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A woman takes a vision test for a new pair of glasses at a mobile dental and medical clinic in Terre Haute, Ind., in August. 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 (Spencer Platt\/Getty Images).<\/p>\n
In Kentucky, patients drive up to two hours to see Dr. Manikya Kuriti, one of the few endocrinologists who serve the rural communities surrounding Louisville.<\/p>\n
Kuriti\u2019s husband, a pulmonologist, drives from Louisville to small hospitals an hour south and north, in Indiana, to help small teams treat critically ill patients.<\/p>\n
Rural communities have long struggled to recruit and retain doctors. Many rural hospitals are struggling financially, and have had to eliminate services or even shut down. The shortage of providers is critical in rural communities that tend to have higher<\/a> rates of chronic illness and early death compared with their urban counterparts.<\/p>\n Many immigrant physicians help fill those gaps thanks in part to the H-1B visa<\/a>, which allows skilled foreign workers to come work in the U.S. Both Kuriti and her husband came to the U.S. via the H-1B visa.<\/p>\n But last month, President Donald Trump announced a new $100,000 fee for H-1B visas. The announcement quickly drew criticism from leading medical organizations, which note immigrant physicians make up a significant portion of the health care workforce. They\u2019re concerned the move will hinder the flow of immigrant doctors to the U.S. and exacerbate the nation\u2019s doctor shortage, which is expected to worsen in the coming decades.<\/p>\n 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 payment. They argue that the move is unlawful and that the president doesn\u2019t have the authority to circumvent Congress to collect such revenue. The plaintiffs \u2014 represented by the South Asian American Justice Collaborative, the Justice Action Center and others \u2014 include the AFL-CIO Committee of Interns and Residents and Global Nurse Force.<\/p>\n Last month, the American Medical Association and more than 50 other organizations sent a letter<\/a> to the Department of Homeland Security urging the administration to exempt international medical school graduates from the fee.<\/p>\n According to projections by the Association of American Medical Colleges, the U.S. could see a shortage<\/a> of up to 86,000 doctors by the year 2036, the groups emphasized in the letter.<\/p>\n The president\u2019s order says the secretary of homeland security can, at her discretion<\/a>, waive the $100,000 requirement for prospective H-1B workers in specific industries if it\u2019s in the \u201cnational interest and does not pose a threat to the security or welfare\u201d of the nation.<\/p>\n The AMA\u2019s joint letter urges the secretary \u201cto clarify that all physicians, including medical residents, fellows, researchers, and those working in nonclinical settings\u201d are \u201ccritical to our national interest\u201d and therefore exempt.<\/p>\n The Department of Homeland Security referred a Stateline request for comment to the White House, which hadn\u2019t responded as of Thursday.<\/p>\n Dr. Tom Price, who served as secretary of health and human services during Trump\u2019s first term, said in an interview that medical workers should be exempt from the $100,000 fee.<\/p>\n \u201cA significant fee for any further H-1B visas in the area of the health care workforce will be detrimental \u2026 especially in low-served areas or rural areas,\u201d said Price, a former Republican member of Congress.<\/p>\n In 2024, nearly a quarter of licensed physicians in the U.S. were foreign-trained and roughly 46% of foreign-trained physicians practiced in rural areas, according to data from the Federation of State Medical Boards cited by the AMA. And between 2001 and last year, almost 23,000 H-1B physicians worked in communities considered underserved.<\/p>\n Trump and other critics of H-1B visas\u00a0say that some employers, especially tech companies, have abused the program by using it to replace native-born workers with foreigners who will work for less, rather than using it to fill jobs they can\u2019t find Americans to do. But tech companies would have an easier time paying the fee<\/a> than many hospitals.<\/p>\n Elizabeth Ricci, a Tallahassee, Florida-based immigration lawyer and national expert in immigration law, said at least one hospital in the South has asked her whether it must pay the fee itself or whether it can pass it on to the prospective physician. Before the new $100,000 fee, employers had to pay between $2,000 and $5,000 <\/a>for each potential H-1B employee.<\/p>\n \u201cIt\u2019s probably going to require litigation to get that guidance,\u201d Ricci said. \u201cAnd in the meantime, people aren\u2019t filing because they are concerned that they\u2019re going to be responsible for $100,000,\u201d Ricci added.<\/p>\n The University of Washington said it has paused H-1B visa petitions.<\/p>\n \u201cThe uncertainty around visas creates a significant disruption for talented individuals who hope to train and work at UW Medicine,\u201d Dr. Tim Dellit, CEO of UW Medicine and dean of the UW School of Medicine, wrote in email to Stateline. \u201cIt represents a loss for the research and education communities, as well as for the vital clinical care we provide on behalf of our patients and the broader community.\u201d<\/p>\n Iowa, West Virginia and North Dakota \u2014 conservative-leaning, largely rural states \u2014 had the largest share of physician applicants under the H-1B visa relative to total physicians, according to a study<\/a> published in July in the Journal of General Internal Medicine.<\/p>\n When Dr. Sridevi Alla arrived in Mississippi two decades ago, she was part of a small team of hospitalists at a rural clinic in Kosciusko, in the central part of the state. She now practices in Jackson, and on any given day, she could be treating patients having a stroke, complications from untreated diabetes, or someone with dangerously high blood pressure.<\/p>\n \u201cIn a state which already has a physician shortage, I think that\u2019s definitely going to affect primary care,\u201d Alla said, referring to the payment.<\/p>\n Alla said she considers herself a Mississippian, and that she\u2019s always felt welcomed and valued by hospital leadership and patients.<\/p>\n \u201cWe never felt [like] foreigners in the medical community,\u201d she said. \u201cMaybe from an immigration standpoint we are, but not around being a part of health care.\u201d<\/p>\n She noted Mississippi\u2019s high rates of diabetes, heart disease, infant mortality and poverty.<\/p>\n \u201cThis is where I was trained. I sincerely feel like the need is there,\u201d she said. \u201cEven though maybe there are opportunities out [there], I never sincerely looked outside because I felt this is the home after home.\u201d<\/p>\n Many physicians come to the U.S. under the temporary J-1 visa, which allows medical graduates to come for training and graduate medical education. They are then required to return to their home countries for at least two years. But they can apply for a waiver to stay if they work in rural or underserved communities, which allows them to transfer to an H-1B visa<\/a>.<\/p>\n In addition to the new $100,000 fee, the administration has proposed a four-year limit<\/a> on how long J-1 visa holders can stay in the U.S.<\/p>\n AMA President Dr. Bobby Mukkamala, a Flint, Michigan, otolaryngologist, said both his parents immigrated to the U.S. from India to complete their medical residencies.<\/p>\n \u201cIn that same hospital where they did their training back in 1970, here in 2025, we still have 30 to 35 international medical graduates that come in,\u201d he said.<\/p>\n Now, hospitals have to \u201cfigure out where we\u2019re going to get $100,000 per doctor.\u201d<\/p>\n \u201cWe need to not just have the physicians talking about this, but to add to that the understanding of our own lawmakers,\u201d he said.<\/p>\n Dr. Mette Strand, an internal medicine physician at Livingston HealthCare, a 25-bed critical access hospital serving rural Montana, emigrated from Norway. Many of those who mentored her, including specialist colleagues, are immigrants, too.<\/p>\n \u201cCutting IMGs [international medical graduates], we would be in further need of doctors in an already underserved state,\u201d she said. \u201cI would have a hard time seeing how we would run our hospitals and our clinics.\u201d<\/p>\n Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org<\/a>.<\/em><\/p>\n![\"Endocrinologist](\"https:\/\/missouriindependent.com\/wp-content\/uploads\/2025\/10\/immigrant-doctors-couple.jpg\")
National interest<\/h4>\n
\u2018The need is there\u2019<\/h4>\n
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Four-year limit proposal<\/h4>\n