One approach to getting a green card is to go through labor certification. In this process, the employer shows that it has tried but failed to hire a U.S. physician for the position.

The employer must advertise the job in a major national publication or a major specialty publication and review all the submitted curricula vitae to ensure that no qualified U.S. applicant is available. The national interest waiver represents a second method. The employer demonstrates a history of difficulty in recruiting physicians to an area that needs one. This can reduce processing time to less than a year. Other methods for obtaining a green card include using the help of a U.S. citizen relative. If the IMG is an exceptional physician, s/he may qualify for a “superstar” (O) visa. Physicians may get green cards by marrying U.S. citizens or by winning the annual “visa lottery.” The United States has four Immigration Service processing centers, and their processing time can take months or years.