The Physician National Interest Waiver (NIW) is one step in the process for a foreign physician to obtain permanent resident status (green card) through the U.S. Department of State and U.S. Citizenship and Immigration Services. To get a NIW, you must obtain a statement from a federal agency or a state department of health that has knowledge of your qualifications as a physician and that states your work is in the public interest. In Florida, that sponsorship/recommendation is coordinated through the Florida Department of Health.

Physicians may request support letters from the Department year-round, but they must meet the following eligibility requirements.

Eligibility

  1. Physician must practice clinical medicine in Florida.
  2. Physician must practice medicine full time – no less than 40 hours per week of direct patient care – for at least five years total; either all in Florida or for at least the final year.
  3. The practice site(s) must be located in a Health Professional Shortage Area (HPSA), medically underserved area (MUA), or U.S. Department of Veterans Affairs facility. A primary care HPSA is required for all physicians except psychiatrists, who must serve in a mental health HPSA.
  4. Applicants must have a current, unrestricted, clear, active Florida medical license (license prefix is ME or OS).
  5. The practice must accept Medicare and Florida Medicaid patients and offer a sliding-fee scale (or comparable charity-care arrangement) for uninsured and low-income patients. The practice must post a notice of the sliding-fee scale.

Requirements based on employment type

Physician works for an employer
  • Complete the NIW request for letter of support form. List the employer, practice locations, dates of service, weekly clinical hours, and HPSA/MUA designation, and answer the Medicare/Medicaid and sliding-fee questions.
  • If the five-year service period involves more than one employer, complete an additional employers form for each prior employer.
Physician owns their clinical practice
  • Complete the NIW request for letter of support form. In the employer information section, list the name of the physician’s practice (or the legal entity name). Provide the practice location(s), dates of service (or intended start date), weekly clinical hours, and HPSA/MUA designation, and answer the Medicare/Medicaid and sliding-fee questions.
  • If the five-year service period involves more than just the physician’s self-employed practice, complete the additional employers form for each prior employer.
  • The physician must provide a statement confirming the commitment to full-time clinical practice (minimum 40 hours per week of direct patient care) for the required five-year aggregate period. The statement must note any steps taken or planned to establish and maintain the practice.
  • If the practice is not yet open, provide proof the location is secured (signed lease, deed, or equivalent) and evidence the practice is being formed (Florida business-entity document or Agency for Health Care Administration clinic license application/issuance, if applicable).
  • If the physician has already been practicing full-time at the site, provide a letter on business letterhead confirming the start date of full-time clinical practice.

    Application Process

    How to submit the application

    Email the application packet to FL.PCO@FLHealth.gov or mail it to:

    The Florida Department of Health
    State Primary Care Office
    4052 Bald Cypress Way Bin #A05
    Tallahassee, FL 32399-1720

    What to expect after submission

    After reviewing the request, the Department will draft the letter of support and email it to the physician and their lawyer to include with their application filing for an NIW.

    The Department requests that the employer and physician report on the physician’s activities every 12 months during the five-year obligation service period using the Florida NIW Physician Practice Status Report.

    How to report employment changes or termination

    Changes

    If a physician needs a new letter of support due to changes in employment, they must submit a new request form. This form should be emailed to FL.PCO@FLHealth.gov or mailed to the Department’s State Primary Care Office at 4052 Bald Cypress Way Bin #A05 in Tallahassee.

    Termination

    In the event of a termination of employment, the employer and/or the employee must notify the Department in writing within five business days of the termination.

    Self-employed physicians must notify the Department in writing within five business days of the practice’s permanent closure or cessation of full-time clinical service in a qualifying location.