The federal National Interest Waiver (NIW) program allows certain foreign workers with advanced degrees, including foreign physicians (MDs), or exceptional abilities to work in the United States. A national interest waiver granted to a foreign physician by the USCIS exempts the foreign physician from the labor certification process administered by the United States Department of Labor. Under the federal NIW program, a state health department may support with an attestation letter a request for a national interest waiver for a foreign physician. The foreign physician must agree to provide medical services full-time in a federally designated primary care health professional shortage area (HPSA), medically underserved area (MUA), medically underserved population (MUP), or mental health professional shortage area (MHPSA) for five years.