, the Texas governor's letter and the court records above on 2026-11-01 and 2026-11-02.

This is general information, not legal or tax advice; your own I-797, I-94 and contract, your J-1 sponsor and a licensed immigration attorney govern your case.

If you are weighing attending offers and want a search aimed at employers that file H-1B petitions, F1Jobs helps international candidates run a focused, visa-aware job search.