International medical graduates often overcome the J-1 visa two-year home residence requirement through a J-1 waiver based on the support of an Interested Government Agency (IGA). These waivers require three years of service as a physician in certain designated underserved areas. The grant of this waiver opens up the possibility of pursuing U.S. permanent residence status. International medical graduates completing J-1 waiver requirements most commonly choose between two options to file and obtain the U.S. Green Card: the National Interest Waiver (NIW), or the Labor Certification-based Green Card process. 

For physicians, both options are within the employment-based, second preference category (EB2). The NIW is a waiver or elimination of the standard requirement of obtaining a certification from the U.S. Department of Labor, as the first step in an employment-based Green Card case. The medical care that must be provided by the physician to qualify for the J-1 waiver is considered to be in the National Interest, and important enough to override the purpose of the Labor Certification process.