President Trump has instituted a $100,000 price for H-1B visas. The reason for this price in the Sept. 19, 2025, presidential proclamation was to prioritize the hiring of American employees as a substitute of foreigners. Principally, that foreigner had higher be at the least $100,000 higher than a comparable American, or corporations will rent the American. Commerce Secretary Howard Lutnick referred to as the H-1B visa program the “most abused visa” and additional defined that this price was meant to cease tech corporations from exploiting this system. The price is meant to cease corporations from “spamming the system” and driving down wages.
Like many bulletins by the Trump administration, this one got here all of the sudden and brought about a number of chaos on a weekend (the weekend I wrote this) as individuals scrambled to know what was occurring. Then, it was nearly instantly modified/clarified after the preliminary announcement. The $100,000 fee was initially understood to be an annual price, however it isn’t; it is a one-time price. It additionally solely applies to NEW visa holders, not these already right here on a visa.
We do not touch upon each financial motion taken by the administration, however this is a matter value discussing right here at WCI. A number of medical doctors prepare within the US on H-1B visas, and a few attendings stay on them for fairly a while. How will this price have an effect on future international medical doctors?
How Visas Work
Earlier than we get into the doctor-specific points, we most likely want a broader dialogue about visas. I did not know a lot about them previous to penning this put up, and most WCIers most likely do not both. A visa is a cross to enter a rustic, comparable to america. Folks from nations that take part within the Visa Waiver Program (42 nations, largely European) shouldn’t have to get a visa for brief vacationer or enterprise stays. Listed below are the nations in this system:
In case you’re from one other nation not on that listing, you must get a visa. Even in the event you’re from a VWP nation, in the event you’ve traveled to Iran, Iraq, Libya, Cuba, North Korea, Somalia, Sudan, or Yemen, you will additionally must get a visa even for a brief go to. A visa would not assure entry. It’s a required however not ample situation. An immigration officer can nonetheless deny you entry. A visa just isn’t a passport both. You at all times want a passport, however you solely generally want a visa.
There are greater than 180 several types of visas, broadly divided into immigrant visas and non-immigrant visas. Non-immigrant visas want a function, comparable to tourism, work, research, or medical remedy. For our functions immediately, we’re largely speaking about non-immigrant visas to review and work. Foreigners could research in US medical faculties (thus turning into AMGs) identical to People can research in international medical faculties (thus turning into IMGs). A foreigner, whether or not an IMG or AMG, will generally apply to match right into a US residency or fellowship. Since medical doctors typically receives a commission higher within the US than wherever they got here from and since they prefer it right here or have relationships right here, they usually attempt to keep completely after finishing their coaching.
The letter within the title of a visa has a that means.
- B — Vacationer
- F and M — Pupil
- H and L — Non permanent work
- J — Non permanent training or cultural change
- E — Treaty merchants or traders
- O — Athletes and entertainers
- C — Transit by the US
- I — Journalists
There are additionally numerous varieties of visas inside every class. For instance, listed below are some H visa classes:
- H-1B — For employees in “specialty occupations” that require a excessive degree of training or specialised expertise.
- H-2A — For non permanent or seasonal agricultural work.
- H-2B — For non permanent or seasonal non-agricultural work.
Usually, foreigners in US medical faculties are on an F-1 visa. Residents and fellows may be on an H-1B visa, though I consider most are actually on a J-1 visa. Roughly 3% of US medical college students are foreigners, however since they’re often on F-1 visas, this new price doesn’t apply to them. Roughly 6,600 (18%) non-residents matched into residency in 2025. That is a MUCH greater share than 3%, and the proportion tends to be highest in main care residencies. Thirty-nine p.c of inner drugs residents are IMGs (though clearly not all of these are non-residents). I could not discover the precise variety of residents and fellows at the moment on an H-1B visa, however I might love so as to add it to this put up if in case you have a dependable supply.
What Is the Distinction Between H-1B and J-1 Visas?
H-1B visas require employer sponsorship, and they’re for non permanent, specialised employees. However they could be a direct path to a inexperienced card (everlasting residency). There are annual limitations and caps on H-1B visas except the employer qualifies for an exemption. Principally, H-1B visas provide extra flexibility to remain within the nation and work after residency. The Division of Labor oversees H-1B visas.
Downsides of an H-1B visa embody:
- Visa is tied to a selected employer, resulting in potential job loss or concern of retaliation for complaining
- May additionally result in decrease wages in some jobs on account of a scarcity of different choices (no good BATNA)
- Annual lottery system makes it tougher to get the visa within the first place (though I’m now instructed that the lottery would not apply to docs)
- Six-year most length
- New one-time visa price ($100,000)
- Employer prices are greater to run this system, each financially and in time and problem
- Employers are required to pay the “prevailing wage” (most likely an upside for the foreigner)
J-1 visas are sometimes sponsored by organizations just like the Instructional Fee for Overseas Medical Graduates (ECFMG). They’re for academic and cultural change, with the expectation that the doctor will return to their dwelling nation. They require a two-year dwelling residency requirement after completion of this system, or a waiver, to remain within the US longer. Extra residency applications settle for J-1 visas for preliminary coaching, and extra international residents are on J-1s than H-1Bs. You can not apply for everlasting residency whereas on a J-1, although—that is referred to as “twin intent.” The ECFMG and sponsors oversee J-1 visas.
Downsides of a J-1 visa embody:
- Two-year dwelling residency requirement earlier than making use of for citizenship
- Strict adherence to accredited program (i.e., no moonlighting)
- Poor sponsor oversight resulting in poor working circumstances, lack of promised coaching or cultural expertise
- Will need to have medical health insurance, pay taxes, and keep away from welfare
- Some classes have a five-year restrict (docs sometimes rise up to seven)
- 24-month ban on repeat participation
- No medical appointments
- One-time SEVIS price ($220)
There was a motion a number of years in the past towards extra residents being on H-1Bs than on J-1s, however that pendulum has swung again in the previous few years.
Extra info right here:
Touchdown a Doctor Job within the US Whereas on a J-1 Visa
IMG Monetary Survival Information to Residency within the US
What Is This ‘H-1B Spamming’ That the Administration Would not Like?
H-1B spamming is fraud, gaming the H-1B lottery system. It is when a number of corporations (which can all have the identical proprietor) submit quite a few lottery registrations for a similar international employee to extend that employee’s odds of choice. It’s apparently incessantly utilized by tech staffing and consulting corporations. Beginning in 2023, a number of functions for a similar employee turned extra widespread than single functions, so it truly is an issue. Presumably, the price will cease this, though it’s prone to produce other results as effectively.
How Is the New Charge Going to Have an effect on Medical doctors?
Now that we now have some background info, we will speculate about how that is going to have an effect on medical doctors. First, it isn’t going to have an effect on residents on a J-1 in any respect. It is also not going to have an effect on medical doctors who have already got an H-1B visa. We’re actually speaking solely about future residents. I believe the principle impact right here is that the pendulum between H-1B and J-1 will swing even additional towards the J-1 facet and that there might be few H-1 B residents in any respect in a number of years. It is simply going to be simpler for hospitals to do J-1s moderately than fork out $100,000 a resident to rent these on H-1B visas.
The draw back of coaching on a J-1, after all, is that you just’re most likely not staying right here after coaching. So, the general impact is that we’ll have fewer international medical doctors, and, thus, fewer medical doctors general. Our residency applications might be coaching medical doctors who will not be going to work within the US, at the least for a few years after coaching. Definitely, we’ll have fewer main care medical doctors. It would most likely be a bit of simpler for US medical doctors to match into residency and to seek out jobs afterward, notably in main care. With fewer main care medical doctors, these docs could make more cash, however entry to them might be extra restricted.
Extra info right here:
How the ‘One Large Lovely Invoice’ Act Will Have an effect on Medical doctors
Trump Will Permit You to Make Harmful Strikes in Your 401(ok), Together with Including Crypto
Trump Accounts — What to Know About This ‘Child Bonus’ from the One Large Lovely Invoice
What Ought to I Do If I Am on an H-1B?
Nothing. This price would not apply to you.
What Ought to I Do If I Need to Get an H-1B to Prepare within the US?
Wait a number of months and let this all get sorted out. We’ll must see if hospitals and residency applications are nonetheless prepared to pay this price so that you can fill their program. In case you have wealth, you could possibly presumably pay for half or all of this price your self (though I am instructed this isn’t allowed), making you extra enticing to a residency program. Maybe H-1B price mortgage applications will pop as much as assist, as effectively. Possibly that is not the finish of the world since many FMGs have no scholar loans.
Is One thing in This Publish Incorrect?
Virtually certainly. We’ll repair it as quickly as you level it out or the foundations change once more. We all know many WCIers are on these visas and hope you’ll assist us all to know this challenge higher by submitting feedback beneath.
What do you consider this new coverage? What are the possible results to be? What do you assume will occur to the medical occupation if H-1B employees (or their employers) should pay this price?
