The Physician National Interest Waiver (PNIW) is a green card category created by Congress to recognize that physicians working in underserved areas of the United States is in the national interest. To qualify, a physician must work for five (5) years in an area designated by the US Department of Health and Human Services (HHS) as having a shortage of physicians. Generally, the five-year commitment must be shown in an employment agreement with a term of five years, and the physician must complete the five years of service prior to receiving a green card. If the physician will be self-employed, he or she may execute an affidavit detailing the plans to establish the practice.
A PNIW application must be accompanied by a letter from the relevant state’s department of health supporting the physician’s work as in the “public interest.” States may support an unlimited number of PNIWs in a given year. Each state has its own rules and procedures for issuing PNIW support letters, so it is important to consult those rules before pursuing a PNIW petition.
Once the state letter of support is received, the doctor may self-file the Form I-140 petition with USCIS. In addition, if the doctor is otherwise eligible, he or she may also file the I-485 adjustment of status application concurrently. Note that the PNIW is in the EB-2 category, so doctors who have backlogged priority dates, such as those from India and China, may not file adjustment of status applications until they have a current priority date.
Once the Form I-140 is approved, a doctor is eligible to port the petition to a subsequent employer in an underserved area, regardless of whether an I-485 also is pending. In this way, the filing of PNIW petition might give a physician future employment flexibility and does not necessarily tie the physician to the position held at the time the petition was filed.
The Physician Immigration Handbook, 5th Ed. (2020).