DOCTORS Act Recycles Unused J-1 Physician Waivers, Mandates 10% for Underserved Areas Starting 2026

The “Directing Our Country’s Transfer of Residency Slots Act”—mercifully shortened to the DOCTORS Act—is all about making sure we don’t waste crucial opportunities to staff healthcare facilities. Think of it like a legislative recycling program for doctor slots. Specifically, this bill deals with the J-1 visa waivers that allow foreign physicians trained in the U.S. to skip the required two-year foreign residency period if they agree to practice in underserved areas here.

The New Waiver Recycling Program

The core of the DOCTORS Act is establishing a formal system to recapture and redistribute these waivers if states don't use them. Right now, if a state gets 30 waivers and only uses 20, those extra 10 often just vanish. Starting September 30, 2026, state agencies must report to the Secretary of State exactly how many waivers they didn't use in the previous fiscal year. This creates transparency and accountability for these limited slots.

How the Reallocation Formula Works

Once the unused waivers are tallied, the Secretary of State calculates a pool for reallocation. The formula is a little wonky: the total number of waivers available minus the total number of waivers actually used, multiplied by one-thirteenth (1/13). This number is then spread out equally among eligible states for use in the following year. While the goal is efficiency, that 1/13 multiplier might mean the actual number of recycled slots is smaller than expected, which could make the administrative effort feel a bit heavy for the return.

Targeting Medically Underserved Communities

Here’s the provision that directly impacts patient access: any state receiving these supplemental, recycled waivers must use 10% of them specifically to fill positions in healthcare facilities that serve areas officially designated as medically underserved. This is a direct push to get doctors into places that struggle the most to recruit, such as rural communities or certain inner-city neighborhoods. If you live in an area where it takes months to get a primary care appointment, this 10% mandate is designed to improve your access to care.

The Catch: Who Gets to Play?

Not every state agency is eligible to receive these recycled waivers. The bill defines an “eligible State agency” as one that actually used at least 30 of the special J-1 waivers in the year before the reallocation. This is where the bill gets restrictive. If a state has a smaller program, perhaps only using 25 waivers annually, they are locked out of the recycling program entirely. This could disproportionately affect smaller states or those with less immediate demand, meaning they miss out on a chance to staff their facilities even if they have a critical need. In essence, you have to be a big player in the waiver game to get a piece of the recycled pie. The Secretary of State is required to tell eligible state agencies how many supplemental waivers they are getting by January 1st each year, which at least provides a predictable planning schedule for hospitals and clinics.