Hundreds of overseas doctors about to finish coaching in the U.S. should depart the nation if the federal authorities doesn’t quickly course of their visa waiver functions, which have been languishing because the fall and winter, immigration attorneys say.
The waiver program, run by the Department of Health and Human Services, permits physicians who aren’t U.S. residents to remain in the nation whereas transitioning from the visa they used throughout their coaching to short-term employee standing. In alternate, the doctors comply with work in underserved areas for no less than three years.
“It will be the patients that suffer the most because in about three months, there’s going to be hundreds of places that are not going to have a physician that should have,” mentioned a psychiatrist caught in the delay.
The physician — whom KFF Health News agreed to not establish as a result of they concern authorities reprisal — was amongst hundreds who utilized this 12 months for a J-1 visa waiver via the HHS Exchange Visitor Program.
If they obtain one, the psychiatrist — who attended medical college in their house nation in Europe earlier than coming to the U.S. for his or her residency and fellowship — would work with susceptible and deprived sufferers in New York.
In current years, the HHS program reviewed waiver functions in one to a few weeks, based on two immigration attorneys.
But it at present has a backlog of hundreds of functions, which nonetheless should be reviewed by the State Department and authorised by U.S. Citizenship and Immigration Services, based on 4 attorneys interviewed by KFF Health News.
They mentioned the overseas physicians will probably must return to their house international locations if their functions don’t advance to USCIS by July 30.
For them to reenter the U.S., their employers must pay a brand new $100,000 charge related to the H-1B work visa. It’s a value that many hospitals and clinics in rural and underserved areas say they will’t afford. “That’s the cliff that this train is headed for,” said Charles Wintersteen, a Chicago-based attorney who specializes in health workforce-related immigration.
HHS spokesperson Emily Hilliard didn’t answer questions about the number of pending applications or explain what caused the delays. But she said the Exchange Visitor Program has reviewed all fiscal year 2025 clinical J-1 waiver applications, as well as some from fiscal 2026.
The department is “implementing key process improvements to prevent future delays” and “working diligently” to evaluate remaining applications ahead of the July 30 deadline, she said.
The psychiatrist in limbo said employers hiring J-1 waiver physicians have to show they were unable to fill positions with American workers. If the doctors they planned to hire can’t arrive on time — or at all — patients will have to wait even longer for those vacancies to be filled, they said.
Wintersteen said postgraduate medical education positions are largely funded through Medicare and that “the taxpayers who pay for that training will not get the benefit of it.”
Physicians and immigration attorneys said HHS hasn’t explained the delays or let them know what to expect from their applications.
“Why would HHS want to take a program that is working — a program that places hundreds of U.S. trained international physicians in highly underserved parts of the country every year — and slow-walk it into non-existence,” Jennifer Minear, a Virginia-based health workforce immigration lawyer, said in an email. “How does that serve the public health? It is baffling.”
The U.S. healthcare system depends on foreign-born professionals to fill its ranks of doctors, nurses, technicians, and other health providers, particularly in chronically understaffed facilities in rural and low-income urban communities.
Nearly a quarter of physicians in the U.S. went to medical school outside the U.S. or Canada, according to 2025 licensing data.
Once noncitizens full postgraduate training in the U.S., which generally ends on June 30, they need to return to their house nation and wait two years earlier than making use of for an H-1B work visa. Or, they will search a J-1 waiver, which lets them stay in the U.S. on H-1B standing in alternate for working for 3 years in a supplier scarcity space.
The attorneys mentioned they’re seeing delays solely in the Exchange Visitor Program, not in the opposite federal or state J-1 waiver packages.
The HHS scientific care program acquired 750 waiver functions final 12 months, Minear and Wintersteen mentioned, and is reserved for doctors working in pediatrics, psychiatry, household and inner medication, or obstetrics and gynecology.
The program usually must ahead suggestions to the State Department by mid-March, according to a letter from John Whyte, CEO of the American Medical Association.
Minear mentioned HHS stopped processing functions in late September or early October earlier than it began forwarding them once more a couple of months in the past.
“But the pace is dramatically slower” than traditional, she mentioned.
Minear mentioned the State Department normally takes two or three months to evaluate HHS suggestions and should ship them to USCIS earlier than July 30 for many of the doctors to remain in the nation.
If they don’t make that deadline, Wintersteen mentioned, doctors should depart the nation until they receive one other form of visa, get a J-1 waiver via one other program, or prolong their present visa by taking board exams or doing extra coaching.
The psychiatrist, who is meant to begin work on July 1, mentioned they utilized for a waiver in order to remain in the united stateswith their accomplice, and since it will allow them to assist probably the most susceptible psychological well being sufferers. They mentioned their future shoppers would probably embody trafficking survivors, homeless individuals, and jail or jail inmates. “That’s the population I want to work with,” they mentioned.
President Donald Trump issued a September proclamation that railed in opposition to the tech business’s use of H-1B work visas. The order created the $100,000 charge that applies to staff in all fields — not solely tech — dwelling outdoors the U.S. The cost doesn’t apply to these already in the nation.
As of Feb. 15, employers had paid the charge for 85 staff, according to a court filing from USCIS. It’s unclear if any of these funds have been for physicians or different medical suppliers.
The psychiatrist mentioned officers on the hospital that plans to rent them mentioned they will’t afford to pay to carry them again to the U.S. if they need to go house.
“A lot of hospitals who hire J-1 waiver physicians are in underserved areas, and so they treat Medicare and Medicaid patients,” they mentioned. “By definition, for the most part, they’re not rich hospitals.”
Barry Walker, an legal professional in Tupelo, Mississippi, centered on well being workforce-related immigration, mentioned employers have already spent cash on recruiters and attorneys like him to assist with the waiver course of.
Adding the H-1B charge is “just a deal killer, especially for the small, rural hospitals,” he mentioned.
Attorneys mentioned most employers will sponsor physicians in want of an H-1B visa provided that they’re in profitable specialties, corresponding to cardiology or orthopedics, in which they will recuperate the fee of the charge.
They mentioned healthcare amenities are a lot much less more likely to pay the charge to rent overseas nurses, lab technicians, and different healthcare professionals who’re extra probably than physicians to finish their coaching outdoors the U.S.
Employers can request fee exemptions, however attorneys mentioned they haven’t heard of a hospital or clinic being granted one.
Physicians, hospital leaders, lawmakers, and immigration specialists try to attract consideration to the J-1 waiver delays at HHS whereas hoping to overturn or restrict the brand new H-1B charge.
The Trump administration hasn’t acted on letters from hospitals, medical societies, and rural health organizations that requested an exception to the $100,000 charge for physicians or all healthcare staff.
In March, a bipartisan group of lawmakers introduced a bill that will create a healthcare exemption. It has not but had a listening to.
At least three lawsuits — from the U.S. Chamber of Commerce, a group of 20 states, and a coalition of plaintiffs that features a firm that recruits overseas nurses and a union that represents medical graduates — are searching for to finish the charge solely.
As for the J-1 waiver delays, the American Medical Association CEO requested the Exchange Visitor Program to make use of “emergency batch processing” for physicians with contracts to begin work this summer time.
Efrén Manjarrez, president of the Society of Hospital Medicine, which represents doctors who work in inpatient models, additionally referred to as for emergency measures.
“Every day this backlog persists is a day that hospitalized patients in these communities face greater risk,” he wrote in a letter to the program.
Meanwhile, Canadian hospitals have been recruiting overseas physicians finishing their coaching in the U.S, the psychiatrist mentioned. They mentioned one of their buddies accepted a suggestion, withdrawing their HHS waiver utility to move north.
The psychiatrist mentioned if they need to depart the U.S., they’ll be separated from their accomplice and out of a job for months as they work to get licensed in their house nation.
Even if their employer have been in a position to afford the H-1B charge, they’re unsure they’d wish to return.
“This entire process has been so incredibly painful and just soul-crushing,” they mentioned. “I would rather go to a country that would appreciate my motivation to work with patients.”