The
Trump
administration’s
recent
changes
to
the
H-1B
visa
application
process
are
causing
concern
among
healthcare
experts,
with
many
worried
that
the
plan
could
make
the
industry’s
workforce
crisis
and
care
access
gaps
more
severe.
Last
month,
the
White
House
imposed
a
$100,000
fee
on
new
H-1B
visa
petitions.
Before,
the
fee
typically
ranged
between
$2,000
and
$5,000,
depending
on
the
employer.
This
new
fee
applies
only
to
new
H-1B
visa
applicants,
not
current
H1-B
holders
whose
employers
are
seeking
to
renew
their
visas.
The
H-1B
program,
established
in
1990,
was
created
to
allow
U.S.
employers
to
temporarily
hire
foreign
professionals
in
specialized
fields
like
healthcare,
technology
and
engineering
to
fill
workforce
gaps
—
but
the
White
House
argues
that
the
program
has
“been
deliberately
exploited
to
replace,
rather
than
supplement,
American
workers
with
lower-paid,
lower-skilled
labor.”
In
addition
to
the
fee,
the
White
House’s
plan
also
aims
to
prioritize
international
workers
with
higher
skills.
The
administration
is
establishing
a
weighted
lottery
system
that
favors
H-1B
applicants
with
higher
wages,
saying
this
will
protect
domestic
employees
from
wage
competition
as
well
as
ensure
that
H-1B
visas
are
used
to
fill
roles
that
require
highly
skilled
professionals.
While
these
changes
are
intended
to
curb
abuse
of
the
program,
the
blanket
fee
applies
to
all
industries
and
has
prompted
legal
concerns
about
the
administration’s
authority
and
its
adherence
to
policymaking
procedures.
Multiple
lawsuits
have
already
been
filed
to
contest
the
measure.
For
instance,
a
coalition
of
healthcare
employers,
unions
and
religious
groups
filed
a
lawsuit
to
block
the
change
on
October
3,
and
a
group
of
higher
education
organizations
did
the
same
on
October
6.
The
American
Hospital
Association
has
urged
the
Department
of
Homeland
Security
to
make
healthcare
professionals
exempt
from
the
new
H-1B
visa
changes,
arguing
that
they
would
worsen
staffing
shortages
and
increase
burnout,
particularly
in
rural
and
underserved
communities.
Steep
costs
imposed
on
providers
that
can’t
afford
them
The
U.S.
healthcare
system
relies
heavily
on
clinical
workers
from
across
the
world,
with
data
from
the
Census
Bureau
and
Bureau
of
Labor
and
Statistics
showing
that
the
industry
employs
about
262,000
foreign-born
physicians
and
about
500,000
foreign-born
nurses,
though
the
vast
majority
are
not
H-1B
visa
holders.
The
nation
is
supplementing
its
clinical
workforce
with
international
workers
at
this
scale
out
of
dire
necessity.
According
to
the
Health
Resources
and
Services
Administration’s
most
recent
data,
the
U.S.
is
expected
to
have
a
shortfall
of
187,130
full-time
equivalent
physicians
by
2037,
with
rural
areas
experiencing
the
most
severe
gaps.
For
nurses,
projections
from
the
National
Center
for
Health
Workforce
Analysis
indicate
a
6%
nationwide
shortage
by
2037,
rising
to
13%
in
non-metro
areas.
Most
of
the
country’s
foreign-born
clinicians
are
not
recipients
of
H-1B
visas
—
with
many
of
them
holding
green
cards,
using
other
temporary
visas
like
J-1
or
TN
visas,
or
being
naturalized
as
U.S.
citizens.
During
the
fiscal
year
2024,
only
8,492
of
the
approved
141,205
H-1B
visa
applications
went
to
workers
in
the
healthcare
field,
and
another
8,445
of
258,190
the
H-1B
visas
approved
for
renewals
went
to
workers
in
this
sector,
according
to
the
Department
of
Homeland
Security.
Still,
many
providers
still
rely
on
H-1B
workers
to
keep
critical
services
running,
noted
Jimmy
Lai,
CEO
of
Oklahoma
City-based
Lai
&
Turner
Law
Firm.
Unless
the
Department
of
Homeland
Security
grants
an
exemption
for
healthcare
providers,
the
new
fee
would
expose
these
provider
organizations
to
“seven-
or
even
eight-figure
annual
liabilities,”
Lai
said.
“For
community
hospitals,
clinics
and
mid-size
practices,
$100,000
per
new
hire
is
often
prohibitive.
These
employers
typically
rely
on
H-1B
clinicians
to
fill
critical
shortages,”
he
stated.
Another
healthcare
immigration
attorney
—
John
Dawson
of
Cincinnati-based
law
firm
Musillo
Unkenholt
—
agreed
that
very
few
healthcare
providers
will
be
able
or
willing
to
pay
the
new
$100,000
fee
per
H-1B
hire.
Instead,
hospitals
could
be
forced
to
freeze
hiring,
increase
shifts
for
existing
staff
or
rely
more
on
costly
travel
nurses
—
or,
in
extreme
cases,
close
departments
or
facilities,
Dawson
explained.
He
finds
some
hope
in
the
legal
challenges
underway
to
block
the
imposition
of
the
new
fee.
The
lawsuits
are
challenging
whether
the
executive
branch
has
the
authority
to
institute
the
fee
without
approval
from
Congress,
with
plaintiffs
arguing
the
change
violates
the
Administrative
Procedure
Act.
Various
institutions
—
including
healthcare
staffing
firms,
unions,
higher
education
groups,
nonprofits
and
religious
organizations
—
have
filed
lawsuits,
and
Dawson
thinks
more
legal
challenges
could
be
on
the
way,
though
many
are
waiting
for
clarification
on
exemptions.
“One
important
thing
that
we’re
looking
at
is
that
the
proclamation
talks
about
the
national
interest
exemption,”
he
remarked.
“We
still
don’t
have
basic
guidance
from
the
government
as
to
what
that’s
going
to
look
like,
but
we’re
hoping
that
there
will
be
a
number
of
healthcare-related
occupations
that
are
included
on
that
exemption
list
that
goes
through.”
Until
the
White
House
clarifies
which
roles
qualify
for
exemptions,
hospitals
and
clinics
could
be
forced
to
delay
hiring
or
reduce
services.
International
clinicians
stabilize
U.S.
providers
Healthcare
providers
rely
on
foreign-born
clinicians
not
only
to
address
workforce
shortages,
but
also
to
fill
experience
gaps,
pointed
out
Kara
Murphy,
president
of
healthcare
staffing
firm
PRS
Global.
Her
firm
focuses
on
international
recruiting
and
integration,
primarily
for
Filipino
nurses
working
in
U.S.
hospitals.
H-1B
visas
cover
positions
that
require
at
least
a
bachelor’s
degree,
and
in
healthcare,
workers
receiving
this
visa
are
typically
specialty
nurses,
physicians,
medical
laboratory
scientists
and
physical/occupational
therapists,
Murphy
explained.
She
said
the
hospitals
that
PRS
Global
works
with
usually
hire
international
staff
for
areas
like
the
intensive
care
units,
emergency
department
and
other
departments
that
use
floating
staff
to
help
with
shortages.
Murphy
noted
that
hospitals
often
need
international
hires
to
mentor
new
domestic
graduates,
explaining
that
having
these
experienced
clinicians
to
lean
on
can
help
reduce
burnout.
“For
the
hospitals
[we
work
with],
as
they
bring
in
international
nurses,
they
actually
become
preceptors
pretty
quickly.
That
ends
up
supporting
the
new
grads
to
increase
retention,”
Murphy
explained.
Hospitals
are
facing
high
turnover
rates
among
nurses
who
are
recent
graduates
—
with
about
30%
leaving
during
their
first
year
—
due
to
rising
burnout
and
violence
within
hospital
units,
she
added.
One
Filipino
nurse
recruited
through
PRS
Global
—
who
spoke
anonymously
due
the
sensitive
nature
of
current
immigration
issues
—
said
she
knows
firsthand
that
rural
hospitals
will
struggle
to
fill
shifts
if
the
pipeline
of
foreign-born
workers
diminishes.
At
the
hospital
she
works
at
in
rural
Missouri,
about
30%
of
the
nursing
staff
comes
from
overseas,
she
stated.
“Without
international
nurses,
staffing
shortages
would
get
worse
very
quickly.
That
would
lead
to
higher
burnout
among
the
remaining
staff,
potentially
affecting
patient
safety
and
satisfaction,”
she
declared.
Potential
innovation
slowdown
In
addition
to
having
a
negative
impact
on
the
nation’s
clinical
workforce,
the
new
H1-B
visa
fee
could
also
slow
down
the
pace
of
innovation
in
the
domestic
healthcare
sector.
About
65%
of
H-1B
visa
holders
work
in
the
tech
sector,
which
often
has
significant
overlap
with
the
digital
health,
medical
device
and
pharmaceutical
industries.
The
majority
of
these
H-1B
workers
hail
from
India.
Making
it
more
difficult
for
foreigners
to
work
in
the
tech
sector
could
disrupt
the
speed
of
innovation
in
healthcare
—
including
the
development
of
new
drugs,
medical
devices
and
healthcare
AI
tools
—
because
a
meaningful
portion
of
the
workforce
driving
this
R&D
is
made
up
of
immigrant
talent,
noted
Sujay
Saha.
Twenty
years
ago,
he
came
to
the
U.S.
from
India
on
a
H-1B
visa
to
work
as
an
IT
consultant,
and
he
currently
serves
as
president
of
Cortico-X,
a
business
consulting
firm.
“The
U.S.
is
going
to
lose
some
of
its
edge,
so
to
speak,
in
the
healthcare
tech
and
healthcare
innovation
space,”
Saha
remarked.
Down
the
road,
U.S.
companies
may
respond
to
the
new
fee
by
setting
up
satellite
innovation
centers
abroad
if
costs
become
too
prohibitive
to
bring
international
workers
to
the
U.S.,
he
added.
Until
the
Trump
administration
clarifies
exemptions
or
Congress
steps
in,
the
impact
of
these
changes
is
still
unclear.
But
without
clear
guidance,
the
combined
pressures
of
staffing
shortages
and
innovation
slowdowns
might
ripple
across
U.S.
healthcare
for
years
to
come.
Photo:
Evgenia
Parajanian,
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