The US Homeland Security and State Departments are adding a $100,000 surcharge for most new H-1B applications including physicians and nurses – something that will have a profoundly bad impact in some hospitals, especially rural ones.
The new fee doesn’t apply to docs and nurses who are already in the U.S. on H-1B status –but all new H-1B applications will be subject to the new fee.
Noem can approve waivers on a case-by-case basis if she thinks “in the national interest” (whatever that might mean to her). Perhaps it’ll mean the waived fees are only for white South Africans.
State Department to Cut Refugee Admissions & Prioritize White South Africans – The New York Times
The H-1B visa is an employer-sponsored, nonimmigrant visa that allows U.S. companies to employ highly educated foreign professionals in “specialty occupations” that require a minimum of a bachelor’s degree or its equivalent – like doctors and nurses.
H-1B FAQ – United States Department of State
The new fee will be especially bad for (red) rural America.
Rural and underserved communities often depend on foreign-born clinicians to keep their hospitals and clinics staffed.
A KFF analysis found that immigrants account for a meaningful share of hospital physicians and other clinical staff… more than a quarter of hospital physicians are immigrants, & foreign-educated nurses have become an important source of hires for many hospitals.
Those clinicians disproportionately practice in specialties and places where U.S. graduates are scarce: family medicine, internal medicine and rural hospitals.
- H-1B-sponsored physicians made up 1.6% of the physician workforce in rural counties versus 0.95% in urban counties
- H-1B-sponsored physicians were nearly 400% more common in the highest-poverty counties than the lowest-poverty counties
- India is by far the largest source (≈71% of approved H-1B petitions
The surcharge changes what had been workable pathway into an unaffordable proposition especially for rural hospitals.
Rural hospitals almost always run on thin money margins and a $100K hit to the budget for a single doctor effectively rules out that option for many.
Clinics and small hospitals that routinely sponsor international medical graduates or foreign-educated nurses will likely pause or stop most new sponsorships. That means openings that had been filled by foreign clinicians will remain vacant or close.
Residency programs, fellowship placements and other training pipelines that rely on international trainees will be scaled back especially among (rural) programs that can’t afford the fee may reduce slots that have been helping a lot in rural and underserved areas.
The bottleneck is worse because we already have a structural shortage of physicians (and residency slots to train physicians) in primary care and rural areas.
The long and short of it is rural areas will be seeing even more delayed care, longer ambulance runs, service limits, clinic closures, and longer drives for rural patients – many in places that voted for Trump by a wide margin.
Trump’s new $100K visa fee could pummel red state hospitals – POLITICO
Just another example of bad policy making – at least bad for here. This will be helpful for hospitals and medical care in India though.
