When the Trump administration introduced final month that each new H-1B visa would come with a $100,000 fee, the target appeared easy: encourage corporations, notably tech corporations that closely on this system, to begin hiring American employees and cease driving down American wages.
But the well being care trade is elevating considerations that the value hike on the H-1B visa will threaten the flexibility of hospitals in rural and underserved areas to herald international employees and fulfill a scarcity of specialists wanted to serve the group.
“There’s no way we’re going to pay $100,000,” Carolynn Lundry, a residency program coordinator at St. Luke’s Hospital within the St. Louis suburb of Chesterfield, Missouri.
“We pool from international graduates, and if we’re going to take away the H-1Bs from that, it’s going to shrink our pool of choices,” mentioned Lundry, who selects 16 inside medication residents a yr for St. Luke’s.
More than 64% of worldwide medical graduates have been training in medically underserved areas or well being skilled scarcity areas, with greater than 45% training in rural areas, in line with a 2021 study published by the National Institutes of Health.
And the United States wants an extra 13,075 physicians simply to fill shortages, in line with a 2024 report from the Health Resources and Services Administration (HRSA). The HRSA forecasts that by 2037, the US will likely be in need of 87,150 full-time equal (FTE) major care physicians.
The White House mentioned the brand new fee for H-1B visa candidates is a part of President Donald Trump’s promise to prioritize American employees.
“President Trump promised to put American workers first, and this commonsense action does just that by discouraging companies from spamming the system and driving down wages,” White House spokesperson Taylor Rogers advised NCS in a press release. “It also gives certainty to American businesses who actually want to bring high-skilled workers into our great country but have been trampled on by abuses of the system.”
Some teams have pushed again in opposition to the $100,000 fee, which was beforehand at about $3,000. Last week, the US Chamber of Commerce turned the most recent group to sue the Trump administration over the fee.
“The new $100,000 visa fee will make it cost-prohibitive for U.S. employers, especially start-ups and small and midsize businesses, to utilize the H-1B program, which was created by Congress expressly to ensure that American businesses of all sizes can access the global talent they need to grow their operations here in the U.S.,” mentioned Neil Bradley, government vp and chief coverage officer of the chamber, which is without doubt one of the greatest pro-business lobbying teams within the nation.
The American Medical Association and greater than 50 different well being care-related societies have urged the Trump administration to declare worldwide medical graduates exempt from the hefty fee.
“States with a higher percentage of H-1B physicians are often those with lower physician density,” they wrote in a letter to Kristi Noem, the secretary of the Department of Homeland Security. “The U.S. health care workforce relies upon physicians from other countries to provide high-quality and accessible patient care.”
In its newest steerage, US Citizenship and Immigration Services mentioned the $100,000 fee solely applies to new H-1B candidates dwelling overseas — not present H-1B visa holders dwelling who must renew their visa, and not those that maintain different visa statuses and want to alter their standing to an H-1B.
For small rural hospitals like St. Luke’s, the scarcity of physicians, together with the brand new fee, will be devastating for his or her staffing. St. Luke’s already has hassle attracting American graduates as a result of it’s not an instructional residency, which is usually extra interesting to American graduates who need to compete for sure hospital positions after ending their residency.
“We need so many physicians in this country, and there just aren’t enough American medical graduates to fill all of those positions. We have to draw from other places,” Lundry mentioned.
These international candidates open up decisions for Lundry to select residents who’ve prior work expertise and “astronomical” scores on American qualifying exams.
“Those people can be stellar stars,” she mentioned.
Dr. Chuck Thigpen, chief scientific and technique officer at ATI Physical Therapy, wonders if he can keep the job provides he made to worldwide college students graduating from US universities in January.
ATI has 450 open scientific roles throughout the United States, and 49 workers on the H-1B visa and 97 workers on the H-4 visa, which is a non-immigrant visa for spouses and single kids beneath 21 of the H-1B visa holders.
“There are way more jobs than we have even applicants applying for those jobs, so there’s not enough qualified therapists with licensure to fill our current workforce needs,” Thigpen mentioned.
With these shortages and federal cuts to the health care industry, an exorbitant fee on hiring immigrants “sort of just piles on,” Thigpen mentioned.
Thigpen says the true loss will likely be borne by Americans who really want the assistance.
“We’re already under severe pressure of just margin to keep clinics open and be sustainable,” he mentioned. “So, if I now layer on an additional $100,000 per hire to bring in, I can’t do it. I just have to close clinics.”
The H-1B fee has forged doubt on the longer term for worldwide graduates.
Mykola, who fled the struggle in Ukraine in 2024, was a training physician in Kyiv. (He requested that his full title not be included out of worry of backlash.)
He arrived within the United States by Uniting for Ukraine (U4U), a US authorities humanitarian parole program that allowed non-public US residents to sponsor and assist assist Ukrainians who left due to the struggle. Mykola determined to organize for exams to qualify to work as a health care provider right here.
As a parolee, he doesn’t qualify for the change-of-status course of, in line with Rakhel Milstein, an immigration lawyer and founder and CEO of Milstein Law Group. “He has to do a new H-1B petition, notifying the consulate. And those are exactly the people who are impacted,” Milstein mentioned.
Mykola has spent 1000’s of {dollars} on qualifying exams, together with textbooks, credential verification and utility charges.
“I’m mainly applying to programs that are in underserved areas,” he advised NCS, including that he has seen how well being care will be accessible in Ukraine and that he want to assist make it extra accessible within the United States.
“I’m willing to help those underserved areas,” he mentioned. “I know that for me, it’s not really a problem to serve there.”
Now, he waits for a residency program to just accept his utility and hopes to be sponsored for an H-1B visa so he can depart his parolee standing behind. But with the brand new $100,000 fee, he wonders if these sponsorship provides will come.