USCIS has just adopted the AAO case Matter of T-O-S-U as USCIS policy. To qualify for an H-1B visa, a physician must normally have passed all parts of USMLE. There is an exception for physicians of national or international renown.
There has never been much in the way of guidance on this subject so this case will be very important in analyzing eligibility for the benefit. The case is linked at https://www.uscis.gov/sites/default/files/USCIS/About%20Us/Directorates%20and%20Program%20Offices/AAO/APPROVED_PM-602-0140_Matter_of_T-O-S-U-_AAO_Adopted_Decision_H-1B_Renow.pdf.
The case mainly makes news for a few reasons. First, if you’re from a small, low population country, you’re going to be graded on a curve. You have to show that your acclaim is equivalent to national acclaim in the US. The AAO also used a standard comparable to an O-1 and suggests presenting evidence similar to an O-1 case. My takeaway is that people interested in using this category will need to treat it like filing for an O-1 (which might just mean it makes more sense to file for an O-1 itself unless a spouse needs an employment authorization document).