What you need to know about the intersection of health care and immigration

The U.S. health care system’s reliance on internationally educated physicians and clinicians is nothing new. In fact, immigration has kept the U.S. health care system afloat for at least the last 40 years. Today, immigrants account for 27% of all physicians at U.S. hospitals, and 17% of licensed registered nurses were educated outside of the United States. Overall, 20% of health care workers (including physicians, nurses, pharmacists, home health aides and others) are foreign-born.

Immigration has been in the headlines like never before. While public debate has focused heavily on border security, asylum and refugee restrictions, travel bans and enforcement, far less attention has been paid to the critical role legal, employment-based immigration plays in sustaining the U.S. health care workforce. This comes at the very moment when legal immigration reforms are needed more urgently than ever.

Historically, health care employers have used a variety of immigrant and non-immigrant visa programs to employ urgently needed clinicians and nonclinical professionals. Here is a quick look at the most used visa programs.

Common visa programs used in health care

Permanent Residency (Green Card, or Employment-Based Visa)

This category is used primarily to recruit internationally educated registered nurses. The program has existed in its current form for more than 30 years and is widely regarded as the gold standard of U.S. visas. While the opportunity to obtain permanent residency for applicants and their immediate family members is a significant advantage, high costs and long processing times (generally ranging from 12 to 36 months) reduce the overall attractiveness of this option. Unpredictable processing timelines remain a major challenge for employers.

H-1B (Non-Immigrant Visa)

The H-1B is one of the most well-known and controversial visa programs used to bring international workers to the United States. Although most commonly associated with the information technology industry, the H-1B has also served as a primary pathway for health care employers to hire allied health professionals, physicians and, more recently, registered nurses in limited circumstances.

H-1B status can provide work authorization for up to six years, but visa holders ultimately need a pathway to permanent residency. Historically, few H-1B petitions were filed for registered nurses because nursing was not classified as a specialty occupation requiring a bachelor’s degree. Recent changes recognizing that registered nurse positions usually require a bachelor’s degree have, in theory, opened the door to broader use of H-1B visas for nurses.

J-1 Visa Program

Health care employers primarily use the J-1 visa program to bring foreign-trained physicians, also known as international medical graduates, to the United States for residency and fellowship training. Within this category, the Conrad 30 Waiver allows hospitals to retain these physicians in underserved areas after training. Physicians may then transition to H-1B status and eventually permanent residency. Without this program, many rural communities would have no access to physician services.

TN (Trade NAFTA/USMCA) Visa

The TN visa category was established under the 1994 North American Free Trade Agreement and retained under its successor, the U.S.-Mexico-Canada Agreement. While limited to approximately 60 specific occupations, TN visas are highly valued by eligible Canadian and Mexican citizens and by U.S. health care employers because they are relatively fast and inexpensive to obtain.

Eligible health care occupations include dentists, dietitians, medical laboratory technologists, nutritionists, occupational and physical therapists, pharmacists, physicians in teaching roles only, psychologists, recreational therapists, registered nurses and veterinarians.

Other Visa Options

Less commonly used immigration strategies in health care include adjustment of status for foreign student graduates of U.S. colleges and universities, asylum and refugee work authorization, and the EB-3 “other worker” category.

Current immigration issues facing health care employers

Permanent Residency Challenges
The primary challenges associated with permanent residency are lengthy processing times and annual numerical caps. Visa processing timelines often exceed employers’ planning horizons. While long-term shortages of physicians and nurses are well established, forecasting future needs for other health occupations is more difficult

H-1B Caps and Filing Fees
Different rules apply to for-profit and nonprofit employers under the H-1B program. For-profit employers are subject to annual visa caps, while most nonprofit employers are cap exempt. However, a major barrier for both is the new $100,000 visa application fee imposed on certain new H-1B petitions filed after Sept. 21, 2025.

Additional restrictions include new adjudication guidelines that prioritize higher-wage positions. When compared with salaries offered to machine learning engineers, cybersecurity experts and software engineers, wages for many physicians and nurses place health care employers at a disadvantage. As a result, most health care organizations will be effectively shut out of the H-1B program for all but a small number of positions unless they can absorb the new six-figure filing fee. Early court challenges to overturn the fee have been unsuccessful.

J-1 Visa Uncertainty
Significant uncertainty surrounds the J-1 visa program heading into 2026. The introduction of a weighted lottery favoring higher salaries and the new $100,000 H-1B filing fee have made it more difficult for J-1 physicians to transition to H-1B status, particularly in lower-paid or high-need specialties. A recent rule change eliminating the home residency requirement for some J-1 holders offers limited short-term relief, but longer-term concerns remain.

Looking ahead

Despite current immigration challenges, the persistent supply-and-demand imbalance in the U.S. health care workforce is not going away. Immigration remains one of the few viable ways for health care employers to add net new workers. Current practices (largely focused on redistributing a limited workforce among employers and relying on costly short-term contract labor) are not sustainable.

There is no question that immigrants play a vital role in the American health care system. In fact, without immigrant workers, the system would collapse. As the nation moves into 2026, urgent reforms to existing immigration programs are needed to ensure the continued contributions of international clinicians and support staff. Embracing foreign-born professionals who have already demonstrated their value would benefit not only health care employers, but all Americans.

Ron Hoppe is the Chief Executive Officer of WorldWide HealthStaff Solutions, a part of Medical Solutions Group. Ron leads an international team of Recruitment, Operations and Immigration professionals who are dedicated to bringing innovative, sustainable workforce solutions to the US and international health care organizations.