In a dramatic shift that could reshape American healthcare, a sharp rise in H-1B visa fees is threatening to push thousands of foreign-trained doctors out of underserved areas across the United States. The new policy, announced in September 2025 under President Donald Trump’s administration, has left hospitals—especially those in rural and high-poverty communities—scrambling to cope with a potential exodus of medical professionals who have long formed the backbone of the nation’s healthcare system.
Until just a few months ago, sponsoring a foreign physician’s visa cost hospitals around $5,000. That figure has now ballooned to a staggering $100,000 per doctor, following Trump’s latest proclamation. The impact is most severe for smaller institutions and those serving rural America, which have historically depended on immigrant doctors to fill roles that many U.S.-trained physicians pass up in favor of more lucrative or prestigious positions. According to NPR, immigrants currently make up about one-fourth of all doctors in the country, with rural communities relying even more heavily on their expertise.
“This is a massive increase,” said Eram Alam, associate professor and author of The Care of Foreigners: How Immigrant Physicians Changed US Healthcare, in comments reported by Business Standard. “Smaller hospitals simply cannot absorb the new cost.” The American Medical Association has already called on the administration to exempt physicians from the higher fees, citing their crucial role in caring for millions of Americans.
Michael Liu, a 28-year-old internal medicine resident at Mass General Brigham in Boston, knows firsthand the turmoil these changes have caused. Liu, who moved to the U.S. from Toronto to pursue the “American dream,” described the moment he and his colleagues—many from Mexico and Costa Rica and holding H-1B visas—learned of the fee hike. “It was terrible to see. One of them definitely started to tear up, and the other one immediately stepped out to call their family. So there’s just a lot of uncertainty and a lot of grief,” Liu told NPR’s Yuki Noguchi.
Liu’s experience is far from unique. There are approximately 325,000 foreign-born doctors practicing in the U.S., not including nurses and other vital healthcare workers. In specialties such as primary care and oncology, immigrants represent half or more of the American doctor workforce, according to research Liu co-authored in the journal JAMA. His study estimates that about 11,000 doctors—roughly 1% of the country’s physicians—currently hold H-1B visas, but in some communities, that figure soars to 40%. High-poverty and rural counties, in particular, have a four times higher prevalence of H-1B physicians than the national average.
The roots of America’s reliance on foreign-trained doctors stretch back decades. In 1965, following the creation of Medicaid and Medicare, the U.S. began recruiting physicians from abroad in large numbers to meet the surging demand for healthcare. “Overnight, you have, you know, 25 million, approximately, people who can now access health care services,” Alam explained to NPR. During the following decade, the U.S. granted visas to 75,000 physicians, and by 1975, nearly 45% of all doctors practicing in the country were immigrants. “There were more immigrant physicians that were entering the labor force per year than there were U.S. trained physicians that were joining,” Alam noted.
For many years, the U.S. offered unparalleled pay and prestige, drawing medical professionals from India, Pakistan, the Philippines, Nigeria, and beyond. In some rural hospitals, immigrant doctors make up the entire medical staff. These physicians have not only filled vital gaps in the healthcare system but have also taken on leadership roles in hospitals and become visible figures in public life, according to Business Standard.
Yet, the new visa fee structure threatens to upend this delicate balance. Hospitals that serve America’s most vulnerable populations may no longer be able to afford the cost of bringing in foreign medical talent. The consequences could be dire: “American patients will feel the impact from that, for generations,” Dr. Julie Gralow, chief medical officer for the American Society of Clinical Oncology, told NPR. Gralow warns that the U.S. is now “undoing a lot of that by dismantling its global leadership role in medicine,” as other countries—including China, Denmark, Germany, and Australia—step in to recruit both American doctors and researchers abroad.
The loss of immigrant physicians is not only a domestic concern. Their departure from home countries, where they are often trained using local taxpayer money, exacerbates shortages in already strained healthcare systems worldwide. Alam emphasized the global implications, stating that the U.S. needs to train enough of its own doctors so it can support health systems worldwide instead of depending on immigration to fill domestic gaps.
Despite the sweeping changes, President Trump has recently struck a more nuanced tone about the value of foreign talent. In an interview with Fox News host Laura Ingraham, Trump responded to questions about deprioritizing the H-1B route by saying, “You do have to bring in talent.” When Ingraham countered, “We have plenty of talent,” Trump replied, “No, you don’t. You don’t have certain talents…” This acknowledgment, while notable, has done little to assuage the fears of hospitals and medical professionals facing the new reality.
For those on the front lines, the uncertainty is palpable. Liu, who recently secured a green card after marrying an American citizen, admitted, “It feels like my contributions—just because I was not born in this country—are less valued. I really hadn’t thought so deeply about going back home before, but definitely it’s been much more top of mind.”
Throughout its history, the U.S. has benefited immensely from the skills and dedication of immigrant doctors. Their willingness to take on challenging roles in underserved areas has been essential to the health of millions. Now, as the nation faces a critical juncture, policymakers, hospital administrators, and physicians alike are left wrestling with the question: Can the U.S. afford to lose the very people who have kept its healthcare system afloat?
The coming months will reveal whether the country can find a solution that preserves both its global leadership in medicine and the health of its most vulnerable citizens. For now, the future of thousands of doctors—and the communities that depend on them—hangs in the balance.
