EB-2 National Interest Waiver (NIW) Visa: Pathway to U.S. Residency for the Immigrant Physicians

• You must work full-time in a clinical practice. For most physician NIW cases, the required period of service is 5 years;
• You must work in a primary care (such as a general practitioner, family practice petitioner, general internist, pediatrician, obstetrician/gynecologist, or psychiatrist) or be a specialty physician;
• You must serve either in a Health Professional Shortage Area (HPSA), Mental Health Professional Area (MHPSA – for psychiatrists only), a Medically Underserved Area (MUA), or a Veterans Affairs facility, or for specialists in a Physician Scarcity Area (PSA); and,
• You must obtain a statement from a federal agency or a state department of health that has knowledge of your qualifications as a physician and that states your work is in the public interest. (This statement is known as an attestation).

Physicians must demonstrate that waiving the job offer and labor certification requirements is in the national interest of the U.S. To do so, the following three prongs (from the Matter of Dhanasar case) must be met:

• Substantial Merit and National Importance:
  • Your work as a physician addresses an important public health issue or shortage (e.g., working in underserved areas or in primary care).
  • Evidence includes working in Health Professional Shortage Areas (HPSAs) or Medically Underserved Areas (MUAs).
• Well-Positioned to Advance the Proposed Endeavor:
  • You must show qualifications and a track record of accomplishments in your field.
  • Evidence includes education, certifications, medical licenses, publications, awards, and letters of recommendation.
• Benefits of Waiving the Labor Certification:
  • Demonstrate that requiring a labor certification would adversely impact the national interest due to a shortage of qualified U.S. physicians.
  • Prove that your work serves an urgent need, such as addressing health disparities or increasing access to healthcare.

For physicians applying under the EB-2 NIW, there are additional considerations:

• Working in Underserved Areas:
  • You must commit to working full-time for five years in a designated Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), or at a Veterans Affairs (VA) facility.
  • The five years can include work completed before filing the petition if properly documented.

Provide documentation such as:

• Medical degree (M.D. or D.O.) and transcripts.
• U.S. medical license or evidence of eligibility for licensing.
• Evidence of employment or offer of employment in an underserved area.
• Letters of support from medical employers, colleagues,      or public health organizations.
• Proof of work in an HPSA, MUA, or VA facility.

• No Employer Sponsorship Required:
  • You can self-petition, giving you flexibility and independence.
• Waiver of Labor Certification:
  • You are not required to go through the PERM labor certification process, which can be time-consuming and restrictive.
• Fast Track to Green Card:
  • EB-2 NIW petitions are given priority in the employment-based immigration system, leading to quicker approval compared to other categories.
• Family Members:
  • Your spouse and unmarried children under 21 can obtain derivative green cards through your petition.

• High Standard of Proof:
  • The USCIS requires substantial evidence that your work benefits the U.S. national interest.
• Commitment to Underserved Areas:
  • Physicians must fulfill the 5-year full-time work commitment in underserved areas or at VA facilities, which may limit job opportunities.
• Processing Time:
  • USCIS processing times for EB-2 NIW petitions can vary, and delays may occur depending on case complexity.

• Form I-140 and filing fee.
• Evidence of medical degree and U.S. licensing.
• Letters of recommendation from experts and employers.
• Employment contracts or job offers in underserved areas.
• Documentation of work in an HPSA, MUA, or VA facility.
• Evidence of your contributions to public health (publications, presentations, awards).
• Proof of commitment to a 5-year service obligation in an underserved area.

In response to physician shortages, particularly in underserved areas, several U.S. states have recently modified their licensure requirements to allow International Medical Graduates (IMGs) to practice medicine without completing a traditional U.S. residency. These changes aim to integrate qualified foreign-trained physicians into the healthcare system more efficiently. Notable state initiatives include:

•  Arizona: Starting January 2025, Arizona will offer provisional licenses to IMGs with a medical degree from a recognized international program. Recipients must work under supervision in rural areas for four years to qualify for full licensure.  

• Arkansas: From 2024, IMGs can achieve full licensure after two years of practice under an academic license in the state.

• Florida: Enacted legislation allowing IMGs with active foreign medical licenses and at least four years of practice to obtain licensure without U.S. residency, provided they secure employment in Florida and commit to working there for a minimum of two years. 

• Idaho: As of July 2024, IMGs can obtain a provisional license by completing 500 hours of supervised clinical experience in Idaho and passing the necessary examinations. 

• Illinois: Passed a law enabling IMGs to practice under a provisional license for two years under the supervision of a licensed physician, after which they may apply for full licensure. 

• Iowa: Starting early 2025, IMGs can receive provisional licensure with an international medical degree, English proficiency, and five years of practice. Full licensure is available after three years of supervised practice. 

• Tennessee: Implemented a law permitting IMGs to obtain a two-year provisional license to work in healthcare facilities without completing a U.S. residency. After this period, they can apply for full licensure. 

• Virginia: Approved legislation granting provisional licenses to IMGs who have practiced medicine for at least five years abroad. After two years of supervised practice in Virginia, they can obtain an unrestricted license.  

These legislative changes reflect a growing recognition of the valuable contributions that internationally trained physicians can make in addressing healthcare access challenges across the United States.