A new analysis of Department of Labor data suggests rural communities and those with higher levels of poverty will be disproportionately affected by the government’s new $100,000 fees for H-1B visa applications.
Published Wednesday in JAMA, the study of H-1B applications found more than 11,000 of the country’s physicians, or just less than 1% of the national workforce, were sponsored for H-1B visas in the 2024 federal fiscal year (ended Sept. 30, 2024). These noncitizen specialized workers have a smaller footprint among the advanced practice provider workers (0.02%), the dentist workforce (0.4%) and other healthcare workers such as optometrists or chiropractors (0.07%).
Geographically, H-1B-sponsored doctors represented 2% of the physician workforce in U.S. counties among the quarter of U.S. counties with the most residents whose incomes were below the federal poverty level. Among the quarter of U.S. counties with the lowest amount of residents in poverty, these doctors compromised 0.54% of the physician workforce, a statistically significant difference.
H-1B-sponsored physicians made up 1.6% of the rural workforce as opposed to 0.95% of urban physicians. These physicians were a larger share of the workforce in Northeastern counties (1.4%) compared to the Midwest (1.2%), the South (0.82%) and the West (0.53%).
The geographic trends were mirrored among H-1B-sponsored advanced practice providers, dentists and other healthcare workers, according to the study.
The researchers noted their analysis may be an overestimate due to its reliance on H-1B application data. That said, 94% of these applications were approved in fiscal 2024.
The authors also warned that the rural and socially disadvantaged communities with more H-1B-sponsored doctors are already facing care workforce shortages.
“As demonstrated by disruptions to J-1 visa interview scheduling this past spring, even temporarily reducing the flow of non–U.S. citizen [healthcare providers] can severely strain clinical capacity, leave residency and fellowship positions vacant and impede patient care,” the researchers wrote in the journal. “… These findings support the proposed implementation of national interest H-1B fee waivers for physicians and extension of such waivers to other [healthcare providers].”
The H-1B visa application fee spike, from $3,500 to $100,000, stems from an executive order signed by President Donald Trump on Sept. 19, which the administration said will incentivize employers across multiple industries to hire more American workers.
Subsequent guidance clarified that the higher fee only applies to new applicants who are living abroad and does not apply when a visa applicant files to move from one type of visa to another. The administration has also suggested exceptions could be made for some of the workers who do not “pose a threat to the security or welfare” of the U.S.
A coalition of healthcare organizations and unions filed a lawsuit against the heightened fees near the top of October, as did the U.S. Chamber of Commerce a few weeks back.
Fifty-four major healthcare associations and lobbying groups including the American Medical Association have urged the Department of Homeland Security (DHS) to exempt physicians from the fee, writing that 23% of licensed physicians in the U.S. were foreign-trained and that limiting their flow into the country would do little to stem the 86,000-physician shortage projected by 2036.
Alongside the fee increase, the DHS has also proposed changing the selection process for H-1B from a random lottery to a weighted selection process favoring higher wage levels. In a letter submitted to the department this past week, the American Hospital Association warned that such a change could greatly hamper care from rural hospitals and called for occupations categorized as medical or health-related roles to be placed at the equivalent level as high-wage applicants.