New visa rules and fees have disrupted international physician recruiting at healthcare systems across the nation this fall, leaving many worried about long-term effects on existing staff shortages.
Foreign clinicians typically enter the U.S. on two types of work visas: H-1B and J-1. H-1B visas are a temporary professional worker visa for a specialty occupation with “dual intent” — meaning holders can apply for a green card while on H-1B status. Last month, President Donald Trump imposed a $100,000 payment to accompany any new H-1B visa petitions, starting Sept. 21. A few days later, the Trump administration was reportedly considering exempting physicians and medical residents from the fee after healthcare industry groups raised concerns.
While White House officials have said the fee will address abuses of the visa program, healthcare experts have warned it could worsen personnel shortages. Hospitals and health systems often use H-1B work visas to sponsor physicians and medical residents, and the fee would make it more difficult for them to train and practice. Immigrants make up 27% of physicians and surgeons, 22% of nursing assistants and 16% of registered nurses in the U.S.
Here is how systems are responding:
1. Cleveland Clinic, one of the largest sponsors of H-1B visas, told Becker’s that the system is assessing the potential effects and awaiting additional information from the federal government.
2. A spokesperson from The University of Texas MD Anderson Cancer Center in Houston told Becker’s the system is awaiting further guidance from federal authorities and will remain in close coordination with The University of Texas System.
3. A June study found that Iowa, North Dakota and West Virginia employ the highest percentage of healthcare workers with H-1B visas. While systems wait for more guidance, many are advocating for changes in hopes of reducing the fees.
“The fee imposed on H-1B Visas is especially prohibitive to nonprofit health systems that serve rural communities, which are already facing severe financial pressures,” Ryan Miller, chief human resources officer at Trinity Health in Minot, N.D., told Becker’s. “Along with the advocacy work of the AHA, we’re voicing our concerns to our elected representatives in Washington and encouraging our team members, board members and community leaders to do the same. With other healthcare immigration legislation, like the Healthcare Workforce Resilience Act cosponsored by our own Senator Cramer, receiving broad bipartisan support, we’re very hopeful that physicians and nurses will be exempted from this new fee, as having the talented people needed to provide quality healthcare is a pressing issue of national interest.”
4. Fred Hutch — one of the state of Washington’s top healthcare employers of H-1B visa holders — is pausing new hires due to the “rapidly changing federal situation around employer sponsorship of immigrant workers,” a cancer center spokesperson told The Seattle Times. The system has approved 181 applications in the past five years.
5. The University of Washington also paused H-1B petitions for its medical and academic institutions, including UW Medicine, shortly after the Sept. 19 announcement. The university has offered jobs to about 20 people requiring H-1B sponsorship, with about 75% expected to work for UW Medicine, officials said.
6. The impact of the immigration changes are ongoing, but many worry it could have long-term effects on recruiting in areas that already struggle with shortages, and could add millions in labor costs.
“The U.S., and in particular our rural areas, are experiencing crisis-level shortages of the physicians and nurses needed to deliver high-quality care, and this shortage is only projected to become more acute in the decade ahead,” Mr. Miller said. “The communities we serve, and those like ours all throughout the nation, rely on attracting physicians who have completed their training in the U.S. medical system and hope to legally immigrate in order to build their practices and lives in the United States.”
Paige Twenter contributed to the reporting.
