Medical Groups Warn Against Visa Fees for Foreign Doctors

The American Medical Association and scores of specialty groups are urging the Trump administration to exempt foreign doctors from steep new fees for H-1B visas, saying the charges will exacerbate physician shortages, worsen patient care and drive up health care costs.

Doctors from abroad make up nearly one quarter of the physician work force in the United States. They provide much of the staffing in rural and underserved areas of the country, and many fill positions in important areas of medicine that are often shunned by U.S.-trained physicians, like primary care, psychiatry and pediatrics.

Many of the doctors are in the United States on H-1B visas, which permit educated foreign citizens to work in “specialty occupations.” President Trump this week announced plans to charge $100,000 for each new H-1B visa.

“If a hospital needs 50 foreign residents and it’s $100,000 for each one, that’s $5 million, and that’s not going to happen,” said Dr. Bobby Mukkamala, the president of the American Medical Association. “There will be shortages.”

The cost, borne by employers, will be burdensome to hospitals and health care systems, he added. Most operate as nonprofits, and in rural areas many are reducing services or closing.

If exemptions to the fee are not made for physicians coming from abroad to care for Americans, Dr. Mukkamala said, “spots at hospitals will not be filled. Wait times will go up, and people will wait even longer at emergency departments.”

Dr. Mukkamala, an ear-nose-throat surgeon in Flint, Mich., is himself the son of physicians who immigrated to the United States from India in the 1970s.

The United States is already facing a shortage of up to 86,000 physicians by 2036, according to the A.M.A. The aging population will require more care over time, as the burden of chronic disease and behavioral health conditions rises.

The new visa fees may also exacerbate the nursing shortage. The health care system depends heavily on registered nurses from other countries. As of 2022, a half million immigrant nurses worked in the United States, accounting for one in six of the nation’s more than three million registered nurses.

The visa expenses add to hospitals’ financial stress as they anticipate a heavier load of uninsured patients after cuts in health insurance subsidies and reduced Medicaid payments.

In a letter to Kristi Noem, the secretary of Homeland Security, the A.M.A. and other medical organizations asked that the new H-1B visa fees be waived for physicians.

The order imposing the fees stated that they should not apply to foreigners who are “specialty occupation workers” and whose employment “is in the national interest and does not pose a threat to the security or welfare of the United States.”

President Trump imposed the $100,000 fees on Sept. 21, saying they were needed to protect American workers, curb abuses, and ensure that only highly skilled and highly paid foreign nationals get the visas. (The new fees do not affect current H-1B visa holders.)

The White House and the Department of Homeland Security did not immediately respond to requests for comment. The proclamation said that fee exemptions could be made for sectors and companies on a case-by-case basis.

This is not the first time in recent months that visa restrictions have threatened staffing at the nation’s hospitals.

In late May, President Trump suspended new interview appointments for J-1 visas, which are required for newly minted doctors from abroad to work here as residents and interns, jobs that typically come with 80-hour workweeks and relatively low salaries. Hospitals rely on residents for adequate staffing.

New doctors from other countries account for one in six medical residents and specializing fellows at U.S. teaching hospitals. In 2024, the Educational Commission for Foreign Medical Graduates sponsored more than 15,500 doctors from over 150 countries to fill residency or fellowship training spots at 770 hospitals.

Although some hospitals have expanded training and are trying to produce more health professionals, “one of the short-term strategies used by U.S. hospitals to address personnel shortages is the use of foreign-trained health care workers,” said Colin Milligan, an American Hospital Association spokesman.

The group said it would “also work with the administration to stress the importance of including health care personnel in potential exemptions to these changes.”

Dr. Mukkamala, the A.M.A. president, said that when his parents came to the United States, “it was an open door, because the country needed physicians.”

“Now it’s not an open door,” he said. “It’s a closed door, and you’ve got to pay $100,000 to open it.”