The American Hospital Association is calling for changes to the Department of Homeland Security’s proposed weighted selection process for H-1B petitions.
“The AHA appreciates that DHS’s goal in proposing a weighted selection process is to ensure the H-1B visa program fills labor shortages in positions requiring highly skilled or highly educated workers,” Akinluwa Demehin, vice president of quality and safety policy at the AHA, wrote in a comment submitted to the department on Oct. 24. “However, the revised policy could inadvertently hinder the ability of hospitals to use the H-1B program to fill critical shortages of highly skilled health care workers and ultimately hamper access to care.”
Here are proposed changes AHA recommends:
1. The AHA recommends that all occupations under medicine and health categories be equivalent to level IV, the highest weighted level, regardless of wage level.
2. In 2024, 4.2% of total H-1B petitions were for medicine and health occupations, and many of those would be affected by the statutory cap and proposed rule.
“While hospitals and health systems are committed to investing in training the next generation of health care workers, the H-1B visa program is a critical short-term approach used by hospitals to recruit highly skilled health care professionals and maintain access to care in their communities,” the comment letter said. “Foreign-trained medical professionals do not displace American workers. Instead, they play a critical role in improving the health of the communities our hospitals serve.”
3. The salaries and wages of these healthcare workers vary significantly among occupations and geographies. Healthcare has the largest variation of annual compensation between the 25th and 75th percentiles. Most healthcare occupations would see significantly reduced chances in receiving H-1B visas under the new proposed policy.
4. About 78% of H-1B healthcare practitioners and technical occupations would be slotted for the lowest two levels under the weighted rule. This could include pharmacists, technicians, physicians and therapists. Only 2.3% of healthcare workers would qualify under the highest weighted wage level.
5. Health systems could also face challenges in raising wage levels for H-1B recipients, because recipients are generally paid at the level corresponding to their U.S. experience — which is often none. Additionally, some states require international clinicians to work a certain number of supervised clinical hours or pass exams before taking on full practice authority, which would limit initial salary.
6. The weighted policy would also have a “detrimental” impact on rural and underserved areas, the comment letter said.
“Hospitals and health systems serving these areas face substantial financial headwinds, placing constraints on their ability to pay higher wages that could increase the probability of receiving H-1B visas in a weighted selection process,” the letter said. “For all the above reasons, the AHA believes that automatically weighing all health care workers at a level IV will provide the best opportunity for these critical staff to be selected to ensure continued access to care.”
7. The H-1B is one of the two visa types foreign physicians use to enter the country. It is a temporary professional worker visa for a specialty occupation with “dual intent,” meaning visa holders can apply for a green card while on H-1B status, and requires employer sponsorship.
H-1B petitions have undergone a number of policy changes in recent weeks.
On Sept. 19, President Donald Trump issued a proclamation imposing a $100,000 payment to accompany any new H-1B visa petitions starting Sept. 21. The fee applies only to new applicants outside the U.S., not to individuals already residing in the nation, the White House said Oct. 20. The fee does not apply to previously issued and valid H-1B visas or those submitted before Sept. 21.
On Sept. 24, the Department of Homeland Security proposed a new weighted selection process for H-1B petitions that would be based on wage levels. Applicants with higher wage levels would have greater probability of being awarded visas. The system would be based on four levels of wage, with each level receiving one extra submission into the selection pool. This new process would replace the current lottery process.
