Major medical groups are urging the Trump administration to exempt foreign healthcare workers from new H1-B visa application fees, saying the steep charge will exacerbate a clinician shortage and hit rural and underserved areas particularly hard.
The Trump administration proclamation titled “Restriction on Entry of Certain Nonimmigrant Workers” took effect Sept. 21, imposing a $100,000 fee on every new H-1B visa petition.
The American Medical Association (AMA), in a letter signed by 53 leading medical societies, urged the Department of Homeland Security (DHS) to exempt physicians from the newly announced H-1B visa application fee. The groups warned that the new fee would worsen access to care and increase wait times for patients.
Other groups to sign the letter include the American Academy of Family Physicians, the American College of Cardiology, the American College of Emergency Physicians, the Infectious Diseases Society of America, the Medical Group Management Association and the Association of American Medical Colleges (AAMC).
The groups called on the DHS to issue guidance clarifying that physicians, residents and fellows are essential to maintaining a strong healthcare workforce and should be categorically exempt from the fee.
International medical graduates account for about 1 in 4 practicing physicians in the U.S. and play a vital role in filling gaps in care, the AMA and other medical groups wrote in the letter.
In 2024, 23% of licensed physicians in the U.S. were foreign-trained, according to data from the Federation of State Medical Boards.
In 2021, about 64% of foreign-trained physicians were practicing in medically underserved areas or health professional shortage areas, with almost 46% of these physicians practicing in rural areas.
The U.S. is facing a projected shortage of up to 86,000 doctors by 2036, based on data from the AAMC.
"There is a growing need for a larger physician workforce that the U.S. cannot fill on its own, in part because the U.S. does not have enough people in the younger generation to care for our aging country. Accordingly, H-1B physicians play a critical role in filling this void, especially in areas of the U.S. with high-need populations," the AMA and other medical groups wrote.
The American Hospital Association (AHA), which represents nearly 5,000 member hospitals, health systems and other healthcare organizations, also called on the DHS to exempt healthcare personnel from the new H-1B visa fees.
Data from the Health Resources and Services Administration’s 2024 workforce report shows that the nation is projected to have a shortage of 187,130 full-time equivalent physicians by 2037, with rural or non-metro areas experiencing greater shortages than other parts of the country, the AHA wrote in a letter to DHS Secretary Kristi Noem.
By the same year, 2037, there is projected to be a 6% shortage of registered nurses nationwide with a 13% shortage in nonmetro areas, according to the National Center for Health Workforce Analysis. There also are critical shortages of medical laboratory personnel, with the most recent comprehensive survey from the American Society of Clinical Pathology showing average vacancy rates of between 7% and 18% across laboratory areas.
"While the U.S. must do more to invest in training the next generation of health care workers, we believe that recruiting qualified foreign-trained medical professionals is an effective short-term approach that is vital to ensuring access to care in communities across the country," Richard Pollack, president and CEO of the AHA, wrote in the letter.
Of the almost 400,000 H-1B petitions approved in fiscal year 2024, 16,937 of those, or 4.2% of the total filed petitions, were for medicine and health occupations, and half of those approved petitions are for physicians and surgeons, the AHA said.
"Foreign-trained clinicians do not displace American workers. Instead, they play critical roles in ensuring the health of the communities our hospitals serve. They are highly qualified and required to meet our nation’s standards for education, English fluency and state licensure," the hospital association wrote.
The new visa fees will undermine hospitals’ ability to hire H1-B visa holders—including physicians, nurses, therapists, pharmacists, clinical lab experts and other healthcare workers—for their facilities.
"This constraint will be felt most by our rural and underserved communities, which already face challenges in hiring and retaining staff to serve their patients. About 17% of hospital clinicians are immigrants, and of those, 74% are U.S. citizens and 26% are noncitizen immigrants," the AHA wrote.