Trump’s new H-1B visa fee could strain hospitals, workforces: 8 notes

On Sept. 19, President Donald Trump issued a proclamation imposing a $100,000 payment to accompany any new H-1B visa petitions. The administration said the fee will combat “systemic abuse” of the H-1B visa program, but healthcare experts said it will worsen worker shortages.

Here are eight things to know.

1. The executive order said the H-1B nonimmigrant visa program was created to bring temporary workers to the U.S. to perform additive, high-skilled jobs, but its long-term abuse is a security threat.

“The large-scale replacement of American workers through systemic abuse of the program has undermined both our economic and national security,” the proclamation said. “Some employers, using practices now widely adopted by entire sectors, have abused the H-1B statute and its regulations to artificially suppress wages, resulting in a disadvantageous labor market for American citizens, while at the same time making it more difficult to attract and retain the highest skilled subset of temporary workers, with the largest impact seen in critical science, technology, engineering, and math fields.”

2. The new fee associated with the visa is designed to stop companies from replacing American workers with foreign ones. However, American Medical Association President Bobby Mukkamala, MD, told Bloomberg the fee “risks shutting off the pipeline of highly trained physicians that patients depend on, especially in rural and underserved communities.”

3. Healthcare employers often use H-1B visas to sponsor medical residents and physicians. The fee would make it harder for them to train and practice. Recruiting foreign-born physicians is crucial for communities and patients, “including in rural and other areas where there are well-documented shortages of healthcare workers,” the American Hospital Association said in a statement to Bloomberg.

4. Rochester, Minn.-based Mayo Clinic, Cleveland Clinic and Memphis, Tenn.-based St. Jude Children’s Research Hospital are some of the industry’s top sponsors of H-1B visas. Mayo has more than 300 approved visas, Bloomberg reported. Paying the new fee for those visas could add millions to the labor costs at these systems.

5. The $100,000 fee applies to new H-1B visas as of Sept. 21. It does not apply to previously issued H-1B visas or any renewals.

6. Immigrants account for 27% of physicians and surgeons, 22% of nursing assistants and 16% of registered nurses in the U.S. As of June, 6,653 international physicians had been accepted into U.S. residency programs, and about 1,000 had not yet secured visas. It is unclear how many residents were delayed or have been unable to start their assignments because of visa restrictions.

7. This is the latest in a string of changes to visas in 2025. In May, the White House limited travel from seven countries and banned travel from 12 others. The restrictions included a suspension of J-1 visa applications, which is a program for foreign-based physicians to train in the U.S. During the pause, which ended June 18, international physicians were instructed to make their social media accounts public. 

8. The J-1 is a temporary visitor exchange visa with a two-year home country return requirement. The H-1B visa is a temporary professional worker visa for a specialty occupation with “dual intent,” meaning visa holders can apply for a green card while on H-1B status. The H-1B also requires employer sponsorship.

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