Seismic changes have been announced by the White House with regards to the H1B visa. While the changes are applicable and will have ripple effects in many fields, healthcare is one that could be impacted disproportionately. This will have systems-wide as well as individual level ramifications for doctors throughout the country and world.

What are the changes to the H1B visa?

The Trump administration just announced that new H1B visa applications will incur a one-time $100,000 charge. This is a drastic increase compared to the current fee of $5,000.

Initially, there was widespread panic and fear that this would be an annual charge or apply to existing H1B visa holders. Many employers started to recommend that any H1B visa holders abroad should return to the US immediately. However, after clarification, this is not the case.

The new $100,000 fee is only applicable upon approval of the visa and applies only to new applications.

Even so, the impact could be broad across multiple sectors. The general reason for doing this is to reduce the number of unskilled workers coming to the US in an effort to favor increasing jobs for US workers. The idea is that the $100,000 price tag will scare away employers from sponsoring immigrant workers who do not bring a significant value to the company i.e. they are unskilled. However, skilled workers bringing great value would still be a good enough reason for their sponsoring company to pay the $100k fee.

The logic is there, regardless of which side of the political aisle you fall on. However, there is a unique issue when it comes to medicine…

How will these H1B visa changes impact healthcare?

There are currently around 43,000 residency spots in medical training programs in the US. Approximately 1/3 of those spots are filled by international medical graduates. And about 25% of those spots are filled by H1B visa holders. The remainder are largely J1 visa holders (more on this later).

The reason that residency works is because medical students need a training program to become independently practicing doctors while hospitals/practices need cheap labor for the hospitals to run as efficiently as possible.

With that in mind, let's look at the economics involved under the new light of these changes:

• Residents earn a low salary – in the range of $67,000 on average in 2025
• If a residency program/hospital has to pay a $5,000 H1B visa charge to fill a spot, this still makes economic sense
• If a residency program/hospital has to pay a $100,000 H1B visa charge to fill a spot, this still stops making economic sense

The result?

Less programs sponsoring H1B visa holders to join their residency program. Which means less fully trained independent physicians in the healthcare workforce in the US.

There is also a good chance this disproportionately impacts lower paying specialties that form the backbone of the patient care such as family medicine and primary care.

But what about J1 visas?

A secondary effect is that likely many residency programs will stop sponsoring H1B visas to sponsor J1 visas.

The main difference here is that J1 visas carry with them a requirement that the holder returns to their country of origin after training and spends at least 2 years practicing there. There are also certain programs where they can stay in the US if they work in a rural or underserved area for 3 years.

So this is definitely another option. But it certainly limits the physician visa holder more and may result in fewer IMG spots in residency programs.

Why does this matter?

The simple reason is that the U.S. faces a projected shortage of up to ~86,000 physicians by 2036. That's scary.

It's not hard to see why this is the case:

• Lower physician compensation
• Higher administrative burden
• Higher student loan burden with less federal support
• Reduced autonomy
• Rising rates of burnout/moral injury
• Increasing litigation

And so on…

In the long term, the solution is to improve these factors to encourage more US students to go into medical school and become doctors. It is still a great career!

But, in the short term, the US needs doctors. And anything that raises cost/complexity for IMG hiring (including H-1B fees and stricter rules) risks intensifying shortage. And again, this is especially the case in underserved areas and some primary care and hospitalist roles where IMGs are vital.

A possible solution

It is still possible as details of these changes emerge that there will be a waiver for doctors, nurses, and healthcare workers as it is in the best interest of the United States.

Personally, I hope this is the case. I unfortunately do not see any of the long term solutions to the systematic issue of our country's doctor shortage being solved anytime soon. So the waiver would help mitigate the potential damages to healthcare.

How will these H1b visa changes impact you as a doctor?

Let's zoom in now and go from a systems level view to a personal view. How will these changes impact individual doctors?

From the perspective of future international doctors applying for visas to attend US residency programs, it's pretty simple

You will likely need to pursue a J1 visa. Unless there is a waiver added in the H1B visas for healthcare workers.

But let's look from the perspective of current, practicing physicians in the US (whether born in the US or on a current H1b visa to whom these changes do not apply)

The supply and demand curve in medicine is tilting towards increased demand for doctors given the current and future shortages in the US. And, as I just explained, these shortages are only going to worsen due to this new announcement.

As a result, as doctors, we find ourselves with tremendous leverage. Hospitals, clinics and practices need our services. Don't let any administrator try to tell you otherwise because it is simply not the case no matter how they try to obfuscate it.

This is an opportunity to:

• Ask for more money
• Re-negotiate your contract to more favorable terms
• Look for new job opportunities that may suit you better
• Go on your own to form a private practice (you know demand for your services is on the rise)

Our job as doctors is to care for patients. But that does not mean that we should completely ignore the economic and financial factors that give us the best ability to provide top notch care. Unfortunately, ignoring our finances has led to a lot of the factors that are currently dissuading future doctors and worsening the doctor shortage.

Take this opportunity to evaluate your current practice and seek opportunities to better align it with your values! These posts can help:

• 7 Do’s and Don’ts of Building a Successful Medical Practice
• 3 Ways I Defined My Value Ahead of My Contract Negotiations
• How to Start Your Own Medical Practice in 2025: A Step-by-Step Guide for Any Physician
• 5 Successful Strategies for Doctors to Negotiate Their Non Compete Clause

What do you think? Will these H1B visa changes impact healthcare in the US? What do you expect in your practice? Is the doctor shortage concerning to you? Let me know in the comments below!