There are two main paths to Permanent Residency, or green card, for foreign national physicians.  The first is the Physician National Interest Waiver (PNIW), created for those physicians who serve five years in primary care in a physician shortage area.  Sounds great!  It’s a win-win. The physician provides much-needed medical care in a shortage area and gets a path to a green card.  But hold on --  it's not so straightforward when the current immigration policies keep shifting underfoot; and when the majority of the physicians filling these roles are Indian nationals and subject to lengthy backlogs in the visa numbers. The backlog in visa numbers for Indian nationals also impact the second path to a green card: the labor certification. Labor certification-based green card cases require that an employer show it has been unable to recruit a U.S. Citizen or Permanent Resident with minimum qualifications who is immediately available to fill a job.  The problem is, these types of cases can take longer to process; and if it is for an Indian national physician, employers are stuck with the same problem of the visa backlog.

What is the PNIW dilemma?

In the past several months, USCIS has started scheduling green card interviews early for those physicians who submitted PNIW petitions (before the five years of service is complete) and approving green cards for these doctors well before they should under the laws. Why is this a problem? They are incorrectly issuing green cards to these individuals and putting them in a situation of violating the law by accepting the green card, courting the risk of being stripped of their status if/when the error is caught; OR trying to get the Immigration Service (USCIS) to right their own wrong, take the card back and reverse the process. Is it just improperly trained and/or clueless and careless adjudicators at USCIS?  Or is it part of a bigger pattern of the current administration’s policies at work – which means trying to deny as many applications as possible?

Although PNIW was created to make the applications process smoother for the foreign-trained physician, this situation is the perfect example of a well-intentioned process being misapplied. These sudden and baseless shifts in procedure on behalf of USCIS under the current administration are unfortunate for both the physicians and the communities that need them.  In the end, it turns what should be a relatively clear process into a dilemma and hassle for the physician.

Dealing with a decade-long backlog

Even for highly skilled positions such as physicians, the backlog of annual per-country visa numbers impacts Indian nationals to an inordinate degree. Currently the Visa Bulletin (put out monthly by Department of State ) shows that the current processing dates for Indian nationals in the PNIW category are backlogged to April 16, 2009.  That’s a 10-year backlog!  And this in addition to the historic delays in processing for every type of Immigrant and Non-immigrant visa processing.  Recently 80 members of Congress have asked the Government Accountability Office to investigate the record-breaking backlog of pending immigration cases.

Indian nationals mobilize for advocacy

So what is a brilliant, highly-skilled, much-needed Indian national physician to do? Besides being gifted with endless patience (and patients!), they are also determined to find a way to stay in the U.S. and practice medicine. Fittingly, these Indian physicians have tapped into the American can-do spirit in the best way possible. They have organized behind their cause for a more efficient, merit-based path to green card status; and they have joined with other Indian activist groups to get their issues heard and addressed by our federal government.

One such advocacy group is GCReforms, self-described members of the Indian diaspora living in the United States.

"We are a community of individuals from diverse backgrounds and are physicians, nurses, entrepreneurs, educators, researchers and technology professionals. Our organization is focused on creating awareness about immigration challenges faced by Indian highly-skilled workers. We seek to garner support across the nation on targeted legislation that resolves the Green card backlog."

In February 2019, a group called Republican Hindu Coalition organized a rally outside the White House, with other Indian activist groups joining in the efforts.