Permanent Residence for Physicians

Labor Certification for Physicians
Physicians of Extraordinary Ability
National Interest Waivers for Physicians

A foreign physician may be able to obtain permanent resident status (or a "green card") in the United States. An employer may apply for permanent residence for a foreign-born physician through the labor certification process by demonstrating that there are no qualified U.S. physicians to fill the position. Individual physicians may also apply for permanent resident status through achievement-based options such as the National Interest Waiver or as an Alien of Extraordinary Ability.

If the physician has previously entered the United States in J-1 visa status and is subject to the two year home residency requirement, this requirement must first be satisfied or waived before applying for permanent resident status. See the J-1 Visa for Doctors page for more information.

Labor Certification for Physicians

Labor certification requires the sponsoring employer to prove to the U.S. Department of Labor that no qualified U.S. doctors are available to do the given job. In the labor certification process, the employer is typically required to advertise for a job opening for a physician in newspapers and/or national journals. After reviewing the resumes received and interviewing any applicants who may be qualified for the position, the employer must demonstrate to the Department of Labor that there are no U.S. physicians ready, able and qualified to perform the job. The employer submits a labor certification application to the Labor Department. Once that application is certified, the employer can then file an I-140 petition for the physician with the USCIS, showing that the position is full-time with no definite termination date and that the employer has the ability to pay the salary. If a visa number is immediately available, the physician and family can apply to adjust status to permanent residence (if within the United States in valid status) or process an immigrant visa at a U.S. consulate or embassy abroad.

The labor certification process can take a long time. In California, for example, some labor certifications can take more than three years because of state and federal labor department backlogs. When and if the PERM program becomes available, this electronic filing process for labor certification applications may greatly speed the process and make this a more realistic choice for physicians and other foreign workers.

Physicians of Extraordinary Ability

Those physicians who have risen to the very top of their field may be eligible to file EB-1A petitions as Aliens of Extraordinary Ability. This category requires a showing that the physician has developed national or international recognition in the field. This type of petition requires documentation of significant awards, publications, scientific contributions, judging others’ work, and/or membership in prestigious organizations.

National Interest Waivers for Physicians

Physicians whose employment would be in the “national interest” do not need to go through the labor certification process. Generally, physicians may petition for a national interest waiver if they intend to work at least five years in a medically underserved areas (“MUA”) or at a Department of Veterans Affairs (VA) facility. You can search the HHS database of MUA’s on their website. National interest waivers do not require a permanent job offer, and may be filed by physicians who are independent practitioners rather than "employees" of a U.S. company or organization.

Application Process

A petition for national interest waiver by a physician should include the following information:

A full-time employment contract (issued and dated within 6 months prior to the date the petition is filed) for the required period of clinical medical practice, or an employment commitment letter from a VA facility, if the physician is an employee. If the physician will establish his or her own practice, the physician must submit a sworn statement committing to the full-time practice of clinical medicine for the required period, and describing the steps the physician has taken or intends to take to establish the practice;
Evidence that the physician will provide full-time clinical medical service in a medically underserved area and in a medical specialty designation by the HHS or in a VA-facility;
A letter from a Federal agency or state public health department stating that the foreign physician’s work is or will be in the public interest. These letters should reflect knowledge of the physician’s qualifications and describe the agency’s background and interest in medical affairs.
Evidence of satisfaction or waiver of the J-1 home residency requirement, if the foreign physician has received medical training in the United States as a J-1 exchange visitor.

Working in the Underserved Area

Once the petition for a national interest waiver is approved, the foreign physician must satisfy the requirement to work for five years in the medically underserved area. If the physician already has authorization to accept employment (other than as a J-1 exchange alien), the beneficiary physician must complete an aggregate of five years of qualifying full-time clinical practice within a six-year period beginning on the date of approval of the Form I-140. If the physician requires employment authorization before the physician may lawfully begin working, the six year period to complete the five years of qualifying full-time clinical practice begins on the date the USCIS issues the necessary employment authorization document.

Within 120 days after the second anniversary of the approval of the I-140, a physician must submit the following evidence showing completion of at least 12 months of qualifying medical service:

If the physician is an employee, the employer should provide an attestation specifying the date that the physician began medical service in the practice area or facility and noting that full-time medical service has been rendered during the two years. Any breaks in medical service should be noted.
If the physician established a private practice, the physician must submit documents noting the actual establishment of the practice, including incorporation of the medical practice (if incorporated), business license, business tax returns and tax withholding documents.
The physician's W-2 forms and individual federal income tax returns that are available.

This submission is not required if the physician also has a three-year service obligation pursuant to a J waiver recommendation.

Completion of Medical Service in Underserved Area

Within 120 days of the completion of the five years of medical service, the foreign physician must submit:

If the physician is an employee, the employer must submit an attestation specifying the date that the physician began medical service in the practice area or facility and noting that full-time medical service has been rendered for the required five years. Any breaks in service should be noted;
The physician's W-2 forms and individual federal income tax returns for the five years of medical service;
If the physician established a private practice, the physician must submit documents noting the actual establishment of the practice, including incorporation of the medical practice (if available), business license, and business tax returns and tax withholding documents;
A medical examination report for each family member, performed by a physician approved by the USCIS.

Upon receiving this documentation, USCIS will schedule a fingerprinting appointment and an adjustment interview with an immigration officer (unless the interview is waived). Upon the completion of the adjustment interview the physician and family may be granted permanent resident status in the United States.