Physicians play a vital role in improving public health and saving lives. Recognizing their critical contribution, the U.S. Citizenship and Immigration Services (USCIS) offers a special pathway for doctors to obtain permanent residency through the EB-2 Green Card with a National Interest Waiver (NIW). If you are a medical professional seeking to live and work permanently in the United States, this guide explains everything you need to know about qualifying for a Physician NIW.
Understanding the EB-2 Green Card
The EB-2 immigrant visa is intended for individuals who meet one of the following criteria:
- Exceptional Ability: You have a proven record of exceptional skill in your field, demonstrated through major awards, peer recognition, or high compensation.
- Advanced Degree: You hold a master’s degree or higher and plan to work in a position that requires that level of education.
Because the National Interest Waiver (NIW) is only available under the EB-2 category, understanding the EB-2 requirements is the first step toward eligibility.
What Is a National Interest Waiver (NIW)?
Normally, applicants for employment-based green cards must have a U.S. employer sponsor them through the PERM Labor Certification process, which includes proving that no qualified U.S. workers are available for the position. This can take months or even years, especially if the Department of Labor audits the application
The National Interest Waiver allows eligible professionals to bypass the labor certification requirement and self-petition for a green card. By demonstrating that your work benefits the United States as a whole, you can “waive” the employer sponsorship requirement.
This is especially valuable for physicians, researchers, and other experts whose work supports national priorities such as improving healthcare, strengthening underserved communities, or advancing medical innovation.
How a Physician NIW Differs from a Standard NIW
While a general NIW can apply to many professionals, Congress introduced special rules for doctors through the Nursing Relief for Disadvantaged Areas Act of 1999. Under this program, physicians may qualify for a green card if they commit to serving in medically underserved communities.
To qualify for a Physician National Interest Waiver, you must:
- Be a J-1 physician working in one of the following specialties: pediatrics, internal medicine, obstetrics, psychiatry, or family medicine.
- Agree to work full-time for at least five years in your medical practice.
- Serve in one of the following designated areas:
- Health Professional Shortage Area (HPSA)
- Mental Health Professional Shortage Area (MHPSA)
- Medically Underserved Area (MUA)
- Department of Veterans Affairs (VA) facility
Attestation Letter for a Physician NIW
When applying for an EB-2 NIW, you must provide an attestation letter confirming that your work serves the public interest.
- If you plan to work in a Veterans Affairs facility, your attestation letter should come from the Department of Veterans Affairs.
- If you are serving in a shortage area, your letter must come from a state department of health or another government agency, affirming that your medical services are in the public interest.
Each state has its own process for issuing attestation letters, so it’s important to contact the appropriate agency early. The letter must be dated within six months before filing your NIW petition with USCIS.
Required Documentation for a Physician NIW
In addition to the attestation letter, you must include the following evidence in your EB-2 NIW petition:
1. Employment Contract
Provide an employment contract or offer letter covering at least five years of clinical medical practice. If you are joining a VA facility, submit a commitment letter from that institution.
If you are establishing your own medical practice, include a sworn statement confirming your full-time commitment, along with supporting documentation such as a lease, proof of financial investment, or a business plan.
2. Proof of Eligible Worksite Location
Submit documentation showing that your practice is located in one of the following:
- A facility under the Department of Veterans Affairs
- A geographic area designated by the Secretary of Health and Human Services (HHS) as an HPSA, MHPSA, or MUA
Unlike the standard NIW, physicians must meet all major requirements to qualify under the physician category.
Who Can Apply for a Physician NIW?
Doctors seeking a National Interest Waiver for physicians generally fall into two categories:
- Employed Physicians – Those who wish to work for a healthcare institution without undergoing the PERM Labor Certification process.
- Self-Employed Physicians – Those planning to establish their own practice and cannot obtain a PERM certification on their own behalf.
How to Apply for a Physician NIW
Because obtaining an attestation letter can take time, most applicants start with this step. You can request your letter from the Department of Veterans Affairs or your state health department, depending on where you plan to serve.
When filing your Form I-140 (Immigrant Petition for Alien Worker) with USCIS, you must include:
- A full-time employment contract or sworn statement for at least five years of medical practice in an underserved area.
- Proof of medical licensure and that you have passed the required U.S. medical licensing examinations.
- Evidence of English proficiency, including the ability to read, write, and communicate effectively.
- If you previously held a J-1 visa, include your J-1 waiver approval notice.
Steps to Obtain a National Interest Waiver (NIW) for Physicians
Step 1: File Form I-140
The first step toward obtaining an NIW as a physician is filing Form I-140, Petition for Alien Worker, along with all required supporting documentation. This petition must be sent to the USCIS Texas Service Center or the Nebraska Service Center, the two designated facilities that handle National Interest Waiver applications. The immigration attorneys at Green Card Link can help ensure your petition is properly prepared and filed with the correct service center to avoid unnecessary delays.
Step 2: File Form I-485
Once your Form I-140 is approved and your immigrant visa number becomes current, you can proceed by submitting Form I-485, Application to Register Permanent Residence or Adjust Status. Many applicants also choose to file Form I-765 (Employment Authorization Document) and Form I-131 (Advance Parole travel document) at the same time as their I-485.
USCIS permits concurrent filing of these forms to help applicants continue working and traveling lawfully during the lengthy adjustment process. Typically, Forms I-765 and I-131 are processed within a few months, while Form I-485 may take longer.
As a physician applying for a National Interest Waiver, your adjustment of status will not be approved until you complete five full years of qualifying medical service in a designated underserved area or a Veterans Affairs (VA) facility. Once USCIS receives your I-485, it will record the start date of your medical service and later request supporting evidence to confirm your progress toward the five-year requirement.
For example, physicians must provide their first round of evidence within 120 days after the second anniversary of I-140 approval. This documentation must verify at least 12 months of full-time qualifying service during the initial two-year period. A final set of documents will be required at the completion of the five-year term.
During the time your adjustment of status remains pending, your Employment Authorization Document (EAD) and Advance Parole (AP) documents act as valid work and travel permits. This means you can continue working legally and traveling internationally without jeopardizing your immigration status. These permits can be renewed multiple times until your green card is approved. Once USCIS confirms you have met your five-year service commitment and approves your I-485, you and your dependents will become lawful permanent residents—with no need for EAD or AP renewals moving forward.
Important Tip: Although an EAD allows you to work legally, the immigration attorneys at Green Card Link recommend maintaining your valid nonimmigrant status throughout your NIW process. Doing so helps prevent any lapse in employment authorization in case of renewal delays.
Concurrent Filing for National Interest Waiver Physicians
If your priority date is current and there is no visa backlog, you may choose to file Form I-140 and Form I-485 concurrently. Whether you submit them together or separately, you can still include Forms I-765 and I-131 with your I-485 to ensure you receive employment and travel authorization while waiting for green card approval.
Evidence Required After Two Years of Medical Service
Within 120 days after the second anniversary of your I-140 approval, you must provide evidence showing completion of at least 12 months of qualifying medical practice. USCIS typically requires:
- A detailed letter from your employer verifying your start date, full-time service, and any breaks during the two-year period.
- Federal income tax returns and W-2 forms reflecting your employment in the qualifying area.
- For self-employed physicians, documents such as business registration (LLC or incorporation), business tax returns, tax withholdings, and professional licenses.
Evidence Required After Five Years of Aggregate Service
Within 120 days of completing your full five years of qualifying medical service, you will need to submit updated evidence similar to the documents listed above. Additionally, USCIS requires a medical examination report as part of the final review.
Once USCIS verifies that all requirements have been met, it will approve your Form I-485, granting lawful permanent residence to you and your eligible family members.
NIW for Physicians: Frequently Asked Questions
Can time spent as a J-1 visa holder count toward the five-year requirement?
No. The five-year service requirement begins only after your EB-2 NIW petition is approved and you start working under that status in a qualifying underserved area or VA facility.
Can I change my practice location to another underserved area?
Yes. You may relocate your medical practice to another medically underserved area at any time during the required five-year service period. However, you must file a new Form I-140 explaining the reason for your relocation before making the move.
What if my service area is no longer designated as underserved?
If your designated area loses its underserved status after you have begun working there, you may continue your service without penalty. However, if this change occurs before your NIW approval or the start of employment, you will need to select another qualifying area.
Can I apply for an NIW based on past employment in a shortage area or VA facility?
Yes. Physicians who previously worked in a VA facility or underserved region may qualify for an NIW by submitting a public interest letter from the relevant state health department or the VA. Keep in mind that these agencies have discretion in granting such letters and may decline requests from physicians who are no longer employed within their jurisdiction.
When can I apply for adjustment of status?
You may file Form I-485 once USCIS confirms that you have completed the full five-year medical service requirement. Because USCIS requests periodic documentation throughout the process, it is crucial to work closely with the immigration attorneys at Green Card Link to ensure you meet every submission deadline and maintain compliance.
How Green Card Link Can Help
The requirements for a National Interest Waiver for physicians can be complex and vary depending on your situation. The experienced immigration attorneys at Green Card Link specialize in employment-based immigration and can guide you through every step—from filing Forms I-140 and I-485 to gathering evidence of qualifying service.
Their team is committed to helping physicians obtain permanent residency through the NIW pathway and continue serving in areas that advance the nation’s healthcare priorities. To begin your journey toward a green card, contact Green Card Link today for a personalized consultation with one of its experienced immigration attorneys.