There is a shortage of physicians in the United States who can provide healthcare. That is why the the recruitment of International Medical Graduates (IMGs) is important here. Pursuant to the Nursing Relief for Disadvantaged Areas Act of 1999, IMGs who agree to work as full time physicians in underserved areas for five years can apply for a green card through the National Interest Waiver program. I have previously touched on the National Interest Waiver application. However, the physician’s national interest waiver is particular to IMGs. The underserved areas must be established as such by the Department of Health and Human Services. This falls under the purview of the national interest waiver because the IMGs service to the medically underserved areas also benefit the well-being of the communities, hence the U.S. national interest.
The advantage of the national interest waiver avenue to the green card is, the IMG can avoid the labor certification process and directly self petition by submitting the I-140 Petition to the USCIS. If an IMG qualifies for the national interest waiver, they can also submit the petition while within the three years of the J-1 visa service period. The self-petition process adds another advantage to applying for the national interest waiver. The physician who is self employed or whose employer is unwilling to submit a petition may still apply for the green card through the national interest waiver.
Requirements of the Physician National Interest Waiver
- The IMG must work full time for 5 years in a federally designated underserved area or veteran’s facility.
- A federal agency or public health department must determine that the IMG’s work is in the public interest. This requires getting an attestation. An attestation from a Federal agency must reflect the agency’s knowledge of:
- The IMG’s qualifications;
- The agency’s background and qualifications to make such determinations involving medical affairs and that the IMG’s work is or will be in the public interest; and
- The attestation must be from the agency that has jurisdiction over the place where the IMG intends to practice clinical medicine. If the alien physician intends to practice in more than one undeserved area, attestations from each intended area of practice must be included.
The health department in each state will have their own application process to receive the attestation.
Steps to Apply for the Physician National Interest
Step 1: Apply for the Attestation
Apply for the Attestation from the applicable federal or state health department. It is important to check for the state’s requirements. It may differ from state to state. For example, some states count the years in residency as years of service towards to the required 5 years. Some do not.
Step 2: Submit the I-140 Petition to the USCIS
After receiving all the required evidence and the attestation, the IMG can self-petition by submitting the Form I-140 (available on the uscis.gov website). The IMG can submit the petition as long as they can show that they will work for the required 5 years in the underserved areas. Prior times worked in underserved areas can count towards the 5 years but the employment must be within 6 months of filing the petition. Once the USCIS approves the I-140 petition, it can also be used to extend the H-1B six year term.
Step 3: File for I-485 Adjustment of Status Application
Once the USCIS approves the I-140 petition and an immigrant visa becomes available, the IMG can file the I-485 Adjustment of Status application. The USCIS will not adjudicate the application until the IMG completes the 5 years of service.The advantage of the Adjustment of Status is the ability of the IMG and their spouse to receive a work permit and travel document. However, the IMG must still uphold their J-1 three year service requirements.The IMG must report continued employment compliance two years after the filing of the adjustment of status and six years after (to show the completion of the 5 year work requirement. As usual, there is the scheduled adjustment of status interview after completing all application requirements, where the IMG will likely receive the final decision.
NOTE: As always this is for informational purposes only and is not legal advice. Consult an immigration attorney, like myself, for advice regarding your particular circumstances.