The American Medical Association and American Hospital Association are asking the Department of Homeland Security to exempt clinicians from a proposed $103,265 fee on H-1B visa petitions.
The AMA warned the fee would make recruiting physicians to underserved areas “next to financially impossible.”
In a Sept. 22 letter to Homeland Security Secretary Markwayne Mullin, the AMA said the jump from a few thousand dollars per petition would have “devastating consequences” for patient access. It said small practices and hospitals would feel the effects most.
“The physician workforce shortage is well documented, and the U.S. healthcare workforce relies upon physicians from other countries to provide high-quality and accessible patient care,” the AMA said. “This shortage is a real crisis with tangible, negative effects on U.S. citizens.”
International medical graduates make up about one-fourth of U.S. physicians. Nearly 20 million Americans live in areas where foreign-trained physicians account for at least half of practicing physicians, according to the AMA.
How the proposed rule works
DHS published the proposed rule Aug. 25, and the comment period closed Sept. 24. The fee would apply to all 85,000 initial cap-subject H-1B petitions. That includes international graduates of U.S. schools who apply to change their status without leaving the country, which the earlier $100,000 fee did not cover.
Cap-exempt petitions would not be charged. These include petitions from universities, their affiliated nonprofits and nonprofit research organizations. Extensions and change-of-employer petitions are also exempt. DHS projects the fee would raise $8.8 billion a year, and about 64% of that would go to agencies other than U.S. Citizenship and Immigration Services.
The American Hospital Association asked DHS on Sept. 23 to exempt all healthcare workers from the fee. It also asked DHS to waive the home-country physical presence requirement for physicians in the Conrad 30 waiver program.
The $100,000 fee: still blocked, now extended
The proposed rule is separate from the $100,000 fee President Donald Trump created by proclamation in September 2025.
A federal judge in Massachusetts vacated that fee in June. The judge ruled it exceeded the fee-setting authority Congress delegated. On July 24, the 1st Circuit declined to stay the ruling.
On Sept. 18, President Trump extended the proclamation through September 2027. The court order still bars collection of the fee. The proclamation also still allows case-by-case exceptions for hires deemed to be in the national interest.
A JAMA analysis found about 11,000 physicians were H-1B sponsored in 2024, roughly 1% of the physician workforce. High-poverty counties had four times as many H-1B-sponsored physicians as low-poverty counties.
In September 2025, the AMA and 53 medical societies urged DHS to exempt physicians, residents and fellows from six-figure fees. The AMA also supports bipartisan legislation that would exempt physicians and other health professionals.
