Another type of common NIW application comes from foreign doctors who wish to practice medicine in the United States. In order to eligible for this type of national interest waiver, doctors need to be willing to work for a committed five year period in one of the following clinical areas:
- HPSA—A Health Profession Shortage Area. HPSA scores are determined by the National Health Service Corps to determine priorities for assigned clinicians. Scores range from 1-25 for primary care and mental health. The higher the score, the higher the priority. Please see the following graphic for an illustration of the United States coded by HPSA scores: https://data.hrsa.gov/ExportedMaps/HPSAs/HGDWMapGallery_BHPR_HPSAs_PC.pdf
- MHPSA—Mental Health Professional Shortage area. The link above applies in terms of scores as well.
- MUA—Medically Underserved Area. Populations are areas or populations designated by HRSA as having too few primary care providers, high infant mortality, high poverty, or a high elderly population.
- VA—Veterans Affairs office.
Methods for Filing a Physician NIW
The USCIS is looking for supplementary materials for physicians looking to become clinicians in the United States in the same that academics or researchers need to attach a certain burden of proof to their application. For physicians, there are two options for coming to the United States, granted one has their NIW approved:
- The physician can pledge to the USCIS that they will be opening up their own practice in the United States. Documents that should be included for such an applicant include the physician's medical certification, a sworn statement committing to full-time (40 hours a week) practice, evidence of leasing an office, a business plan for their private practice, and generally other means of financing such an operation. The private practice must also be in one of the HRSA established underserved areas.
- The physician can pledge to work in an established clinical practice, in which case they will need a letter from a U.S. state department of public health or federal agency asserting that the physician’s work is in the public interest. This letter should be written within 6 months of the application filing an NIW self-petition. Any longer and it will be considered invalid. This letter is referred to as the applicant's employment “contract”.
Foreign physicians who are interested in this path should note that the process for becoming a green card holder still takes a long time, and requires intermittent evidence checks that need to be submitted to the USCIS. For example, after the physician has been a clinician in the U.S. for 2 years in their underserved area or at a VA facility, they will need to submit the following to the USCIS within 120 days:
- W2s for the applicant's first two years of employment in the United States.
- A letter from the employer/office manager stating that the employee has so far fulfilled two years of service from the time of the second work anniversary.
- If the NIW recipient started their own private practice, they need to submit evidence after the two-year anniversary that they have legitimately established a private practice. Some documents that would suffice include a business license, as well as business tax returns and tax withholdings from the appropriate period.
At the end of the five-year full-time clinical role, similar submissions will again need to be made and submitted, to the USCIS. The point is to verify the eligibility of the applicant for an I-485 application they may file as not filing one federal income taxes is an inadmissibility standard for the green card process.