$100,000 H-1B visa fee would hit rural and high-poverty counties hardest, study finds

A new research letter published Wednesday in JAMA estimates that employers sponsored 11,080 physicians for H-1B visas in fiscal year 2024 — 0.97% of the U.S. physician workforce — with the highest dependence in rural and high-poverty counties.

The analysis comes weeks after President Trump’s Sept. 19 announcement that created a $100,000 payment requirement for new H-1B petitions. The policy went into effect Sept. 21.

“Our findings suggest that the most socioeconomically vulnerable communities will be hit hardest in terms of health care worker supply and care access by the recent visa application policy change,” said study lead author Michael Liu, M.D., M.Phil., a resident physician in the Mass General Brigham Department of Medicine. “Foreign health care workers fill critical gaps in health systems such as primary care and rural health, and millions of Americans depend on them to receive timely and high-quality health care.”

Senior author Rishi K. Wadhera, M.D., M.P.P., M.Phil., associate director of the Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center, added: “Our study provides evidence supporting proposed exemptions from H-1B visa fee increases for physicians, along with their extension to other health care workers.”

What the study found

Using Department of Labor Condition Applications for FY 2024 and county-level workforce counts, the authors estimated H-1B-sponsored clinicians accounted for:

• 0.97% of physicians (11,080 of 1,138,056)
• 0.02% of advanced practice providers (APPs) (122 of 641,605)
• 0.40% of dentists (1,004 of 251,551)
• 0.07% of other health professionals (132 of 181,495)

Reliance was uneven. The percentage of H-1B-sponsored physicians was nearly two times higher in rural compared with urban counties, and nearly four times higher in the highest-poverty versus the lowest-poverty counties.

International physicians disproportionately help fill gaps in primary care and psychiatry and often practice in areas with persistent shortages.

Policy context

On Sept. 19, the White House issued the proclamation “Restriction on Entry of Certain Nonimmigrant Workers,” requiring a $100,000 payment to accompany new H-1B petitions filed after 12:01 a.m. ET on Sept. 21. U.S. Citizenship and Immigration Services subsequently clarified that the requirement applies to new petitions and outlined a potential national-interest exemption process.

Since then, leading medical groups have urged federal officials to create health care exemptions.

On Sept. 25, the American Medical Association (AMA) + 53 leading medical societies asked the Department of Homeland Security (DHS) to categorically exempt physicians, residents and fellows, writing that the administration should “consider H-1B physicians' entry into the U.S. to be in the national-interest of the country, and waive the new application fee, so that H-1B physicians can continue to be a pipeline that provides health care to U.S. patients.”

On Sept. 26, the Association of American Medical Colleges (AAMC) joined the AMA + 53 society letter to DHS requesting an exemption for physicians and trainees.

On Sept. 29, the American Hospital Association (AHA) urged the administration to exempt health care personnel from the new fee, warning that rural and underserved communities would be most affected.

What to watch

Budget impact. A six-figure payment on new H-1B petitions materially changes the recruitment math for independent practices, rural hospitals and community health centers. Refresh workforce plans and hiring timelines.

Exemptions and guidance. Monitor DHS/USCIS guidance on national-interest exemptions and any sector-specific clarifications for physicians, residents and fellows.

Local exposure. Rural counties and those with higher poverty levels show greater measured reliance on H-1B-sponsored physicians; leaders there may see longer time-to-fill and should consider contingency staffing plans.

The bottom line

International clinicians are a small share of the overall workforce, but a larger share where access to care is most fragile.

With a $100,000 H-1B fee now in effect for new petitions — and exemptions under active consideration — staffing strategies in rural and high-poverty counties may require immediate adjustment to avoid widening care gaps.