In August, a woman takes an eye test to fit a new pair of glasses at a mobile dental and medical clinic in Terre Haute, Indiana. Many immigrant physicians treat patients in underserved areas thanks to the H-1B visa. But last month, President Donald Trump announced a new $100,000 fee for H-1B visas. (Photo: Spencer Platt/Getty Images)
In Kentucky, patients can commute up to two hours to see Dr. Manikya Kuriti, one of the few endocrinologists serving rural communities around Louisville.
Kuriti’s husband, a pulmonologist, travels from Louisville to diminutive hospitals an hour south and north in Indiana to support diminutive teams treat critically ill patients.
Rural communities have long struggled to recruit and retain physicians. Many rural hospitals are struggling financially and have had to cancel services or even close them. The shortage of providers is critical in rural communities that typically have them higher rates of chronic disease and premature death compared to their urban counterparts.
Many immigrant physicians support fill these gaps, in part by: H-1B visawhich enables qualified foreign workers to come to work in the USA. Both Kuriti and her husband came to the U.S. on H-1B visas.
But last month, President Donald Trump announced a new $100,000 fee for H-1B visas. The statement quickly drew criticism from leading medical organizations, which noted that immigrant doctors make up a significant portion of the medical workforce. They fear such a move will hinder the flow of immigrant doctors into the U.S. and worsen a physician shortage in the country that is expected to worsen in the coming decades.
Earlier this month, labor unions and other groups filed a lawsuit in the U.S. District Court for the Northern District of California against the administration over the payout. They argue that the move is illegal and that the president does not have the authority to bypass Congress to collect such revenues. The plaintiffs – represented by the South Asian American Justice Collaborative, the Justice Action Center and others – include the AFL-CIO Intern and Resident Committee and the Global Nurse Force.
Last month, the American Medical Association and more than 50 other organizations sent a letter letter to the Department of Homeland Security, urging the administration to waive fees for graduates of international medical schools.
According to the forecasts of the Association of American Medical Schools in the USA, you can expect approx lack to 86,000 doctors by 2036, as these groups highlighted in their letter.
National interest
The president’s executive order says the secretary of homeland security can assault her discretionwill waive the $100,000 requirement for potential H-1B workers in certain industries if it is in the “national interest and does not pose a threat to the safety or welfare” of the nation.
The AMA joint letter calls on the secretary to “clarify that all physicians, including medical residents, faculty members, researchers, and those working in nonclinical settings” are “critical to our national interest” and are therefore exempt.
The Department of Homeland Security referred Stateline’s request for comment to the White House, which did not respond by Thursday.
Dr. Tom Price, who served as Health and Human Services secretary during Trump’s first term, said in an interview that medical workers should be exempt from the $100,000 fee.
“A significant fee for any further H-1B visas for health care workers will be harmful … especially in underserved or rural areas,” said Price, a former Republican member of Congress.
According to data from the Federation of State Medical Boards cited by the AMA, in 2024, nearly a quarter of licensed physicians in the U.S. were foreign-trained, and approximately 46% of foreign-trained physicians practiced in rural areas. And between 2001 and last year, nearly 23,000 H-1B physicians worked in communities considered underserved.
Trump and other critics of H-1B visas say some employers, especially tech companies, have abused the program, using it to replace native workers with foreigners who will work for less, rather than using it to fill jobs they can’t find Americans to fill. But tech companies would easier time to pay the fee than many hospitals.
Elizabeth Ricci, an immigration attorney in Tallahassee, Florida, and a national expert on immigration law, said at least one hospital in the South asked her whether she had to pay the fee herself or could pass it on to a future doctor. Before the new $100,000 fee was introduced, employers had to do this pay between $2,000 and $5,000 for each potential H-1B worker.
“Obtaining such guidance will likely require litigation,” Ricci said. “And in the meantime, people are not filing because they are afraid they will be required to pay $100,000,” Ricci added.
The University of Washington said it has paused H-1B visa petitions.
“Visa uncertainty is causing significant disruption for talented individuals who hope to train and work at UW Medicine,” Dr. Tim Dellit, CEO of UW Medicine and dean of the UW School of Medicine, wrote in an email to Stateline. “This creates a loss to the research and education communities, as well as to the vital clinical care we provide on behalf of our patients and the broader community.”
According to a study conducted in Iowa, West Virginia and North Dakota – conservative, mostly rural states – had the highest percentage of doctors applying for H-1B visas compared to all doctors. test published in July in the Journal of General Internal Medicine.
“There is a need”
When Dr. Sridevi Alla arrived in Mississippi two decades ago, she was part of a diminutive hospital team at a rural clinic in Kosciuszko, in the central part of the state. He currently practices in Jackson and on any given day may treat patients who have had a stroke, complications of untreated diabetes, or people with dangerously high blood pressure.
“I think in a state where there’s already a physician shortage, it’s definitely going to have an impact on primary care,” Alla said, referring to fees.
Alla said she considers herself a Mississippian and has always felt welcomed and valued by hospital leadership and patients.
“We never felt it [like] foreigners in the medical community,” she said. “Maybe from an immigration perspective it is, but it’s not about being part of health care.”
She noted the high rates of diabetes, heart disease, infant mortality and poverty in Mississippi.
“This is where I was trained. I honestly feel there is a need for this,” she said. “Though perhaps there are some possibilities [there]I never honestly looked outside because I felt like it was a house behind a house.
Four-year limit proposal
Many doctors come to the U.S. on a short-lived J-1 visa, which allows medical graduates to come to train and complete their medical studies. They must then return to their home countries for at least two years. However, they can apply for a residency waiver if they work in rural or underserved communities, which allows them to move to the H-1B visa.
In addition to the new $100,000 fee, the administration has proposed four-year limit on how long J-1 visa holders can stay in the US
AMA President Dr. Bobby Mukkamala, an otolaryngologist from Flint, Michigan, said both of his parents immigrated to the United States from India to complete medical training.
“The same hospital where they trained in 1970 still has 30 to 35 international medical graduates here in 2025,” he said.
Now hospitals have to “figure out where we’re going to get $100,000 per doctor.”
“We need to not only encourage doctors to talk about this issue, but also add understanding from our legislators,” he said.
Dr. Mette Strand, an internal medicine physician at Livingston HealthCare, a 25-bed critical access hospital serving rural Montana, emigrated from Norway. Many of the people who mentored her, including fellow professionals, were also immigrants.
“IMG cut [international medical graduates]we would still need doctors who are already understaffed,” she said. “It would be hard for me to imagine how we would run our hospitals and clinics.”
Stateline reporter Nada Hassanein can be reached at: nhassanein@stateline.org.
This story was originally produced by state linewhich is part of States Newsroom, a nonprofit news network that includes the Ohio Capital Journal and is supported by grants and a coalition of donors as a 501c(3) public charity.
