Doctor Shortages Persist as Trump’s Policies Hinder Foreign Physicians

(UNITED STATES) The Trump administration moved to sharply raise the cost and complexity of hiring foreign physicians this fall, unveiling a series of steps that hospital leaders and immigration counsel say could deepen the nation’s doctor shortages. In a Presidential Proclamation signed on September 19, 2025, President Trump approved a new $100,000 fee on each H-1B visa petition for specialty occupations, a category that includes many foreign-trained doctors working in U.S. hospitals and clinics.

The Department of Labor also rolled out “Project Firewall,” a new enforcement push focused on the H-1B program that signals stricter reviews and a tougher stance on employers that sponsor foreign workers, including medical professionals. These actions arrive amid earlier pauses on visa interviews and expanded travel bans that have already slowed or blocked entry for some foreign medical residents and physicians, heightening concern inside health systems that rely on international talent to keep clinics open and residency programs on schedule.

Immediate financial and operational impact on hospitals

Hospital administrators and residency directors who have counted on the H-1B visa to fill staffing gaps say the combined effect of the fee and Project Firewall could be immediate and far-reaching.

• A single H-1B petition already requires employers to pay government filing fees, engage immigration counsel, and process wage and compliance paperwork.
• Adding a $100,000 surcharge on top of those costs makes many hiring decisions far less feasible—especially for safety-net hospitals and small practices without deep reserves.

According to analysis by VisaVerge.com, the new fee is expected to deter a large share of potential H-1B filings for medical roles—not because the doctors aren’t needed, but because budgets at hospitals and clinics cannot absorb a sudden six-figure levy for each candidate.

What Project Firewall means for employers

Project Firewall, launched by the Department of Labor, is designed to increase audits and strengthen oversight of how the H-1B visa is used.

• Employers should expect:
  • More document requests
  • More site visits
  • Deeper reviews of wage levels and job duties
  • Penalties if the government concludes program rules were not met

Even institutions with strong compliance records may face delays as cases move through extra layers of scrutiny. Health systems that planned to onboard foreign physicians late this year or early next year could encounter longer timelines, forcing costly temporary staffing or last-minute schedule changes that affect patient continuity of care.

State-level responses vs. federal control

Many states have moved in the opposite direction, passing bipartisan laws to help internationally trained medical graduates (IMGs) work more quickly in underserved areas.

• State measures include:
  • Simplified credentials review
  • Pathways to practice that match doctors with clinics short on staff

However, federal immigration control remains decisive:

• Without visas, state-level fixes have limited effect.
• When federal policy tightens, the pipeline states are trying to build can narrow or stop—regardless of local demand and supportive laws.

Sensitivity for training hospitals and residency programs

The timing of visa slowdowns is especially sensitive for training hospitals and clinics that depend on predictable intake of residents and fellows each year.

• Recent reports described foreign medical workers denied re-entry after brief travel, unexpected deportations while awaiting status updates, and delayed visa interviews that pushed start dates back.
• A delayed start for one resident can ripple through a program—shifting patient loads and stretching supervision plans.
• If many foreign physicians face barriers simultaneously, entire departments may struggle to maintain services.

Administration’s rationale and health care leaders’ response

The administration defends tighter rules on employment visas as part of a broader policy favoring hiring within the U.S. workforce.

• Health care leaders counter:
  • Many areas (rural hospitals, community clinics, specialty lines) lack enough physicians available to hire.
  • The H-1B visa has been a key avenue for foreign physicians to work in the U.S. after training, often filling roles that domestic recruitment has not.

When employers pull back due to cost or compliance risk, patients may see:
– Longer wait times
– Reduced clinic hours
– Fewer specialists on call

Budgetary calculus: the $100,000 fee in practice

The $100,000 fee sits at the center of hiring decisions.

• Large, well-funded systems may still file for essential roles.
• Many hospitals must consider:
  • Redoing budgets
  • Postponing hires
  • Dropping recruitment altogether

Example:
– A clinic planning to bring in two foreign physicians could face $200,000 in additional fees just to file—before legal costs or standard government charges.
– If a case is delayed or challenged under Project Firewall, the clinic could incur even more expense with no guarantee of timely approval.

Administrative steps and references

Employers must follow established steps, but the process is now more fraught in practice:

1. File a Labor Condition Application (LCA) with the Department of Labor attesting to wages and working conditions.
2. Petition with U.S. Citizenship and Immigration Services using Form I‑129 for H-1B classification.
3. If approved, proceed to consular processing or change of status.

For official descriptions and details:
– USCIS H‑1B: Specialty Occupations — https://www.uscis.gov/working-in-the-united-states/temporary-workers/h-1b-specialty-occupations
– Form I‑129 — https://www.uscis.gov/i-129

Compliance challenges in medicine

Under Project Firewall, compliance offices face broader requests tied to wages, job locations, and exact duties.

• Medical roles are often fluid (e.g., shifting between outpatient and inpatient work), which clashes with the enforcement preference for precise job descriptions.
• Evolving employer needs after a petition is filed increase the risk of follow-up questions or penalties.

Short-term fixes and long-term consequences

When planned arrivals fail, hospitals often resort to temporary measures:

• Overtime for existing staff
• Hiring locum tenens doctors

These options are:
– Expensive
– Temporary
– Unsustainable if the new fee reduces filings and Project Firewall lengthens reviews

Consequences for foreign physicians:
– Rethink career paths (seek alternative visas, move to other countries, or wait)
– Family and life disruptions
– Loss of trusted patient-physician relationships

Workforce planning and future talent pools

The policy change introduces uncertainty for long-term planning:

• Health systems forecasting several years out depend on steady inflows of graduates and experienced hires.
• If foreign physicians cannot rely on predictable visa pathways, long-term planning becomes guesswork.
• Education partners worry fewer international graduates will apply to U.S. programs, shrinking the future talent pool as patient demand grows.

Arguments on both sides

Supporters of tougher rules say higher costs and enforcement will encourage employers to recruit domestic physicians.

Critics say:
– Vacancies persist despite domestic recruitment efforts and signing incentives.
– Foreign physicians often fill rural and high-need roles that local hiring did not solve.

Both points can be true: while local pipelines should be strengthened, many gaps will remain in the short to medium term—leaving patients exposed when international hiring is curtailed.

Practical impacts on patient access

Fewer H-1B filings could affect patient access before staffing reports reflect it.

Potential effects:
– Longer waits for specialist appointments
– Reduced clinic hours or limited new patient intake
– Emergency departments struggling to meet on-call coverage needs
– Increased use of traveling physicians at high cost

Each adjustment affects care quality and hospital budgets.

How hospitals are responding now

Hospitals that continue filing are:

• Preparing for more paperwork and longer timelines
• Reviewing wage documentation and job descriptions closely
• Setting aside funds for the $100,000 fee where possible
• Spreading out hires to manage budget shock
• Watching consular operations for interview pause changes

Every action has become more deliberate, as errors are costly and speed is rare.

State efforts and ongoing uncertainty

Some state leaders continue to push licensing reforms that welcome IMGs, betting on future federal easing.

• State reforms may:
  • Lower the barrier to practice once physicians are authorized to work
  • Signal to global talent that states value their skills

Uncertainty remains whether these signals can overcome federal headwinds. The current mix of high fees, tight enforcement, and prior travel and interview restrictions discourages many employers from attempting the H-1B path.

Final considerations

On paper, the official mechanics of the H-1B program remain the same: LCA, Form I‑129, and then consular processing or change of status. In practice, the environment has changed:

• The $100,000 surcharge plus Project Firewall alters budgets, timelines, and employer confidence.
• In health care, where delays affect real patients, loss of confidence in the visa process can be as damaging as formal denials.

Hospitals and clinics now face difficult choices:

1. Accept higher costs and risks to keep recruiting internationally.
2. Slow or stop international hiring and stretch existing staff.
3. Redirect funds into short-term coverage (which doesn’t build stable teams).

None of these options solves the underlying shortage. For many communities—especially those already struggling to attract doctors—the federal moves could mean fewer physicians seeing patients and more clinics warning of reduced hours. That is the practical result when policy reaches the bedside, and it explains why health system leaders have expressed sharp concern about the changes.