First, the J-1 physician must assess whether he or she is subject to a two-year home residency requirement. In most cases, the answer to this question is yes. Please see my post, entitled "Do I need a J-1 waiver?"
Second, the physician must determine his or her J-1 waiver options. For purposes of this question, let's say the physician has chosen to pursue a hardship waiver.
Third, the physician must complete the DS-3035 form with the Department of State (DOS) and request a DOS case number.
Fourth, the physician must prepare and submit the Form I-612 Application for Waiver of the Foreign Residence Requirement to United States Citizenship and Immigration Services (USCIS).
Fifth, if USCIS believes the hardship test is met, it will forward the application to the DOS.
Sixth, the DOS will consider the J-1 waiver application. If it recommends the waiver, the DOS will forward the case back to USCIS.
Seventh, upon DOS recommendation, the physician is now free to proceed with immigrant or non-immigrant visa processing. USCIS will finally approve the J-1 waiver.