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National Interest Waiver for Physicians

Posted on August 12, 2022
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By Heather Beliles, M. Ed.

The National Interest Waiver for Physicians is an employment-based visa for doctors wanting to work in the United States. This allows the applicant to work in the U.S. medical field for five years without having to get a labor certification letter – or meet a few other standard EB-2 visa requirements. 

Put simply, there are generally two main factors, and four areas required under the NIW:

  1. Obtain a public interest letter from the state or federal health department, or the VA
  2. Submit a five-year job commitment the area of shortage with the Immigrant Petition for Alien Worker (Form I-140)

Approved Areas:

  • Health Professional Shortage Area (HPSA)
  • Medically Underserved Area (MUA)
  • Mental Health Professional Shortage Area (MHPSA)
  • Veterans’ Affairs (VA) facility.

A labor certification is usually required by the U.S. Citizenship and Immigration Services (USCIS), but because of the value clinicians give to the United States, medical care specialists can adjust their status from J-1 to a permanent U.S. resident without it. Neither do hiring employers need to advertise the open position and try to fill the role with a U.S. citizen (a process known as PERM). 

Medically under-served, shortage areas and VA facilities simply cannot wait for medical profession jobs to undergo the lengthy labor certification process, which can easily take at least six months.

Physicians contribute to humanity in inexplicable ways. And so, we extend our heartfelt gratitude. Your expertise and work is invaluable. May your efforts continue to exponentially touch lives with an everlasting ripple effect.

National Interest Waiver Requirements for Physicians

  • Clinical practice for five years – no time limit, and can be aggregated
  • In disciplines such as family medicine, internal medicine, obstetrics, pediatrics, or psychiatry
  • Have, or have obtained a J-1 waiver 
  • Work full time – 40 hours per week
  • Approved areas – HPSA, MHPSA, MUA, or VA 
  • Can be before or after filing the immigrant worker petition – form I-140
  • Shortage areas must maintain their designation – HPSA, MUA, MHPSA, VA

Note: If the doctor has changed from a J-1 to an H-1B visa, but has not worked in the requisite areas whilst holding a J-1 visa, their time spent servicing in a medically underserved area while holding an H-1B shall still be factored in.

National Interest Waiver for Physicians: Initial Evidence Requirements

Physicians petitioning for an NIW must submit the following evidence:

  • A clinical employment contract for a five-year period in medical practice, or
  • An commitment letter of employment from a VA facility, or 
  • Proven evidence of self-employment in the medical field, and area
  • Proof of licensure – U.S. medical licensing exam
  • Evidence that the HPSA, MHPSA or MUA worksite is a geographical area location currently designated by the United States Department of Health and Human Services 
  • A letter from a federal or state Department of HHS declaring the medical practitioner’s work is of public interest
  • The issuance date on the letters must be within six months directly preceding the NIW petition date

Note: It is at the discretion of the state department or federal agency to provide or to deny the primary care physician’s letter request. Denial can be the result of the physician not currently, or no longer working where they are requesting the letter. 

Doctors establishing their own practice, while adhering to the physician NIW requirements, must also submit the following supporting evidence:

  • A sworn statement committing to the full-time practice of clinical medicine
  • Past or present business plan
  • Commercial lease for the clinic 
  • Proof of self-employment financing

Requirements at Year Two

This is the time when applicants make their initial evidence submission after having served in an appropriate medical area.

When the medical practitioner completes their first two years in the medical field, provided their I-140 was approved at least two years prior, they have a maximum of 120 days to submit proof of employment. 

This includes a letter of attestation from the physician’s employer. As well as the following:

  • Commencement date 
  • Facility or area of practice
  • Whether the medical care specialist’s classification is full-time during the two years of employment – though it must be, to qualify
  • The number of years employed at that facility
  • Any applicable breaks within the two-year period
  • Federal income tax returns and 
  • W-2 forms – available after second anniversary of I-140 approval

Doctors with a private practice must submit the following:

  • Documents noting their practice’s establishment
  • Incorporation or LLC documentation, where applicable
  • Tax documents
  • Business license

Requirements at Year Five 

This is when applicants submit their second set of documented evidence to the USCIS.

After completing the first five years, physicians have 120 days to submit evidence of their employment, along with aemployer letter from their , attesting the physician’s:

  • Start date
  • Facility 
  • Classification – should be full-time
  • Number of years employed at that location
  • Any applicable breaks in employment during the five years
  • W-2s and federal income tax returns for the years employed

Doctors who have established their own practice must submit the following:

  • Documents noting their practice’s establishment
  • Applicable LLC documentation 
  • License for the business 
  • Tax returns for the business 
  • Other tax documents
  • Medical examination report

Note: Physicians and their spouses or children will receive their green cards upon approval of their adjustment of status for permanent residence (Form I-485). 

Adjustment of Status

When a USCIS officer receives the applicant’s I-485 Adjustment of Status petition, he or she will notate the physician’s start date, and consequently send a notice detailing the evidence they will require for petition approval. The AOS will remain in a pending status until the immigration officer receives the rest of the required supporting documents.

Applicants can be assured, they can still work and travel until their AOS is approved, because they have received official employment authorization and an advance parole. Both the EAD and AP can be renewed as many times as needed. 

Of course, once the medical practitioner gets their green card, they become a permanent resident. Thus, they no longer need authorization for employment or for reentering the U.S.

Conclusion of National Interest Waiver for Physicians

Physicians’ service in the United States is of great value, and is of national interest. Therefore the USCIS gives them employment authorization in a reduced amount of time than what is required of non-NIW applicants.

Foreign physicians will need to get a public interest letter from either a state or federal health department, or from a VA facility, where they will be employed. They must also submit a five-year job commitment with their immigrant worker petition. These two steps are in addition to the other general NIW requirements for medical practitioners.

The stipulation is the facility must be approved as a shortage or medically underserved areas.

Evidence submission is required at the two-year and five-year time frames within the scope of the physician’s employment. If the doctor has established a private practice, he or she will need to submit business and tax documents as well.

Note: Medical practitioners applying for an NIW in the U.S. must be able to speak, write and understand English.

Frequently Asked Questions About National Interest Waiver (NIW) for Physicians (FAQs)

Can any medical practitioner apply for a National Interest Waiver?

Yes, provided the physician agrees to a full-time position and works in an underserved or area of shortage for five years.

Do I have to work for five years in a row to qualify for an NIW for physicians?

The five years in the medical field are not required to be consecutive. They can be combined over time, or aggregated. There is no limit on the span of time during which the service years can be combined.  

Are chiropractors, dentists, podiatrists, or optometrists eligible for an NIW?

No they aren’t. Eligibility is limited to internal medicine, family medicine, obstetricians, pediatricians, and psychiatrists.

I’ve been working in a medically underserved, shortage area or a VA facility, but it is not considered medically underserved any more. Do I have to move to a new area?

No, if the medical practitioner has been serving within their five years, he or she will not have to find a new job.

I am still in my NIW application process, have already received a job commitment from a medical profession shortage area, but have learned it is not considered underserved anymore. Do I have to find a different area? 

Yes, unfortunately the physician will need to find a new position in a medically underserved, shortage area or VA facility, since they are still in the application process.

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