A new federal policy requiring employers to pay a $100,000 fee to sponsor highly skilled workers from other countries could disproportionately affect the nation’s poorest areas when it comes to healthcare access, according to an analysis published Oct. 29 in JAMA.
The analysis is based on data from H-1B visas approved for healthcare workers in 2024, covering 3,240 U.S. counties. About 1% of physicians in the U.S. — or 11,000 — were sponsored under H-1B visas in 2024. Counties with the highest poverty levels had four times as many H-1B-sponsored physicians than those with the lowest poverty levels, researchers found. Similar trends were observed for advanced practice providers and other healthcare workers, though they accounted for smaller shares of the workforce.
The findings support the need for the Trump administration to exempt physicians and other healthcare workers from the $100,000 fee, researchers said.
“Increasing visa fees could exacerbate workforce shortages and worsen access to care, particularly in rural and high-poverty communities,” which already experience the most significant healthcare shortages. “Physicians on H-1B visas are far more likely than their domestic counterparts to fill critical gaps in healthcare delivery systems, such as primary care and psychiatry.”
Hospitals have been urging federal officials to exempt healthcare workers from the policy — first announced in September — warning the steep fees would likely deter many providers from recruiting international workers, compounding existing staffing shortfalls and forcing service reductions.
Hospitals and health systems often rely on the H-1B visa program to sponsor physicians and residents; more than 4,000 research centers and hospitals sponsored visas as of June, according to federal data cited by Bloomberg. The $100,000 fees took effect for new H-1B visas Sept. 21. Previously, sponsors typically paid around $3,500 for new petitions. On Oct. 20, the White House clarified that the increased fees apply only to new applicants living abroad, not individuals already living in the U.S.
Federal officials say the policy is meant to encourage companies to hire more American workers. While the administration has signaled it will consider exemptions for physicians and medical assistants, it’s unclear whether any have actually been granted. The new policy gives the Secretary of Homeland Security authority to make exceptions on a case-by-case basis, if they determine a worker’s hiring is in the national interest.
“President Trump promised to put American workers first, and this commonsense action does just that by discouraging companies from spamming the system and driving down wages,” White House spokeswoman Taylor Rogers said in a statement to Becker’s. “It also gives certainty to American businesses who actually want to bring high-skilled workers into our great country but have been trampled on by abuses of the system.”
The White House did not respond to questions about whether the administration has or will approve exemptions for physicians or other clinicians.
