Uncertainty over whether physicians and medical residents will be exempt from a newly imposed $100,000 fee for H-1B visa applications has left many hospitals in wait-and-see mode as they finalize recruitment plans for the year, according to a Jan. 21 report from AAMC News.
In September, President Donald Trump signed an executive order requiring employers to pay a $100,000 fee for each new H-1B visa application — an increase from the roughly $3,500 employers previously paid. The fee took effect Sept. 21. After healthcare industry groups warned the policy could worsen workforce shortages and undermine access to care in underserved areas, federal officials signaled they would consider exemptions for physicians and medical residents. Four months later, however, there are no reports of such exceptions being granted.
Teaching hospitals say they are still waiting to see whether exemptions will actually materialize for the foreign‑born medical graduates they expected to bring on this summer. In the meantime, many are drawing up contingency plans that include paying the fee for a reduced number of residents, hiring more physician assistants or extending first‑year residents into their second year. In some cases, teaching hospitals are reconsidering applicants who need H‑1B sponsorship.
“We’re going to be as creative as we can to keep the workforce going,” Eric Appelbaum, DO, senior executive vice president and COO of New York City-based SBH Health System, told AAMC News. The Bronx safety-net hospital was expecting 28 international medical graduates to start residencies this summer.
Hospitals and health systems often rely on the H‑1B visa program to sponsor physicians and medical residents to fill critical staffing gaps. More than 4,000 research centers and hospitals sponsored visas as of June, federal data previously cited by Bloomberg shows. Research has shown disruptions to the program could worsen access to care, particularly in rural and medically underserved areas that disproportionately depend on international medical graduates.
The H‑1B program, created in 1990, allows employers to hire highly skilled foreign professionals by sponsoring them for temporary work visas. Initial visas are granted for three years, with the option to extend to six years or longer if the physician is pursuing a green card. The administration’s executive order includes language allowing fee exemptions on a case-by-case basis when hiring is deemed in the “national interest,” but officials have not clarified how or when such exemptions would be applied.
One alternative pathway, the J‑1 visa program for medical training, differs from H‑1B sponsorship in key ways. J‑1 physicians must return to their home country for two years after completing residency unless they secure a waiver, which can delay or complicate their ability to practice in the United States. Some safety‑net hospitals are hesitant to rely on J‑1 visas for that reason.
“For a lot of safety‑net hospitals in particular, they don’t want to go through the process of training somebody for three years, four years, five years and then have a perfectly minted physician that can take care of their community, but that person has to leave for two years,” Tim Johnson, senior vice president for the Greater New York Hospital Association, which represents dozens of teaching hospitals, told AAMC News.
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