Lawmaker Says H‑1B Visas Crucial to Fix Doctor Shortage; Internet Scoffs

(NORTH CAROLINA) Rep. Greg Murphy’s defense of using H-1B visas for doctors has reignited a heated debate. He says they are “critical” to keeping rural clinics open. Online critics push back, arguing the United States 🇺🇸 should “train our own.”

The policy fight comes as national groups warn the physician shortage is worsening fast, and international medical graduates (IMGs) are already filling many gaps, especially in small towns and high‑need neighborhoods.

What happened and why it matters now

On August 10, 2025, Rep. Greg Murphy (R‑NC), a practicing surgeon and member of the House GOP Doctors Caucus, argued that H‑1B visas are essential for rural care. His post drew quick backlash from commenters who say domestic training should solve the problem.

Clinics in underserved areas, however, often rely on IMGs—many on H‑1B or transitioning from J‑1 waivers—to staff primary care, emergency rooms, and surgery. That reliance makes immigration policy a health‑care policy issue for many communities.

The shortage by the numbers

• The Association of American Medical Colleges projects a shortfall of up to 86,000 physicians by 2036.
• About 42% of doctors are over 55, raising near‑term retirement risks.
• The American Medical Association says non‑U.S. citizen IMGs serve where needs are highest. Nearly 21 million people live in areas where foreign‑trained doctors are at least half of all physicians.

These figures explain why the physician shortage—not politics—drives many hiring decisions.

How IMGs reach shortage communities

Three pathways dominate today:

• J‑1 visas for residency and fellowship. Doctors must return home for two years unless they win a waiver, often through the state‑run Conrad 30 program, which places them in shortage areas.
• H‑1B visas for “specialty occupation” jobs. Many hospital roles are cap‑exempt because they’re with nonprofit, university‑affiliated employers or tied to waivers. That allows year‑round filing without the lottery.
• Employment‑based green cards for long‑term stability. Backlogs—especially for Indian and Chinese physicians—can stretch for years and push doctors to stay on temporary status longer than planned.

Policy analysts at the Niskanen Center note that IMGs can plug gaps quickly but face immigration bottlenecks that affect retention.

What Congress is weighing in 2025

• The AMA backs H.R. 1201, the “Doctors in our Borders Act,” which would raise Conrad 30 slots from 30 to 100 per state/commission, expanding the J‑1‑to‑H‑1B pipeline for shortage areas.
• The AMA also supports the “Conrad State 30 and Physician Access Reauthorization Act” (H.R. 1585/S. 709) to renew and improve the J‑1 waiver program.

As of August 11, 2025, both are proposals with strong medical community support; final passage is pending.

Cap realities and long waits

• The general H‑1B cap is 85,000, picked by lottery. But many physician jobs are cap‑exempt, allowing hiring any time of year.
• Standard H‑1B time is up to six years, with extensions possible if the employer starts the green card process.
• Extended green card backlogs mean many doctors stay on temporary status longer, which can deter them from settling in rural posts.

According to analysis by VisaVerge.com, steady policy on cap‑exempt roles and faster green card timelines would help clinics keep doctors where they’re most needed.

What Rep. Greg Murphy and critics are saying

Rep. Greg Murphy calls H‑1B visas “critical” for rural access. His opponents argue the system should expand U.S. medical school and residency positions instead. Conservative voices are divided; some acknowledge that training capacity, funding limits, and retirement waves leave little short‑term alternative to continued IMG hiring.

The data supports both a near‑term and a long‑term track: immigration tools to meet urgent demand, and domestic training growth to build a stable pipeline.

The practical reality: communities need doctors now, and policy changes affect whether those doctors stay.

Practical playbook for hospitals and clinics

Hospitals and clinics in shortage areas can take concrete steps now:

• Recruit through J‑1 waivers (Conrad 30): These placements often lead to cap‑exempt H‑1B roles in Health Professional Shortage Areas.
• Confirm cap‑exempt status: Nonprofit, university‑affiliated employers can file H‑1B year‑round.
• Start green card cases early: Begin PERM (if required) and file Form I‑140 well before the H‑1B six‑year mark to allow extensions under AC21 rules. Link: https://www.uscis.gov/i-140
• Plan retention: Account for long queues for Indian and Chinese nationals by building multi‑year staffing plans and community support that encourages doctors to stay.

Step‑by‑step for physicians (IMGs)

Most IMGs follow this path:

1. Obtain ECFMG certification, then do residency/fellowship on J‑1.
2. Secure a state Conrad 30 waiver, complete the service commitment in a shortage area.
3. Move into a cap‑exempt H‑1B role with the sponsoring employer.
4. Seek an employment‑based green card; expect waits in oversubscribed categories.

For official guidance on the J‑1 waiver process, see the U.S. Department of State page: https://travel.state.gov/content/travel/en/us-visas/study/exchange/waiver-of-the-exchange-visitor.html

Community impact

Areas where IMGs make up half of the physician workforce are highly sensitive to any policy change.

• If Congress adds more waivers, more doctors can move from J‑1 to H‑1B and stay in hard‑to‑staff clinics.
• If green card waits get worse, some doctors may leave underserved posts for roles that better fit long‑term family plans.

Patients feel the results first: fewer primary care appointments, longer drives for surgery, and ERs with thin coverage.

Common questions from employers and physicians

• Are physician H‑1Bs subject to the lottery?
  • Often not. Many roles tied to nonprofit, university‑affiliated hospitals or to waiver placements are cap‑exempt.
• Can H‑1B time go beyond six years?
  • Yes. If the employer timely files the green card process, including Form I‑140, doctors can extend H‑1B past year six.
• What if a clinic isn’t university‑affiliated?
  • Some shortage‑area roles tied to J‑1 waivers still qualify for cap‑exempt H‑1B. Employers should document the waiver basis and shortage‑area service.

Where the debate is headed

Medical groups and policy centers support expanding waivers and easing backlogs to stabilize care. Online critics want more domestic training. In practice, both tracks are needed: immigration tools to meet demand this decade and expanded GME slots to build a larger homegrown pipeline.

As Hindustan Times reported, Rep. Greg Murphy’s statement fanned old arguments, but the need on the ground remains: rural hospitals and urban safety‑net clinics depend on IMGs today, and patients can’t wait years for relief.

Actionable takeaways

For employers:
– Act early on green card sponsorship to keep key doctors.
– Use cap‑exempt hiring where eligible to avoid lottery delays.
– Document waiver and nonprofit/university links to support H‑1B filings.

For IMGs:
– Track timelines from J‑1 waiver approval to H‑1B start and green card steps.
– Discuss I‑140 strategy with your employer to secure H‑1B extensions if needed.
– Keep records current to avoid gaps in status.

The physician shortage is real, the policy pieces are in motion, and communities are watching. Whether Congress moves on waiver expansion or not, H‑1B visas remain a key tool in keeping clinics open and patients cared for.