The Trump administration announced last week that new H-1B visas will cost $100,000, a steep increase from previous fees. While framed as a crackdown on Silicon Valley, the policy is expected to severely affect American hospitals, particularly in rural and underserved areas.
One in four US physicians is foreign-trained, many entering through the H-1B programme. These doctors disproportionately staff rural hospitals and primary care clinics where US-trained graduates rarely practise. In some facilities, every doctor is an immigrant.
The fee increase could prevent hospitals from filling residency positions, leading to longer wait times and potential clinic closures. The Association of American Medical Colleges projects a shortfall of up to 86,000 physicians by 2036, a crisis stemming from decades of underinvestment in medical education rather than immigration policy.
Congress capped funding for graduate medical education in the 1990s and has repeatedly failed to lift those limits. Since the 1960s, lawmakers have relied on immigrant doctors as a stopgap instead of expanding domestic training capacity. The 1965 Hart-Celler Act explicitly recruited foreign professionals, bringing tens of thousands of physicians from India and other nations to staff US hospitals.
Senator Walter Mondale in 1967 called the practice a "national disgrace," as it drained doctors from countries with greater health needs. The new $100,000 fee breaks with this longstanding reliance on immigrant doctors, potentially worsening healthcare access for poor and rural Americans.
