Health Professional Shortage Area/National Interest Waivers
Physicians working in designated medically underserved areas (HPSAs and MUAs) for five years may generally qualify for national interest waivers under certain conditions. The physician must agree to work full-time in such an area for aggregate of five years within a six-year period. For physicians who have obtained J-1 waivers, the five years commence from the time H-1 employment begins. For other physicians, the five-year period does not begin until immigration petition is approved. There is a reporting requirement that within 120 days of the second anniversary of the I-140 approval, the physician proves to the Service that at least one of the years has been in the underserved area. At the end of the five-years of service, the physician must again prove that the obligations have been satisfied.
The Service permits the simultaneous filing of adjustment of status along with the immigrant petition even for J-1 physicians who have not yet completed their obligations under Section 214(l) of the INA to work in the underserved areas for three years. Derivative adjustment applications may at the same time be filed for family members. This strategy has unique advantages in this one regard: adjustment of status may be filed for J-1 and for accompanying family members before completion of the obligations to work for three years in underserved areas. This can greatly benefit a spouse who needs work authorization. Still, the J-1 doctors must complete 214(l) obligations by maintaining H-1B status for a three-year period. Neither statute nor regulations per se limit this strategy to primary care physicians, however, comments to the regulations do. This seems inappropriate, and particularly so for physicians who have obtained waivers through the VA or state programs.
Evidence submitted in a typical case includes a five-year contract to work in the underserved area and a letter of support dated within six months of submission from a federal agency or department of health recommending that the waiver is in the nation's interest.
In certain special circumstances the commitment to work in the underserved area is for only three years (if filed before November 1, 1998).
This strategy is also available for physicians who intend to be self-employed.