Medical groups are calling for the Trump administration to exempt physicians and other healthcare workers from a recent executive order on visas that could drastically limit the number of immigrants living and working in the U.S.
Last month, President Trump issued the executive order targeting what he called "systemic abuse" of the H-1B visa program, which allows employers to temporarily hire foreign workers in occupations that require a bachelor's degree or higher, noting that the program undercuts wages for American workers.
The order directs the Secretary of Homeland Security to impose a $100,000 application fee on every H-1B visa petition, to be paid by a prospective employer during the initial application process. It previously cost employers $2,000 to $5,000 per petition, depending on the size of the company.
The American Medical Association (AMA) and dozens of other medical specialty societies urged Secretary Kristi Noem to exempt physicians from the order in a Sept. 25 letter, while the American Hospital Association requested an exemption for healthcare workers in a separate letter.
"Maintaining a robust healthcare workforce in the U.S. that can address the health needs of all our U.S. patients is in the best interest of the health of our nation," the AMA and other groups wrote in their letter, which cites the projected shortfall of 86,000 physicians by 2036 as proof of the need to expand, rather than shrink, the physician workforce.
"There is a growing need for a larger physician workforce that the U.S. cannot fill on its own, in part because the U.S. does not have enough people in the younger generation to care for our aging country," the letter noted. "Accordingly, H-1B physicians play a critical role in filling this void, especially in areas of the U.S. with high-need populations."
AMA President Bobby Mukkamala, MD, told MedPage Today that 83 million Americans live in areas with insufficient access to primary care.
"Bringing somebody to a rural or underserved area is a challenge period. And when we can't get somebody that's trained here, and we can't afford somebody that's trained elsewhere, it's just going to be an empty spot, and people will suffer," he said.
In 2024, about one in four licensed physicians in the U.S. were trained abroad. Many of these physicians practice in underserved and rural areas, the AMA said.
Deepu Sudhakaran, MD, a general and bariatric surgeon in St. Louis, Missouri, told MedPage Today that there's a lot of anxiety among international graduates across the country.
"People are really worried about what's going to be happening regarding this fee hike ... and that's why we are hopeful that this 'national interest' [fee] waiver would be applied to physicians," he said, referring to language in the executive order that gives the Secretary of Homeland Security the discretion to make exceptions if she determines that hiring certain foreign workers is "in the national interest and does not pose a threat to the security or welfare of the United States."
The AMA's letter specifically calls on the Secretary to include "all physicians, including medical residents, fellows, researchers, and those working in non-clinical settings" in defining categories of H-1B workers covered by such an exception.
Despite skepticism from some in the medical community, international physicians are in no way "substandard" to American physicians, Sudhakaran said, pointing to a 2017 study in The BMJ that found that mortality outcomes were equal or slightly better among patients treated by general internists in U.S. hospitals who graduated from foreign versus U.S. medical schools.
Sudhakaran noted that international medical graduates also often experience a lot of pressure and anxiety from having only temporary status. "Every day we walk out the door wanting to do the right thing for the American public ... we are part of the community ... and [don't] want to be seen as outcasts," he said.
Asked whether the AMA would pursue legal action if no waiver is granted, Mukkamala said the group is still in the "conversation phase ... Legal action is when we've had a conversation that didn't get us anywhere."
The AMA has not received a response to its letter as of press time.
https://www.medpagetoday.com/publichealthpolicy/workforce/117796
