Could 30-day PERM processing ease health care's workforce planning problem?

Staffing problems in the health care world are certainly nothing new. There remains a stubborn shortage of nurses and physicians. Support roles are consistently difficult to keep filled too, and independent practices are often left to compete with large health systems for the same shrinking pool of workers. It's a no-win situation, and every little bit of progress helps.

Immigrants play a critical role in staffing health care roles. They make up 27% of physicians at U.S. hospitals, while 20% of the overall workforce in the health care sector is foreign-born. For the many practices out there already running lean operations, delays in legal pathways for such workers can make it even more difficult to build staffing while maintaining patient access.

Among the biggest obstacles in hiring these workers can be the permanent labor certification process, or PERM. In July, the Department of Labor (DOL) noted that PERM applications were taking an average of 372 days to move through the process. That lengthy window makes hiring much harder to plan around. Employers may not be able to pinpoint when a sponsored worker can move to the next stage. This complicates decisions around recruiting, scheduling, expansion and how long existing staff will need to cover vacancies.

But a new bipartisan proposal in Congress could improve that problem by narrowing the window down to just 30 calendar days. The PERM Backlog Reduction Act of 2026 would create an optional $1,200 premium-processing track requiring DOL to process Form ETA-9089 within 30 calendar days.

For the health care sector, especially physician practices using employment-based sponsorship, if passed, this bill would be a vast improvement for staff planning.

The bottleneck sits inside a bigger workforce problem

PERM often serves as one of the first steps in the process for employers sponsoring a worker on a green card, which includes many EB-3 cases. It helps to ensure that employers are first looking to the U.S. labor market, making certain no qualified domestic workers are available.

By waiting around a year just for the PERM process, a huge chunk of an employer's planning horizon gets eaten up. In the critical work of health care, staffing must be able to move forward while that paperwork sits in the queue. In the meantime, a practice is likely to lose another employee, experience increased volumes of patients or see another clinician retire.

It can be an exceedingly tough and frustrating process to deal with.

What the bill would actually change

Paying the fee isn't a requirement for employers sponsoring immigrant workers. They have the option of choosing between the typical, drawn-out process and the accelerated one. For those employers willing to pay the $1,200 fee, DOL is then required to expedite processing of ETA-9089 within 30 days.

The fees wouldn't simply pay to move applications to the front of the line. Any revenue generated would go to additional DOL staffing, training, case processing, systems improvements and fraud detection, while also requiring enough funding to support faster prevailing wage determinations. In theory, that could add capacity to the broader system rather than just speeding up premium cases at everyone else's expense.

The broader idea is to add resources to a badly backlogged system, not simply to expedite some cases.

Why physicians and practices should care

Of course, not every physician practice pursues PERM cases. And PERM does not apply to every international health care worker the same. Still, though, physicians managing practices should keep their attention on the larger workforce implications.

Independent practices don't have the luxury of absorbing staffing gaps as easily as larger health systems, where there may be more people available to distribute the workload over. Losing just one hard-to-replace employee can affect scheduling and even patient access as the workload gets unloaded onto everyone else. If lawful foreign recruiting is part of a practice's long-term staffing strategy, such long processing times can make that strategy much less effective.

While narrowing the window down to 30 days wouldn't instantly place a worker on the practice floor, it would remove a major piece of uncertainty early in the process, and that's worth paying attention to.

What this bill would not fix

It's important to point out, too, that the bill would not turn EB-3, for example, into a 30-day visa process.

PERM is only one stage of the full process. Employers and workers could still be dealing with delays related to things like visa availability, priority dates, and U.S. Citizenship and Immigration Services (USCIS) and consular processing. The legislation wouldn't create additional green cards or get rid of requirements to recruit U.S. workers first.

This proposal should be viewed as one fix to one bottleneck across a system of bottlenecks.

A better workforce strategy uses more than one path

The overall workforce shortage in health care isn't going to be unraveled by expediting a single immigration form.

That's why a truly holistic strategy is important, including things like stronger domestic recruiting, better onboarding, incentivizing to reduce turnover and providing workers with clearer growth opportunities. Practices also need to have a good understanding of the positions that are consistently hard to fill and whether or not lawful immigration makes sense as another pipeline to maintain the workforce needed for continuity of patient care.

For some practices, EB-3 can be part of that mix too, especially for permanent, full-time positions that remain hard to fill, including certain entry-level and support roles when qualified U.S. workers can't be found.

And that's where the PERM Backlog Reduction Act could make a meaningful difference. It won't create new workers. It could, however, make one existing legal pathway far more predictable.

For physicians leading independent practices, predictability has real value. The less time that is spent waiting on one stage of the process, the better practices can confidently plan their staffing. It's not simply achieving faster immigration for the sake of speed. The realistic goal is building a legal workforce system that works well enough that employers can effectively plan around it.

John Dorer is CEO of EB3.Work, a workforce solutions company that helps U.S. employers address labor shortages through lawful and compliant staffing strategies.