Grrreaatt!!!
The only reason why they didn't decide on the specialist issue is because all the specialists had either obtained permanent resident status (some of the 6 plaintiffs dropped between the district court suit and the appeal) and Kasturi who let his NIW lapse. So the court, although they certainly would have loved to rule on this had no jurisdiction left to decide the issue. Bummer.
If you want to entertain yourself, go to the Shusterman website and listen to the oral arguments in front of the appeals court. He was brilliant. At the point where the judge started to make fun of the goverment lawyer, I felt that we had a good shot at winning.
It is my understanding that unless the goverment appeals this to the supreme court, this will become binding for USCIS after a certain date.
In the ideal case, someone who did a residency+fellowship on H1b could be able to file an I140 during residency if his hospital is in a HPSA/MUA. Might be difficult to get support from the respective state health department in such a case, but some of them are really benign.