Doctors May Get Exemption from $100,000 H-1B Fee, Report Says

(UNITED STATES) Doctors and medical residents may be spared from the new $100,000 H-1B visa fee after a fresh Trump proclamation triggered a wave of alarm across hospitals, teaching programs, and immigrant worker communities. The White House signaled that a physicians exemption is likely under a national interest provision, but said decisions will be made case by case until formal guidance is issued.

The change, signed on September 19, 2025, and described by aides as effective immediately, adds a massive charge to every new H-1B filing. It is meant to curb the inflow of lower-paid foreign workers and raise revenue, but it has also sparked urgent questions from health systems that rely on international medical graduates to keep clinics open, especially in underserved areas.

White House statement and expected procedures

White House spokesperson Taylor Rogers told reporters that “The Proclamation allows for potential exemptions, which can include physicians and medical residents.” While that public line has eased some immediate panic, the final shape of any physicians exemption is still pending.

For now, doctors and employers must assume that an exemption will require a specific request and evidence showing the public benefit. The Department of Homeland Security (DHS) is expected to issue procedures that will:

• Explain how an H-1B petitioning employer should request the waiver
• Specify what proof to include
• Clarify expected timelines for case review

Immediate operational impact on hospitals and residency programs

According to analysis by VisaVerge.com, the fee shock lands hardest on employers planning fall and winter onboarding of international recruits.

• Hospitals operating on tight margins, federally funded clinics, and residency programs face severe pressure.
• Any lag in official guidance risks missed start dates, short staffing, and service cuts in communities already struggling to recruit U.S. physicians.

Residency directors warn that if the physicians exemption stalls or proves too narrow, it could “choke the pipeline,” stranding newly matched doctors abroad and forcing cancellations at rural and inner-city clinics.

Administration rationale and critics’ responses

Supporters argue the new cost barrier will screen out routine or lower-wage roles and ensure only top-tier talent applies. Commerce Secretary Howard Lutnick described the move as corrective, saying it would filter out lower-paid foreign workers and raise over $100 billion for the Treasury.

Counterarguments from business groups and immigrant advocates include:

• H-1B workers already face strict rules; the fee will punish employers who cannot fill jobs locally.
• Critical healthcare positions that serve the United States during persistent doctor shortages could be harmed.

The administration frames the fee as a way to reset the program toward “extraordinarily skilled” workers, but hospitals note many international physicians are already highly qualified and fill high-need roles after careful vetting.

Procedural questions — filing, waivers, and timing

The most immediate questions are procedural:

• How should an employer file an H-1B case now?
• Can the $100,000 charge be deferred while an exemption is reviewed?
• What happens if a waiver is denied?

People familiar with the draft guidance process say the baseline filing steps will remain the same. Employers will still submit a standard petition package, including the core petition form Form I-129, Petition for a Nonimmigrant Worker, and supporting evidence.

If a waiver option is confirmed, the petition would include a specific request under the proclamation’s national interest language. USCIS would then review and rule on whether the case qualifies for an exemption.

Recommended preparatory steps (what lawyers advise)

1. Prepare two parallel tracks:
   • A complete physician exemption request
   • A contingency plan in case the $100,000 fee becomes payable

1. Assemble evidence that the doctor serves a critical need:
   • Placement in a medically underserved area or shortage designation
   • Recruitment records showing failed local hiring
   • Letters from hospital leadership detailing harm from delayed starts
2. For residents:
   • Compile match confirmations, accreditation proofs, and rotation schedules
   • Prepare payroll records, coverage rosters, and patient volume data

Likely filing sequence (pending formal guidance)

• File the standard H-1B petition package centered on Form I-129 with supporting documents and regular fees.
• Request the physicians exemption under the proclamation’s national interest clause, with an evidence-based memo linking the physician’s role to patient care needs.
• Await case-by-case review by DHS/USCIS:
  • If approved — the H-1B visa fee would not be charged.
  • If denied — the employer would need to pay the $100,000 fee to continue processing.

Employers may choose either to file now and request the exemption first (paying only if denied) or wait for agency instructions to avoid missteps. Each path carries risk: filing early may save time but could require quick payment; waiting may protect against mistakes but push start dates out of reach.

Health-care workforce and patient-impact concerns

Hospitals stress international doctors are part of the backbone of care in high-need regions. Large proportions of international medical graduates serve in primary care, psychiatry, and hospital medicine, including rural counties and low-income neighborhoods.

Leaders warn an unrefined policy could raise mortality risks indirectly, because thinner staffing tends to:

• Lengthen wait times
• Reduce access to specialists
• Complicate chronic disease management

These harms appear in emergency room backups and longer travel distances to see a doctor.

Human examples of potential disruption

• A resident from India matched to a rural family medicine program may be the only doctor in a clinic several days a week. Delay could close the clinic one or two days weekly.
• A Gulf Coast hospitalist group relying on two international internists might be forced to divert ambulances if one cannot start.
• Families with spouses and children on dependent visas face disrupted school enrollments, child care, and housing contracts.

Broader economic and industry impacts

The proclamation affects sectors beyond healthcare:

• Indian IT sector stocks fell 2–5% after the announcement.
• India’s government and tech leaders raised concerns about humanitarian and economic impacts.
• Small and mid-sized firms may not absorb the $100,000 shock and could face project delays or lost contracts.

Companies argue the flat fee ignores job type, wage level, location, and company size. Suggested alternatives include wage thresholds or targeted surcharges, which would be more precise and less disruptive.

Calls for a clear, streamlined physicians exemption

Teaching hospitals and physician groups broadly support a targeted physicians exemption and urge the White House to make it broad, fast, and automatic where possible.

Program directors suggest:

• A category-based approach for medical residents matched through national systems
• A streamlined path for attending physicians working in shortage areas
• Training for adjudicators to assess complex medical service needs

Advocacy groups request templates for exemption requests, prioritization of imminent start dates, and standard timelines for adjudicators.

Expected exemption criteria (observer consensus)

Observers expect USCIS to weigh factors such as:

• Service in a designated shortage area or medically underserved area
• Employment by an accredited residency program or teaching hospital
• Evidence of unsuccessful recruitment of U.S. workers
• Community impact statements from hospital systems and local health authorities
• Public health considerations (behavioral health, infectious disease response, etc.)

Premium processing for waiver decisions is a frequent ask from employers; timing and sequencing (what to file first, what to pay, and when) will be crucial.

Legal challenges and policy debates

Potential legal challenges may argue:

• A flat $100,000 charge functions as a barrier inconsistent with statute
• A sweeping fee imposed by proclamation exceeds executive authority
• Lack of clear standards or notice could invite process-based challenges

Defenders will cite national interest powers and the executive’s role in setting entry conditions for noncitizens.

Practical checklists and tips for petitioners

• Keep detailed timelines, correspondence, and proof of harm from delays.
• Prepare objective, measurable national interest arguments (number of patients served, reduced wait times, specialty coverage).
• Programs with residents starting in the next 30–60 days should:
  • Prepare alternate schedules
  • Explore legally and clinically safe telehealth stopgaps
  • Be ready to explain how a single physician’s start date connects to patient outcomes in plain terms

Longer-term program effects and secondary shifts

If the physicians exemption becomes durable, expect potential secondary effects:

• More hospitals may hire H-1B physicians earlier in training
• Employers may pursue permanent residence sponsorship to retain doctors long-term
• Immigration teams could see higher workloads and demand for faster green-card processing in medical categories

If the exemption is narrow, other industries (IT, biotech, advanced manufacturing) will continue to feel the full burden of the fee, potentially shifting work abroad or relying more on remote teams.

Conclusion and immediate resources

While the Trump proclamation has ignited debate, it also forced a conversation about program design: supporting genuine skill gaps, protecting U.S. workers, and meeting urgent needs like healthcare.

For employers preparing immediate filings, the core petition remains Form I-129, Petition for a Nonimmigrant Worker, available at: Form I-129, Petition for a Nonimmigrant Worker.

If DHS instructs petitioners to attach a specific waiver request under the proclamation, follow that template precisely and include clear, numeric evidence where possible. Consider premium processing if it can run alongside exemption review; if not, build extra time into schedules for the waiver decision.

Key takeaway: A swift, clear, and workable physicians exemption would help avert immediate harm to patient care. Until formal guidance appears, document everything, prepare dual filing strategies, and prioritize evidence showing the direct public health impact of any delay.