TL/DR –
The U.S. healthcare system is experiencing a significant workforce shortage, particularly in underserved and rural communities. Recent and proposed immigration policy changes may exacerbate the issue, as a significant portion of the healthcare workforce has traditionally relied on foreign-born professionals. Key issues include the potential elimination of the “Duration of Status” for certain visa classifications, the introduction of a $100,000 supplemental filing fee for new H-1B petitions, changes to shortage area designations, a limited number of visa options for registered nurses, and rollbacks of the Temporary Protected Status program.
Major Concerns Surrounding the U.S. Healthcare System and Immigration Policies
The ongoing workforce shortages in the U.S. healthcare system are remarkably severe, particularly in rural and underserved areas. The dependence on foreign-born professionals, such as physicians and nurses, is being threatened by recent immigration policies, complicating workforce planning.
Almost 25 percent of current physicians in the U.S. are international medical graduates, according to the American Medical Association, playing a key role in addressing primary care and specialty medicine shortages. Approximately 1 million noncitizens ensure essential care provision in hospitals and long-term care facilities.
Implications of Eliminating Duration of Status
The Department of Homeland Security’s proposal to eliminate “Duration of Status” (D/S) for nonimmigrant visa categories, including J-1, which the majority of International Medical Graduates (IMGs) rely on, is causing significant concern for medical institutions and hospitals.
The proposed change could impose financial and administrative burdens on medical institutions and IMGs, as maintaining immigration status would require timely filing of extensions. The policy could also disrupt the continuity of medical training, affecting both physicians and Graduate Medical Education (GME) programs. The healthcare industry strongly opposes the proposed rule due to the potential difficulties it imposes.
New Fee for H-1B Visas
Another policy change includes a $100,000 supplemental filing fee for new H-1B petitions. This fee, which applies to all new H-1B petitions submitted after September 21, 2025, could financially burden hospitals and healthcare systems that rely on H-1B professionals.
While there is a limited exception for jobs in the national interest, this exemption may be narrowly tailored in practice, thus potentially discouraging healthcare employers from pursuing H-1B sponsorship. Healthcare providers and professionals who could be affected by the fee are advised to consult with experienced immigration counsel to explore available options.
Changes to Health Professional Shortage Areas
The Health Resources and Services Administration (HRSA) is revising how it designates Health Professional Shortage Areas (HPSAs). The HRSA Modernization Project could result in the removal of some previously designated areas by July 2026.
These changes may affect healthcare facilities’ eligibility for programs such as the Conrad 30 J-1 waiver program that depend on shortage designations. Given these changes, practices and physicians may need to consider alternative strategies such as the O-1 extraordinary ability for temporary status, or alternative employment-based green card strategies.
Challenges for Registered Nurses and TPS Holders
Registered nurses face limited immigration pathways, as most RN positions do not qualify as a “specialty occupation” under H-1B visa criteria. Additionally, the government’s move to terminate Temporary Protected Status (TPS) designations for nearly all countries may affect tens of thousands of healthcare workers.
Healthcare employers who employ TPS recipients should closely monitor developments and consult with experienced immigration counsel. If possible, exploring alternative immigration strategies may provide a way forward for some affected employees.
Changes to the PERM Process and Visa Options for Registered Nurses
Adjustments to the permanent labor certification (PERM) recruitment process required for many employment-based green card categories are creating challenges for employers. It’s crucial for employers to align their recruitment processes with PERM and non-PERM procedures to ensure compliance.
Registered nurses continue to face limited immigration pathways. The shortage of nursing staff indicates a critical need for foreign-trained nurses, however, immigration gaps limit the ability of healthcare practices to fill vital open roles.
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