A federal policy that went into effect Sept. 21 will require employers to pay a $100,000 fee to sponsor highly skilled workers from other countries.
This policy, however, may disproportionately impact areas in the U.S. already facing severe healthcare shortages, according to an analysis published Oct. 29 in JAMA.
Here are five takeaways from the report:
1. The analysis is based on data from H-1B visas approved for healthcare workers in 2024, covering 3,240 U.S. counties. About 1% of physicians in the U.S. — or 11,000 — were sponsored under H-1B visas in 2024. Counties with the highest poverty levels had four times as many H-1B-sponsored physicians than those with the lowest poverty levels, researchers found. Similar trends were observed for advanced practice providers and other healthcare workers, though they accounted for smaller shares of the workforce.
2. Researchers said that their findings support the need for the Trump administration to exempt physicians and other healthcare workers from the fee.
“Increasing visa fees could exacerbate workforce shortages and worsen access to care, particularly in rural and high-poverty communities,” the researchers said. Rural areas already experience the most significant healthcare shortages. “Physicians on H-1B visas are far more likely than their domestic counterparts to fill critical gaps in healthcare delivery systems, such as primary care and psychiatry.”
3. Hospitals have been urging federal officials to exempt healthcare workers from the policy — first announced in September — warning the steep fees would likely deter many providers from recruiting international workers, compounding existing staffing shortfalls and forcing service reductions.
4. . As of June, more than 4,000 research centers and hospitals sponsored visas, according to federal data cited in a Bloomberg News report, which also showed Rochester, Minn.-based Mayo Clinic, Cleveland Clinic and Memphis, Tenn.-based St. Jude Children’s Research Hospital as among the industry’s highest sponsors of the visas. Mayo Clinic sponsors more than 300 visas.
5. In a statement following the order’s release, the American Hospital Association emphasized the role the visa program plays in hospitals’ recruitment efforts, particularly in rural areas.
“One of the short-term strategies used by U.S. hospitals to address personnel shortages is the use of foreign-trained healthcare workers,” the AHA said. “The AHA is reviewing the recent memo from the Department of Homeland Security and evaluating the potential impact of these policy changes on hospitals and the communities they serve. We will also work with the administration to stress the importance of including healthcare personnel in potential exemptions to these changes.”
