Immigration for Physicians

International Medical Graduates have different options for acquiring permanent residence in the US based on their professional credentials and where they obtained them.

Waiver of 2-year Foreign Residence Requirement:

J-1 exchange students studying medicine may seek a waiver of the 2-year foreign residence requirement after they have completed their course of study and before applying for admission in the US on the strength of their credentials. A J-1 exchange student studying medicine who is subject to the 2-year foreign residency requirement WILL be subject to that waiver even if he or she seeks to adjust status to permanent residence through an immediate relative or the family preference system.

Many foreign medical graduates (FMGs) obtain a waiver of the 2-year foreign residence requirement by recommendation of a state or federal agency to allow the FMG to work in a federally designated “medically underserved area.” There is also a Veterans Administration program that allows for IMGs to serve in VA facilities.
Medically underserved areas that will qualify for a J-1 waiver are classed as “Health Professional Shortage Areas” (HPSAs), “Mental Health Professional Shortage Areas” (MHPSAs), and “Medically Underserved Areas or Population” (MUA/Ps). A list of these areas is published by Health and Human Services.
State Agencies. The “Conrad 30” program was designed to waive the 2-year J-1 foreign residence requirement for IMGs who will work in a federally designated shortage area. An “interested” state department of health may recommend up to 30 such waivers each year. To qualify, an applicant:

1. Must obtain a “no objection” letter from his or her home country, if the medical studies or training were financed by the applicant’s country of origin);
2. Must agree to accept full-time employment at a health facility or health care organization within 90 days of obtaining the waiver; and
3. Must practice primary care or specialty medicine for three years in a shortage area OR up to ten nondesignated areas per year while still serving patients coming from underserved areas.

Physicians can qualify for a labor certification under EB-2 or EB-3. This pathway requires a job offer and an employer sponsor who is willing to undergo the labor certification process. Note that a labor certification can be quite daunting and can take up to two years to complete. In addition, the employer sponsor must be willing to shoulder the entire financial burden of the labor certification, including payment of all filing fees and counsel fees.
Physicians may also qualify for an EB-2 with a National Interest Waiver (Physician National Interest Waiver, or PNIW). A physician working for the Veterans’ Administration, or HHS designated underserved areas, OR a federal agency or state department of public health has previously determined that a physician’s work in such an area is in the public interest qualify for the PNIW. To qualify, an applicant must:

1. File a petition seeking classification as an alien with advanced degree under EB-2 along with a NIW request;
2. Must agree to work full-time in a clinical practice providing primary or specialty care in an HHS-designated health shortage area OR for the VA;
3. A federal agency or state public health department has determined that the work is in the public interest;
4. Must work full-time for a total of 5 (five) years in authorized status, NOT including periods worked in J-1 status before becoming eligible to adjust status or consular process for an immigrant visa.

Practice fields for the PNIW include: primary care medicine; family or general medicine; pediatrics; internal medicine; obstetrics/gynecology; and psychiatry.

1 A physician immigrating under a section of the act that does not pertain expressly to physicians will be able to practice medicine in the U.S. after the immigration process has been completed.

2.Canadians have a special provision that allows them to satisfy the 2-year foreign residency requirement by residing in Canada and working in the U.S.  Canadians can apply for H or L status to enter the US and work while they remain residing in Canada during the two years; however, Canadians may not adjust status to lawful permanent resident unless and until he/she has satisfied the foreign residency requirement.