The sharp increase in H1B visa fees under a new United States policy has triggered a staffing crisis across rural healthcare systems. A sudden one lakh dollar fee for employers hiring new foreign professionals has forced small hospitals and clinics to freeze recruitment, leaving communities with already fragile access to care facing longer delays and worsening shortages.

For many nonprofit clinics, the previous cost of filing an H1B petition ranged from a few hundred to about a thousand dollars. The dramatic jump has shocked administrators who rely heavily on foreign trained doctors to fill critical shortages. Rural hospitals in North Dakota, Iowa, West Virginia and parts of the South have depended on international physicians for decades because they struggle to attract American graduates to remote regions with fewer resources and lower salaries.

Data from fiscal year 2024 shows that more than four percent of all approved H1B petitions were for medicine and health occupations. Roughly half of those were for physicians and surgeons. Research also indicates that rural counties employ nearly double the share of H1B doctors compared to urban areas. The new fee threatens this pipeline entirely.

Medical organizations that represent thousands of hospitals have warned the administration that essential services are at risk. Their letters urge the government to exempt healthcare workers from the fee and highlight that shortages already impact emergency rooms dialysis centers and primary care clinics.

The human toll of the policy is clearly visible in the story of Vijaya Chelikani a 30 year old nephrologist from Hyderabad. She was hired by Nephrology Associates of the Carolinas in Shelby North Carolina. Patients had already begun scheduling appointments for her arrival. The region depends heavily on kidney specialists because many elderly and chronically ill residents require regular dialysis.

When the one lakh dollar fee was announced the practice could no longer afford to sponsor her visa. They paused the hiring process and filed a request for a national interest waiver. Such waivers are rarely approved and require extraordinary justification, leaving both the clinic and the doctor in uncertainty.

Chelikani said she feels stuck and wants nothing more than to start her job and begin treating patients. She continues to wait in Hyderabad while the clinic grapples with incomplete guidance and unclear timelines.

The Shelby practice serves more than one and a half lakh people across the region. Without an additional nephrologist existing doctors are overworked and patients may soon face delays in receiving time sensitive care. Many dialysis patients cannot travel long distances several times a week. A staffing gap for even a few months can disrupt treatment schedules and increase health risks.

MedBound times connected with Dr. Munish Kumar Raizada, MD, FAAP (Neonatologist). Dr. Munish explained the process and pathway that medicos can obtain to practice in the States.

• Eighteen states now permit ECFMG certified international medical graduates to practice without completing a U.S. residency.

• These states created alternative licensure routes to address worsening physician shortages, especially in underserved regions.

• IMGs must obtain ECFMG certification, which includes passing the USMLE exams and verifying medical credentials.

• Many states require several years of prior clinical experience, supervised practice, or provisional licensure before granting full licenses.

• The traditional U.S. pathway requires both American and international graduates to complete an ACGME accredited residency.

• These newer state pathways allow supervised practice while waiving standard residency requirements.

The fee hike was introduced to discourage large corporations from hiring cheaper foreign workers. However critics argue that healthcare was not the target and rural communities are now paying the price. The crackdown arrives at a moment when rural hospitals are already preparing for reductions in Medicaid funding, which supports care for low income patients.

Reference:

1. U.S. Department of the Treasury. Financial Report of the U.S. Government: Fiscal Year 2024. Washington, D.C.: U.S. Department of the Treasury, 2024. https://fiscaldata.treasury.gov/static-data/published-reports/frusg/FRUSG_2024.pdf.

(Rh/ARC)