On September 19, President Donald Trump signed a proclamation introducing a $100,000 fee for all new H-1B visa applications. The administration says the measure aims to curb “systemic abuse” of the program, but healthcare leaders warn it will worsen staffing shortages.
Here are eight key points:
Purpose of the H-1B Program
The H-1B visa is designed to bring highly skilled, temporary workers to the U.S. for specialized roles. However, the proclamation claims long-term misuse has become a national security concern, pointing to employers who allegedly replace American workers with lower-paid foreign counterparts particularly in STEM fields thereby weakening wages and competitiveness.
Goal of the Fee
The administration hopes the $100,000 fee will deter companies from using foreign workers in place of Americans. Yet, American Medical Association President Dr. Bobby Mukkamala cautions it could cut off access to highly trained physicians, especially in *rural and underserved communities.
Impact on Healthcare
Hospitals frequently rely on H-1B visas to bring in medical residents and physicians. Industry leaders say the fee will make recruitment harder in areas already facing severe healthcare worker shortages.
Major Healthcare Sponsors Affected
Top institutions like the Mayo Clinic, Cleveland Clinic, and St. Jude Children’s Research Hospital sponsor hundreds of H-1B visas. At Mayo alone, with over 300 approved visas, paying this fee could add millions to labor costs.
Scope of the New Rule
The $100,000 charge applies only to new H-1B visas filed after September 21. It does not affect existing visas or renewals.
Immigrant Contribution to Healthcare*
In the U.S., immigrants make up 27% of physicians and surgeons, 22% of nursing assistants, and 16% of registered nurses. As of June, 6,653 international physicians had matched into residency programs, but around 1,000 still lacked visas many facing delays or inability to start due to restrictions.
Recent Visa Policy Changes
This fee is the latest in several immigration shifts in 2025. In May, travel from seven countries was restricted, 12 others were banned, and J-1 visa processing often used for foreign physicians was suspended until June 18. During the pause, applicants were asked to make social media accounts public.
J-1 vs. H-1B Explained
The J-1 visa is for cultural/educational exchanges and requires recipients to return to their home country for two years before reapplying to the U.S. The H-1B visa allows skilled professionals in specialty occupations to work in the U.S. with employer sponsorship, and holders can pursue permanent residency (“dual intent”).
