The Conrad State 30 and Physician Access Reauthorization Act aims to address physician shortages in rural and medically underserved communities by extending the Conrad State 30 program for three years, retroactively effective to September 30, 2018. This program allows foreign physicians to waive a two-year home residency requirement in exchange for practicing in designated shortage areas. A significant provision creates a direct pathway to a green card for alien physicians who complete their service requirements under a Conrad State 30 waiver, including their spouses and children. The bill also introduces new employment protections , requiring contracts to specify on-call hours, malpractice coverage, and work locations, while prohibiting non-compete provisions . Physicians gain flexibility to change employers under extenuating circumstances or for a new offer in the same state, maintaining lawful status during transitions. The bill enhances the Conrad State 30 program by allowing for an increase in annual waiver allotments for states based on previous usage, potentially raising the total from 30 to 35 and then by increments of 5. It also permits a limited number of waivers for physicians practicing in or on the faculty of academic medical centers , even if not in a designated shortage area, provided their work serves the public interest. Further immigration process improvements include establishing dual intent for physicians pursuing graduate medical education, allowing them to seek both temporary and permanent residency. For National Interest Waivers , the bill clarifies that the five-year service requirement begins when work starts in a shortage area, regardless of immigration status, and allows for various practice types. Additionally, it provides short-term work authorization extensions for H-1B physicians completing residencies and exempts J-1 physician spouses and children from the two-year foreign residency requirement. Finally, the Act mandates an annual statistical report from U.S. Citizenship and Immigration Services to Congress, detailing the number of aliens admitted through the Conrad State 30 program, disaggregated by state.