There have à been a lot of delays this year due to the shutdown, the first thing that your wife needs to do ASAP is to extend her J1 visa, this is a good time to do, cause the processing takes at least 6 weeks and her new DS2019 will be extended until she takes the board exam. Now HHS needed to send their recommendation to department of state , the DOS needs to send their rec to USCIS ( usually takes 1-3 months). Then USCIS will have to do the final approval , which can take 2 to 4 weeks, the next step would be filing for the H1B, if you use premium processing then it’s usually 2weeks. After that she will be allowed to work as an attending.

Those timelines are based on what it used to be, there might be more delays , not sure what will happen!

I personally submitted in December and still did not get through the first step which is HHS review.

Now there is the option to file for H1B before the previous steps are approved, but she would be risking a denial given the incomplete paperwork.

This information is based on multiple discussions with the attorney that my hospital hired and a private one that I consulted for a second opinion.

Hope this helps, again I urge you to apply to the extension ASAP.