The Impact of Trump’s H-1B Fee on Healthcare: A Looming Crisis for Hospitals, Physicians, and Patients.
getty
In a shocking move, the White House recently announced that all new H-1B visa petitions will incur a $100,000 supplemental fee. While much of the media coverage has centered on the technology sector—a domain heavily reliant on H-1B visas for engineering talent—the ripple effects may hit hardest in healthcare. As hospitals grapple with staffing shortages, this fee could exacerbate challenges in recruiting foreign physicians, directly impacting patient care and access.
Understanding the Policy Changes
The H-1B visa program has historically been a vital pathway for skilled foreign professionals. Effective from September 21, 2025, the new ruling introduces a one-time $100,000 fee for all new H-1B petitions. Although this fee will not affect renewal applications, it applies across various sectors, including healthcare.
While the administration has hinted at possible exemptions for physicians and medical residents, no definitive measures have been established as of yet. Instead, employers and applicants might face an uncertain landscape filled with case-by-case “national interest exceptions.” As a healthcare policy advisor, I understand how rules that may appear peripheral in Washington can manifest as real barriers for hospitals aiming to recruit the talent they need—for the patients who depend on them.
Healthcare: A Sector at Higher Risk
While the new $100,000 fee has been perceived as a tech industry issue, the healthcare sector stands to be affected even more significantly due to two fundamental reasons:
1. Physicians are not interchangeable. Hospitals cannot simply substitute local talent when specific roles go unfilled. There exists a severe shortage of certain specialties—such as psychiatry, geriatrics, and basic primary care—where international medical graduates (IMGs) step in to bridge the gap.
2. Tight financial margins. Healthcare systems, particularly rural and safety-net hospitals, operate under constrained financial margins. An additional $100,000 fee, compounded with other relocation and credentialing costs, could lead them to either leave vacancies unfilled or scale back their international recruitment.
The Association of American Medical Colleges estimates a looming shortage of up to 86,000 physicians by 2036, with IMGs often playing a crucial role in alleviating this deficit.
The Varied Impact Across the Healthcare System
The implications of the $100,000 fee will not be evenly felt throughout the healthcare system. Larger academic medical centers in metropolitan regions may absorb the additional cost, whereas smaller community and safety-net hospitals may need to restrict or eliminate their international recruitment efforts. Rural hospitals, under financial strain and often relying heavily on IMGs, are at particularly high risk.
Conversely, larger healthcare systems located in immigrant-dense urban areas may continue hiring internationally, yet with those costs potentially shifted onto payers and patients. This could lead to an exacerbation of healthcare disparities, where urban facilities manage while rural and low-resourced communities fall further behind in obtaining care.
Importance of International Medical Graduates
To fully grasp the implications of the fee on healthcare, we should examine the role of IMGs:
Pipeline dependency: Many IMGs commence their medical careers in the United States on J-1 visas for residency training and then transition to H-1B visas to continue practicing. This critical pathway has been in place for decades.
Serving essential roles: IMGs are disproportionately represented in federally designated Health Professional Shortage Areas, often accepting opportunities in rural communities or underserved urban clinics.
Diverse care delivery: IMGs provide culturally and linguistically appropriate care to immigrant populations, thereby improving healthcare outcomes and patient satisfaction.
If hospitals are forced to scale back their sponsorship of these vital workers, the repercussions will hit precisely where America needs physicians the most.
Anticipated Adjustments in Healthcare Recruitment
While it is unlikely that hospitals and health systems will cease international hiring, the newly imposed fee will certainly alter their approach. A facility that might have sponsored several IMGs may limit itself to one or two, focusing solely on positions that cannot be filled domestically. As renewals are exempt from the fee, hospitals will increasingly prioritize retaining their existing international staff. Some may even explore alternative pathways, such as emphasizing J-1 waivers or accelerating green card sponsorships to bypass the H-1B process altogether. Industry associations are also intensifying their advocacy for exemptions specifically for physicians to prevent a critical shortfall in the workforce.
Effects on Patient Experience
Although the impact on patients may not be immediate, it will inevitably manifest. Lengthened wait times are highly likely, particularly in primary care and psychiatry. Hospitals in rural areas may be forced to limit services, merge practices, or even shut down due to an inability to recruit enough physicians. The reliance on temporary contract doctors may increase, leading to higher costs and decreased continuity of care. Even for those hospitals attempting to maintain direct patient services, savings often come from backend functions like housekeeping and data analysis. Fewer resources in these areas could delay patient room turnover, increase emergency room wait times, and compromise safety protocols. If hospitals choose to absorb the additional fee, that burden may very well transfer to patients through heightened charges or stringent negotiations with insurers, widening healthcare inequities for vulnerable populations.
Potential Changes and Uncertainties
The policy landscape could evolve. For instance, the Department of Homeland Security might grant national interest exceptions for medical professionals, judicial actions could potentially restrain implementation, and mounting pressures from healthcare groups might persuade lawmakers to carve out exemptions. Until such changes are solidified, the mere uncertainty could hinder international recruitment, marking the $100,000 fee as disruptive even before any payments are made.
Health and Economic Implications
This situation presents not just an immigration issue but also a critical health and economic dilemma. A policy that aims to reshape the labor market may inadvertently aggravate a significant health crisis—the shortage of clinicians. As concerns already revolve around equity in healthcare access based on geography and income, this fee poses a risk to increasing disparities. The pressing question for CEOs and policymakers is not merely whether the nation can sustain foreign physicians, but rather whether America can afford not to have them.
Immigration has historically been pivotal in shaping America’s healthcare workforce. With the new $100,000 H-1B fee, that lever could come at a devastating cost. If this surcharge discourages hospitals from looking internationally for physicians, the most impacted will be those with the least options: rural families, aging communities, low-income populations, and individuals who are already facing long wait times for care.
Healthcare leaders view this not as an abstract policy discussion but as a pressing operational challenge. The coming months will reveal if solutions via exemptions, waivers, or legislative amendments can avert a crisis—or whether this policy becomes a full-fledged roadblock in the mission to staff America’s healthcare systems.
