The Trump administration's recent changes to the H-1B visa application process have raised concerns among health care experts, with many fearing the program could make the industry's workforce crisis and health care disparities worse.
Last month, the White House imposed a $100,000 fee on new H-1B visa applications. Previously, fees typically ranged from $2,000 to $5,000, depending on the employer. This new fee only applies to new H-1B visa applicants and does not apply to current H1-B holders whose employers are seeking to renew their visas.
The H-1B program was created in 1990 to allow U.S. employers to temporarily hire foreign professionals in specialized fields such as health care, technology and engineering to fill workforce gaps, but the White House argued that the program was “deliberately exploited to replace rather than supplement American workers with a low-wage, low-skilled workforce.”
Beyond the cost, the White House plan aims to prioritize higher-skilled international workers. The administration is establishing a weighted lottery system that favors higher-wage H-1B applicants, saying it will protect domestic employees from wage competition and ensure that H-1B visas are used to fill positions requiring highly skilled professionals.
While the changes are intended to curb abuse of the scheme, the blanket fee applies to all industries and raises legal concerns about the government's authority and its compliance with the policy-making process. Several lawsuits have been filed challenging the measure.
For example, a coalition of health care employers, unions, and religious groups filed a lawsuit on October 3 to block the change, and a group of higher education organizations did the same on October 6.
The American Hospital Association is urging the Department of Homeland Security to exempt health care professionals from new H-1B visa changes, arguing it will exacerbate staffing shortages and increase burnout, especially in rural and underserved communities.
Providers who can't afford the fees face high costs
The U.S. health care system relies heavily on clinical workers from around the world, with the industry employing about 262,000 foreign-born doctors and about 500,000 foreign-born nurses, according to the Census Bureau and Bureau of Labor Statistics, although the vast majority are not H-1B visa holders.
Out of dire need, the country is supplementing its clinical workforce with international workers of this magnitude. According to the latest data from the Health Resources and Services Administration, the United States is expected to be short of 187,130 full-time equivalent physicians by 2037, with the shortfall most severe in rural areas. For nurses, projections from the National Center for Health Workforce Analysis indicate that the national nurse shortage will reach 6 percent by 2037, rising to 13 percent in nonmetro areas.
Most foreign-born clinicians in the country are not H-1B visa recipients; many hold green cards, use other temporary visas such as J-1 or TN visas, or are naturalized U.S. citizens. In fiscal year 2024, of the 141,205 H-1B visa petitions approved, only 8,492 were issued to workers in the health care field and another 8,492 were issued to workers in the health care field. According to data from the Department of Homeland Security, of the 258,190 H-1B visas approved for renewal, 8,445 were issued to workers in this industry.
Jimmy Lai, CEO of the Oklahoma City law firm Lai & Turner, noted that many providers still rely on H-1B workers to keep critical services running.
Unless the Department of Homeland Security grants health care providers a waiver, the new fees will leave these provider organizations facing “seven or even eight-figure annual liabilities,” Lai said.
“For community hospitals, clinics and mid-sized clinics, $100,000 per new employee is often prohibitive. These employers often rely on H-1B clinicians to fill critical shortages,” he said.
Another health care immigration lawyer, John Dawson of Musillo Unkenholt in Cincinnati, agreed that few health care providers have the ability or willingness to pay the new $100,000 per H-1B employee.
Instead, hospitals may be forced to freeze hiring, increase shifts for existing staff or rely more on expensive travel nurses, or in extreme cases close departments or facilities, Dawson explained.
He sees some hope in the legal challenges blocking new fees. The lawsuits challenge the executive branch's authority to impose fees without congressional approval, a change that plaintiffs argue violates the Administrative Procedure Act.
A variety of institutions, including medical staffing companies, unions, higher education groups, nonprofits and religious organizations, have filed lawsuits, and Dawson believes more legal challenges are likely, although many institutions are awaiting clarification on exemptions.
“One of the important things we're looking at is that the announcement talks about the national interest exemption,” he said. “We still don't have basic guidance from the government on what the situation will be, but we expect a number of healthcare-related occupations to be included in the exemption list.”
Hospitals and clinics may be forced to delay hiring or reduce services until the White House clarifies which positions qualify for the exemption.
International Clinicians Stabilize U.S. Healthcare Providers
Kara Murphy, president of health care staffing firm PRS Global, noted that health care providers rely on foreign-born clinicians not only to address workforce shortages but also to fill experience gaps. Her company specializes in international recruitment and integration, primarily for Filipino nurses working in U.S. hospitals.
Murphy explained that H-1B visas cover positions that require at least a bachelor's degree, and in the health care field, workers who receive this visa are typically professional nurses, physicians, medical laboratory scientists and physical/occupational therapists. She said hospitals that work with PRS Global often hire international staff in intensive care units, emergency rooms and other departments that use mobile staff to help address shortages.
Murphy noted that hospitals often need international employees to mentor new domestic graduates, explaining that having these experienced clinicians can help reduce burnout.
“For the hospital [we work with]when they bring in international nurses, they actually become mentors very quickly. This ultimately supports new graduates to improve retention rates. “Murphy explained.
She added that new graduate nurses at the hospital face high turnover rates, with about 30 percent leaving within their first year, due to rising burnout and violence within hospital units.
One Filipino nurse recruited through PRS Global, who spoke anonymously due to the sensitivity of current immigration issues, said she knows firsthand that rural hospitals will struggle to fill shifts if there are fewer foreign-born workers.
She said about 30 percent of the nursing staff at the rural Missouri hospital where she works comes from overseas.
“Without international nurses, staffing shortages will quickly become more severe. This will lead to greater burnout among remaining staff, potentially impacting patient safety and satisfaction,” she declared.
Potential innovation slowdown
In addition to negatively impacting the nation's clinical workforce, the new H1-B visa fees could slow the pace of innovation in the domestic healthcare industry.
About 65% of H-1B visa holders work in the technology industry, which often has significant overlap with the digital health, medical device and pharmaceutical industries. Most of these H-1B workers are from India.
Making it more difficult for foreigners to work in the tech industry could disrupt the pace of innovation in healthcare, including the development of new drugs, medical devices and artificial intelligence tools for healthcare, as a large portion of the workforce driving this research and development is made up of immigrant talent, Sujay Saha noted. He came to the United States from India on an H-1B visa 20 years ago and worked as an IT consultant. He is currently the president of Cortico-X, a business consulting company.
“It's fair to say that the United States will lose some of its edge in health care technology and health care innovation,” Saha said.
In the future, if the costs are too high to attract international workers to the United States, U.S. companies may respond to the new expenses by setting up satellite innovation centers overseas, he added.
The impact of the changes will remain unclear until the Trump administration clarifies the exemptions or Congress steps in. But without clear guidance, the combined pressures of staffing shortages and slowing innovation could ripple across U.S. health care in the coming years.
Photo: Evgenia Parajanian, Getty Images
