New visa rules and fees have disrupted international recruiting at healthcare systems across the nation this fall, leaving many worried about long-term effects on existing staff shortages.
Foreign clinicians typically enter the U.S. on two types of work visas: H-1B and J-1. H-1B visas are a temporary professional worker visa for a specialty occupation with “dual intent” — meaning holders can apply for a green card while on H-1B status. Last month, President Donald Trump imposed a $100,000 payment to accompany any new H-1B visa petitions, starting Sept. 21. A few days later, the Trump administration reportedly began considering exempting physicians and medical residents from the fee after healthcare industry groups raised concerns.
While White House officials have said the fee will address abuses of the visa program, healthcare experts have warned it could worsen personnel shortages. Hospitals and health systems often use H-1B work visas to sponsor physicians and medical residents, and the fee would make it more difficult for them to train and practice. Immigrants make up 27% of physicians and surgeons, 22% of nursing assistants and 16% of registered nurses in the U.S.
A coalition of nurse recruiting firms, K-12 charter schools and other employers led by Global Nurse Force filed the first legal challenge against Trump’s $100,000 fee, Bloomberg reported Oct. 8.
“It’s truly a patient care issue,” Lalit Pattanaik, president and CEO of Global Nurse Force, the lead plaintiff, told Bloomberg. “These hospitals — nonprofits, in rural areas, and inner cities — they don’t have another $100,000 they can pay per nurse. It’s not financially viable.”
Hospitals respond
Systems are taking a range of approaches to the new rules and fees. Rochester, Minn.-based Mayo Clinic, Cleveland Clinic and Memphis, Tenn.-based St. Jude Children’s Research Hospital are some of the industry’s top sponsors of H-1B visas. Mayo has more than 300 approved visas.
Cleveland Clinic, one of the largest sponsors of H-1B visas, told Becker’s that the system is assessing the potential impact and awaiting additional information from the federal government. A spokesperson from The University of Texas MD Anderson Cancer Center in Houston said the system is awaiting further guidance from federal authorities and will remain in close coordination with The University of Texas System.
St. Jude and Mayo Clinic, two of the other top sponsors of visas, declined to comment or did not respond to requests.
A June study found that Iowa, North Dakota and West Virginia employ the highest percentage of healthcare workers with H-1B visas.
While systems wait for more guidance, many are advocating for changes in hopes of reducing the fees.
“The fee imposed on H-1B Visas is especially prohibitive to non-profit health systems that serve rural communities, which are already facing severe financial pressures,” Ryan Miller, chief human resources officer at Trinity Health in Minot, N.D., told Becker’s. “Along with the advocacy work of the AHA, we’re voicing our concerns to our elected representatives in Washington and encouraging our team members, board members and community leaders to do the same. With other healthcare immigration legislation, like the Healthcare Workforce Resilience Act cosponsored by our own Senator Cramer, receiving broad bipartisan support, we’re very hopeful that physicians and nurses will be exempted from this new fee, as having the talented people needed to provide quality healthcare is a pressing issue of national interest.”
In the meantime, some systems — including Seattle-based Fred Hutchinson Cancer Center and the University of Washington — are putting pauses on international recruitment and H-1B work visa sponsorships.
Fred Hutch — one of the state’s top healthcare employers of H-1B visa holders — is only pausing new potential hires due to the “rapidly changing federal situation around employer sponsorship of immigrant workers,” a cancer center spokesperson told The Seattle Times. The system has approved 181 applications in the past five years.
The University of Washington paused H-1B petitions for its medical and academic institutions, including UW Medicine, shortly after the Sept. 19 announcement. The university has offered jobs to about 20 people requiring H-1B sponsorship, with about 75% expected to work for UW Medicine, officials said.
The impact of the immigration changes are ongoing, but many worry it could have long-term effects on recruiting in areas that already struggle with shortages, and could add millions in labor costs.
“The US, and in particular our rural areas, are experiencing crisis-level shortages of the physicians and nurses needed to deliver high-quality care, and this shortage is only projected to become more acute in the decade ahead,” Mr. Miller said. “The communities we serve, and those like ours all throughout the nation, rely on attracting physicians who have completed their training in the US medical system and hope to legally immigrate in order to build their practices and lives in the United States.”
Paige Twenter contributed to the reporting.
