Background

In September, President Donald Trump issued an executive order implementing a $100,000 fee for any new H-1B visa petition. According to the administration, the fee is designed to help combat "systemic abuse" in the H-1B visa program. The new fee will be implemented during the next lottery cycle in 2026 and does not apply to current H-1B visa holders.

Healthcare employers often use H-1B visas to sponsor medical residents and physicians. In fiscal year 2024, almost 17,000 H1-B visas were granted for medicine and health roles, with around half going to physicians and surgeons.  

Several healthcare leaders spoke out against the new fee after it was first announced, saying that it would worsen the ongoing physician workforce shortage.

The new fee "risks shutting off the pipeline of highly trained physicians that patients depend on, especially in rural and underserved communities," said Bobby Mukkamala, president of the American Medical Association.

Similarly, Jonathan Jaffrey, chief healthcare officer at the Association of American Medical Colleges, said the organization "is concerned that the recent proclamation on H-1B visas will worsen the nation's existing physician shortage and jeopardize patient access to care."

In October, a coalition of labor unions, religious organizations, and others led by healthcare-staffing firm Global Nurse Force filed a lawsuit against the Trump administration, arguing that President Trump implemented the visa fees without the approval of Congress and that the administration violated the Administrative Procedure Act by acting unreasonably and skipping the usual process for considering regulatory changes.

Twenty states, including California, Hawaii, North Carolina, and Wisconsin, also filed their own lawsuit against the Trump administration in December. In the lawsuit, the states said that the policy "is a clear violation of the law because it imposes a massive fee outside of the bounds of what is authorized by Congress and contrary to Congress' intent in establishing the H-1B program, bypasses required rulemaking procedures, and exceeds the authority granted to the executive branch under the Administrative Procedure Act (APA)."

In a cross-sectional study published in JAMA last year, researchers found the percentage of physicians with H1-B visas was significantly higher in vulnerable and underserved U.S. counties, meaning they will likely be disproportionately affected by the new fee.

"The prohibitive increase in H-1B application fees will disproportionately affect rural and socioeconomically disadvantaged communities, which already experience the greatest healthcare workforce shortages," the researchers wrote. "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."

Tarun Ramesh, one of the study's authors from Massachusetts General Hospital, said that the $100,000 H1-B visa fee "could be quite damaging to the physician workforce pipeline."

"Anecdotally, we see that program directors are already getting top-down guidance not to recruit physicians who would require H1-B visas," Ramesh said.

"Some hospitals have said [they're] not going to recruit anybody with an H-1B visa for any other role, but [they] may have to with residents or clinical roles," Johnson said. "So, everybody is in a slightly different place of how they're addressing these issues. And it really speaks to the uncertainty out there right now about this."

Overall, "[h]ospitals and community health centers and others are just trying to provide care to their community and have a workforce," Johnson said. "We don't want to get into a battle between the administration and other industries about the proper use of American workers versus non-American workers."