Fortunately, Congress has passed special rules regarding National Interest Waivers for physicians who engage in clinical practice in VA hospitals or in medically underserved areas. These physicians may obtain permanent residence; provided that they perform full-time medical service in a qualifying facility for five years. There is no restriction as to specialty. After the physician has completed all five years of medical service, the USCIS will approve the permanent residence application and issue the green card (assuming an immigrant visa is available at the time). The USCIS will count all medical service that was completed in lawful status, even if the physician does not apply for the national interest waiver until after he has completed medical service. For example, a physician completes two years in a medically underserved area in O-1 status and then applies for the national interest waiver. The physician needs to work only three more years to meet the five-year medical service requirement.

There is no deadline to meet the five year requirement; however, the physician must provide periodic updates on his or her work status to the USCIS until the service requirement has been met.

To support a national interest waiver application, the physician must provide the following information in the I-140 petition:

• A five-year contract of employment or affirm that he will engage in self-employment for the required period of service;
• Evidence that the location of employment is a designated Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA), or in a Veterans Affairs facility;
• A public interest letter (no older than six months) from a federal agency or department of health of the state where the employment is located;
• Proof of licensing and passage of USMLE examinations; and
• Proof of waiver of the two-year foreign residency requirement for J-1 physicians, if applicable.

If an immigrant visa is available, the physician can submit an I-485 application along with the I-140 petition for the national interest waiver.  With the I-485 application, the physician can receive an employment authorization document (EAD) that will allow the physician to work in the HPSA or MUA location as required.  If the physician moves his practice to another HPSA or MUA, a new I-140 petition must be submitted and approved to get credit for work in the new location.