Foreign nationals in the U.S. as medical residents are generally here as J-1exchange visitors.   Each and every exchange visitor here for graduate medical education or training is required to return to their home country for two years prior to return to the U.S.  Known as the “two year rule,” this requirement can be earth-shattering for medical residents as it precludes receipt of an H-, L-, or K- nonimmigrant visa or green card.  See INA 212(e), 212(e)(iii), 8 U.S.C. Sec. 1101 et seq.  In fact, many may want to remain in the U.S. as practicing physicians —  likely having put down roots, formed a  romantic alliance, and/or identified fruitful business prospects.  And their continued presence certainly benefits the U.S. as physician shortages here are forecast to deepen over time. 

All is not lost.  Various programs are in place to allow foreign national physicians to immigrate to the U.S. by waiving the two year rule.  Some of the more robust programs posit an interested federal or state governmental agency (IGA) as a key player.   The IGA’s role is to recommend that the U.S. Department of State (DOS) waive the two year rule.   See INA Sec. 212(e).  After the IGA’s application is reviewed, and assuming the application survives program and policy scrutiny, the DOS will make its recommendation to USCIS – the final arbiter.   The remaining non-IGA options include fear of persecution, exceptional hardship to a U.S. citizen or permanent resident spouse or child, and self-petitions as an alien of extraordinary ability and national interest waiver.