Why Trump’s H-1B fee threatens hospitals, foreign physicians, and patients.
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When the White House announced that all new H-1B visa petitions would now carry a $100,000 supplemental fee, headlines quickly focused on tech. Silicon Valley has long relied on H-1B visas to recruit engineers from abroad. Yet looking beyond code-writers in California, the fee could have a bigger effect on the deepening doctor shortage in communities already struggling.
With hospitals struggling to find enough staff, this visa fee could make it tougher to bring in foreign physicians — worsening problems with access, fairness and patient care.
The Policy Shift in Context
The H-1B program has long served as a gateway for highly skilled foreign workers. The new presidential proclamation requires employers to pay a one-time $100,000 supplemental fee for new H-1B petitions submitted after Sept. 21, 2025. The fee does not apply to renewals, but it applies broadly across industries, from software engineering to medicine.
The administration has floated the possibility of exemptions — particularly for physicians and medical residents — but as of this writing, there are no blanket carve-outs. Instead, some could request case-by-case “national interest exceptions,” creating uncertainty for employers and applicants alike. As a healthcare advisor, I see firsthand how policies that seem abstract in Washington can quickly become real barriers for hospitals trying to recruit talent — and for patients who need timely, affordable care.
Why Healthcare May Feel the Pinch More Than Tech
At first glance, the fee looks like an IT problem. Tech giants like Google, Microsoft and Infosys file thousands of H-1B petitions each year. For them, $100,000 per head adds up quickly. But healthcare executives point out two crucial differences:
1. Physicians are not interchangeable. Hospitals can’t simply “hire locally” if a role goes unfilled. Certain specialties — psychiatry, geriatrics, rural primary care — already suffer from domestic shortages. International medical graduates often step into those gaps.
2. Margins are tighter. Unlike cash-rich tech firms, many health systems, especially rural hospitals and safety-net providers, operate on razor-thin financial margins. A $100,000 upfront cost, on top of relocation, licensing and credentialing, can make the difference between hiring abroad and leaving a position vacant.
The U.S. is projected to face a shortfall of up to 86,000 physicians by 2036, according to the Association of American Medical Colleges. Many international medical graduates begin in U.S. residencies via J-1 visas, then transition into H-1B status — a path now threatened.
How This Could Vary Across the System
The impact of the $100,000 fee won’t be uniform. Well-resourced academic medical centers in major cities may absorb the cost, while smaller community and safety-net hospitals could be forced to scale back international recruitment altogether.
Rural hospitals, already under financial strain and struggling to attract U.S. physicians, are particularly vulnerable. These facilities often depend on international medical graduates to sustain primary care and critical specialties. In contrast, larger health systems in immigrant-dense metro areas may continue hiring abroad, but with costs passed along to payers and patients.
The result is a likely widening of disparities: urban, well-funded hospitals may manage, while rural and under-resourced communities risk falling further behind in access to care.
Why International Medical Graduates Matter
To understand why this fee lands hardest on healthcare, it helps to look at international medical graduates themselves.
Pipeline dependency: Many IMGs begin in the U.S. on J-1 visas for residency training, then transition to H-1Bs to continue practicing. That step — J-1 waiver to H-1B sponsorship — has been a critical bridge for decades.
Filling the toughest jobs: IMGs disproportionately serve in federally designated health professional shortage areas. They are more likely than U.S. graduates to accept jobs in rural communities or underserved urban clinics.
Diversity of care: IMGs also help patients in immigrant communities receive culturally and linguistically concordant care, improving outcomes and patient satisfaction.
If hospitals curtail sponsorships because of cost, the bottleneck hits right where America needs physicians most.
The Likely Response
Hospitals and health systems aren’t likely to abandon international hiring altogether, but the new fee will change how they approach it. Instead of sponsoring 10 international medical graduates, a hospital might sponsor two, focusing only on roles that truly cannot be filled domestically.
Renewals, which are not subject to the surcharge, will take on added importance as systems work harder to retain the international staff they already have. Some organizations may shift toward alternative routes, such as leaning more on J-1 waivers, exploring telehealth solutions or accelerating green-card sponsorship to bypass the H-1B altogether.
At the same time, industry associations are ramping up pressure on the administration to exempt physicians from the fee, warning that the policy could deepen an already critical shortage of doctors.
The Patient Experience: What Changes at the Bedside
For patients, the effects may not be immediate, but they will be felt. Wait times could grow longer, especially in primary care and psychiatry. Rural communities may see hospitals cut services, consolidate practices or even close when they cannot recruit enough physicians.
To fill gaps, systems may rely more on temporary contract doctors, which drives up costs and weakens continuity of care. Even when hospitals try to avoid cutting direct patient services, the savings often come from behind-the-scenes functions that still affect care. Fewer housekeeping staff, for example, can mean longer turnover times for patient rooms, which delays transfers from the emergency department and increases ER wait times. Reductions in data analysts may slow a hospital’s ability to track adverse events and adapt safety protocols. And if hospitals absorb the surcharge, some will likely pass it along through higher charges or tougher negotiations with insurers.
Most troubling, the burden won’t be shared evenly — urban areas may cope, while rural and underserved populations face widening inequities in access and outcomes.
Possible Off-Ramps and Uncertainties
The policy may still shift. DHS could grant national interest exceptions for physicians, courts could delay or narrow implementation and mounting pressure from healthcare groups might push lawmakers to carve out an exemption. But until those changes take shape, the uncertainty alone could freeze international hiring — making the $100,000 fee disruptive long before it is ever collected.
The Bigger Picture: Health and Wealth Entwined
What looks like an immigration story is also a health and wealth story. A policy designed to reshape the labor market could worsen one of America’s most pressing health crises: the shortage of clinicians. In a system where access already depends too much on geography and income, the fee risks widening divides. For CEOs and policymakers, the question is not just whether America can afford foreign physicians. It’s whether America can afford not to have them.
Immigration has always been a lever in America’s healthcare workforce. With the H-1B fee, that lever now comes at a steep price. If the $100,000 surcharge deters hospitals from hiring abroad, the patients who suffer will be those with the fewest alternatives: rural families, aging communities, low-income populations and those already waiting too long for care.
Healthcare leaders see this not as a distant policy debate but as a live operational challenge. Whether through exemptions, waivers or legislative fixes, the coming months will determine whether the policy ends up being a speed bump — or a roadblock — in America’s struggle to staff its hospitals and clinics.
