On July 17, the Department of Homeland Security finalized a rule capping U.S. stays for international students and exchange visitors at four years, ending the open-ended “duration of status” framework for medical trainees.
Here are six things to know:
1. The final rule eliminates “duration of status,” or D/S, admission for three visa categories: F-1 academic students, J-1 exchange visitors and I foreign media representatives. In its place, the Department of Homeland Security will admit F and J holders for the length of their specific program, which are not to exceed four years.
To stay beyond that window, a visa holder must apply for and be approved for an Extension of Stay — a step that, under D/S, was not required for the duration of a program.
2. Many residencies, fellowships, doctoral and postdoctoral programs run longer than four years. A neurosurgery residency alone spans seven years, orthopedic surgery and general surgery both take five.
Under D/S, an international trainee could complete a five-year training program without a separate federal approval. The rule now inserts an Extension of Stay review partway through longer programs, adding an approval that trainees and their institutions must clear to keep clinicians in place.
3. Roughly 16,000 residents and fellows — or 1 in 10 residents nationwide — train at U.S. academic health systems on J visas each year, according to the Association of American Medical Colleges.
National Science Foundation data from 2023 counted 26,246 international graduate students and 11,422 postdoctoral scholars in the biological and biomedical sciences — 24.9% and 58.5% of the total in those fields, respectively.
4. The AAMC said it is “concerned by the changes DHS has made to the longstanding” D/S policy, arguing the rule “does not take into account the breadth of complexities of graduate, postdoctoral, and medical residency programs, many of which often take longer than four years to complete.”
The association said the change is “inadvisable” amid a physician shortage and warned it “risks undermining the nation’s ability to attract and retain top international medical and biomedical research talent.” The AAMC said it is evaluating the final rule’s full impact.
5. The Department of Homeland Security said replacing D/S with a fixed admission period gives immigration officers “predetermined opportunities” to verify that visa holders are complying with the terms of their status, and said the open-ended system “created incentives for fraud and abuse.” The rule also shortens the window F-1 students have to depart the U.S. after completing a program or post-completion training from 60 days to 30 days.
6. The rule takes effect Sept. 15, though DHS classified it as a major rule subject to congressional review and said the effective date could shift. It stems from a proposed rule in August 2025 that drew nearly 22,000 public comments.
The change lands after a year of visa turbulence for hospitals, such as a spring visa freeze the White House later reversed, hundreds of physicians left in visa limbo, a $100,000 H-1B fee a judge halted in June, and an international medical graduate match rate hitting a five-year low.
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