New $100K H-1B visa fee puts U.S. physician recruitment at risk

WASHINGTON, UNITED STATES — Hospitals across the United States are bracing for staffing disruptions as a proposed $100,000 fee for new H-1B visa applications injects uncertainty into physician recruitment, particularly for safety-net systems and teaching hospitals that rely heavily on foreign-trained doctors.

In a report from the Association of American Medical Colleges (AAMC), health care leaders believed that Trump’s H-1B policy can worsen existing workforce shortages just as hospitals are finalizing residency recruitment decisions for the next academic year.

Visa fee disrupts residency recruitment

The SBH Health System, a 422-bed safety-net hospital, expects 28 foreign medical graduate physicians to begin their residencies on July 1. Historically, SBH has leaned on the H-1B visa program to attract top international candidates, extending offers months in advance.

Even after the proclamation was issued, SBH continued recruiting, believing physicians might qualify for a National Interest Exception. Months later, no such exemptions have materialized. As a result, hospital leaders are weighing alternatives. 

“We’re going to be as creative as we can to keep the workforce going,” said Eric Appelbaum, DO, MBA, senior executive vice president and chief operating officer of SBH Health System.

The clinical teams, which already operate at maximum capacity, will experience additional pressure from three proposed alternatives: hiring additional physician assistants, limiting visa-sponsored resident recruitment, and increasing work responsibilities for current personnel.

Teaching hospitals also face difficult choices as they prepare rank order lists for the National Resident Matching Program.

“Frankly, the hospitals don’t know what to do about that,” said Tim Johnson, senior vice president of the Greater New York Hospital Association, referring to whether programs should consider applicants requiring H-1B visas. 

“We need this now, because it has implications for a hospital’s ability to recruit new residents,” Johnson added.

Physician shortage threatens patient access

Health systems throughout the U.S. face critical challenges because their current condition has reached a critical point. About 25% of practicing physicians in the U.S. are international medical graduates, helping fill a projected shortage of more than 86,000 physicians by 2036. 

The United States approved approximately 11,000 new H-1B visas for physicians during the fiscal year 2024. Most of these physicians practice medicine in rural areas and low-income communities.

“We found that there was substantial variation in the reliance on H-1B visa holders across counties,” said Michael Liu, MD, MPhil, lead author of a JAMA study, noting that some communities depend on them for as many as one in three physicians.

For individual doctors, the uncertainty has personal consequences. 

One physician, identified as F.H., said, “It’s just really, really hard,” describing months-long separation from her husband after being unable to start a job in a medically underserved area.

Health care advocates stress that these physicians do not displace U.S. graduates. 

“Rather, these visa holders serve as an important complement within our health workforce,” said Andrea Price-Carter of the AAMC.

As legal challenges to the $100,000 H‑1B fee proceed, hospitals, clinics, and health systems remain in limbo, warning that prolonged uncertainty could further strain staff and jeopardize patient access to care, especially in rural and low‑income communities.