The Health Divide: Trump’s new H-1B visa fee could worsen America’s doctor shortage

Dr. Prabir Roy-Chaudhury graduated from medical school in India and completed his residency training in Scotland before coming to the United States in the 1990s to specialize in kidney care. He has treated thousands of patients, including many veterans. He has published 175 papers. And he has advocated forcefully for government and corporate investment to develop better drugs and devices to treat kidney disease, which affects one in seven Americans — disproportionately Black, Indigenous and Latino people.

“All those 30 years of work,” Roy-Chaudhury told me. “It started off with an H-1B visa.”

H-1B visas have been in the news since September, when President Trump announced a $100,000 fee for each applicant, to be paid by the employer. Some 65% of these visas go to computer scientists and other highly skilled technology workers. Tech giants like Tesla and Amazon can probably afford the cost. 

But massive fees, new visa restrictions and aggressive immigration crackdowns threaten to severely disrupt, if not crush, health services at places like Brookdale Hospital. It’s part of a network of health centers that depend on foreign-born doctors to serve about 1 million residents of low-income and working-class neighborhoods in Brooklyn, New York. 

The U.S. is projected to face a shortage of 87,000 physicians or more in the next decade — and that estimate was made before the H-1B fee. It will hit especially hard in rural communities, where the shortage is most severe. Sadly, the impact comes just as innovative health care programs that depend on doctors from abroad are springing up. 

What will happen to clinics like the two-year-old Idaho Health Neighborhood Center in Nampa, west of Boise, which hires and trains medical school graduates from abroad to provide culturally sensitive care in a community where nearly one in five residents are refugees or immigrants? Or to Clinica de Salud del Valle de Salinas, which brings physicians from Mexico to serve farmworkers in California’s agricultural heartland?

“You’re going to see a lot of clinics losing doctors,” said Breno Braga, a senior fellow at the Urban Institute. “That’s going to have an adverse impact on the health of the community.”

In 2023, medical and health professionals held 16,684 H-1B visas, just over 4% of the total. They are concentrated in the Northeast and Midwest. That’s only 1.5% of the nation’s physician workforce. But like Roy-Chaudhury, a professor of nephrology and co-director of the Kidney Center at the University of North Carolina, tens of thousands of practicing physicians had H-1B visas early in their careers and then became U.S. citizens. 

Under another visa category, J-1, nearly 16,000 foreign-born physicians, from 155 countries, are training and working in residency programs at 770 hospitals across the U.S. The J-1, too, has suffered policy whiplash in recent months.

Nearly three-quarters of medical residents with J-1 visas are frontline providers, training in internal medicine, family medicine or pediatrics. Once they finish training, they are seven to nine times more likely than American doctors to work in primary care. They’re also more likely to practice in federally designated Health Professional Shortage Areas. 

In 2023 Braga and colleagues studied the impact of yet another visa program for physicians. It provides a bridge from the J-1 visa for medical residents to the H-1B visa for staff physicians. To qualify, physicians must commit to practicing for three years in a medically underserved community. The study found these doctors don’t take jobs away from U.S. citizens but fill gaps in places where most American doctors don’t want to work.

“More accommodating visa policies may improve health care access for U.S. residents,” Braga and his colleagues wrote.

The medical establishment agrees. In a letter, more than 50 medical organizations, including the American Medical Association, the American Academy of Pediatrics and the American Society of Nephrology, where Roy-Chaudhury serves as president, urged the Trump administration to exempt physicians from the H-1B fee on national “health security” grounds. 

In early October, a group of unions, employers and religious groups — along with an unnamed individual described as a postdoctoral researcher from India who studies vision loss — sued to block the fee.

President Trump pledged to support the H-1B visa program during his campaign last year. He endorsed it again after he took office, only to announce the exorbitant fee several months later. Advocacy and legal challenges could press him to back down, or he could change his mind about the visa again. 

But even if doctors get a pass this time, the episode has added to an atmosphere of hostility, uncertainty and chaos that could discourage international medical graduates and clinicians from coming here. In May, the federal government abruptly stopped processing J-1 visas. Roughly 6,600 first-year residency positions — 18% of the total — were assigned to foreign-born and -educated doctors.

The government resumed processing the visas in June. But while it worked through the backlog, hundreds of doctors remained stuck at home across the globe days before their jobs were to start July 1.

Visa battles can seem distant and mind-numbingly bureaucratic to people who have never fought them. It’s up to journalists to bring home the life-and-death stakes. Anna Oakes of The City in New York wrote powerfully about the immigrant medical residents who keep Brookdale Hospital running. Her account inspired this column.

Oakes opened with the story of a young resident in internal medicine who came from war zones in Ukraine. She was shocked to discover that unlike patients at home, many in Brooklyn could not afford their prescribed medications. The government’s visa shifts and high-profile, often violent immigrant roundups weigh heavily on this doctor and her colleagues. 

“We are feeling that we are not valued,” she told Oakes. “We are feeling partially in fear, too, for ourselves.”

The director of the hospital’s residency program clearly values them. “If we didn’t have international graduates, we would close,” he told Oakes.

Like primary care, some specialties rely heavily on immigrant physicians. One survey found that more than 80% of nephrology fellowship programs, which provide specialty training after residency, had J-1 or H-1B visa holders among their clinical or research fellows. 

Roy-Chaudhury said a field with many immigrants tends to attract more. And nephrology is not a top choice among American doctors, which opens doors to professionals from abroad. Compensation “is not the best,” he said.

“There is a huge shortage of nephrologists, particularly in the exact same areas where people with H-1B visas often practice — rural areas, inner-city areas, Black and Hispanic communities.” 

If the new H-1B visa fee stands, he said, it would be a “time bomb in terms of kidney care provision to vulnerable populations.”