On September 19, 2025, President Donald Trump signed a Proclamation imposing a $100,000 fee on all new H-1B visa petitions, effective September 21. While initially described as an annual fee, the White House has since clarified it is a one-time payment that applies only to new applicants—not to renewals or extensions for current visa holders.
This policy shift has immediate and profound implications for the U.S. health care system, which has long relied on international physicians, nurses, and researchers to meet patient care needs.
Clarifications That Matter for Health Care Employers
- The $100,000 fee applies only to new petitions filed after September 21, 2025.
- Current H-1B physicians and other health care workers will not be charged for renewals, extensions, or reentry into the U.S.
- However, health care employers seeking to hire new international medical graduates, specialists, or researchers through H-1B will face this unprecedented financial barrier.
Enforcement and Wage Changes
The Department of Labor (DOL) is simultaneously launching Project Firewall, a new enforcement program under which the Secretary of Labor will personally certify H-1B investigations. DOL has also been directed to propose new regulations to raise prevailing wage levels. For hospitals, community health centers, and research institutions that already operate on tight budgets, this could make sponsorship even less viable.
The Physician Workforce at Risk
The timing of this policy is especially challenging given persistent physician shortages:
- 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.
- Rural and underserved areas are particularly dependent on foreign-trained doctors, many of whom come to the U.S. under H-1B status.
Recognizing this, the American Medical Association (AMA) and more than 70 other medical groups have formally petitioned DHS to exempt physicians, residents, and fellows from the $100,000 fee. They argue the policy could “cripple access to care” in communities already experiencing provider shortages.
Narrow National Interest Exception
The Proclamation does allow for a waiver if employing an H-1B worker is deemed to be in the “national interest” and poses no threat to U.S. security or welfare. Early reports suggest the White House is considering a specific exemption for doctors, though no formal guidance has been issued. Without such an exemption, hospitals and academic medical centers may be forced to reduce their reliance on international medical graduates—leaving critical gaps in specialty care, research, and teaching.
The Bigger Picture: Health Care Brain Drain
Beyond discouraging new applicants, the policy is creating anxiety among existing H-1B health care workers. Despite assurances that renewals and reentry are unaffected, many fear that the climate of enforcement could worsen. This may lead some to leave the U.S. for more welcoming destinations such as Canada, the UK, or Australia. For health care systems already struggling with workforce shortages, this could trigger a damaging brain drain at a time when patient demand is rising.
A Second Fee on the Horizon
Adding to the challenge, beginning October 1, 2025, the U.S. will impose a new $250 “Visa Integrity Fee” on most nonimmigrant visa categories, including H-1B. For hospitals sponsoring multiple clinicians or researchers, these fees quickly add up.
Conclusion: Health Care Caught in the Crossfire
While the $100,000 H-1B fee was pitched as a way to curb program abuse and protect U.S. workers, its blunt application risks undermining the health care workforce. Without an explicit exemption for physicians and other essential health professionals, hospitals, academic medical centers, and community providers could face severe staffing challenges—hurting patients most of all.