Key points
- White House says exemptions under the proclamation could include doctors and medical residents, responding to staffing worries in rural America.
- The $100,000 fee applies to new H‑1B petitions filed on or after Sept 21 and is a one‑time charge, not annual.
- AMA warns fee could choke off international medical graduates vital to primary care in shortage areas.
- Major systems like Mayo Clinic, Cleveland Clinic, St. Jude are top H‑1B sponsors; Mayo has 300+ approvals.
Washington D.C.: President Donald Trump signed a proclamation on Sept 19 introducing a $100,000 application fee for new H‑1B petitions, a sweeping shift intended to limit perceived abuse and channel entries to “extraordinarily skilled” workers. The White House clarified the charge applies only to new petitions filed on or after Sept 21 and is not recurring annually, easing confusion among employers and current visa holders. The policy has rattled technology firms and global talent pipelines, with analysts warning of higher costs and potential delays in critical hiring.
Why doctors may be exempt
Following urgent appeals from hospitals and medical bodies, a White House spokesperson told Bloomberg the proclamation allows potential exemptions that “can include physicians and medical residents,” signaling targeted relief for healthcare staffing. The exemption path aligns with a “national interest” waiver framework referenced in the proclamation language, enabling case‑by‑case discretion by homeland security authorities. This clarification came as industry groups warned that the six‑figure fee could deter international medical graduates essential to underserved communities.
Impact on hospitals and rural care
U.S. health systems depend on H‑1B physicians especially for residencies and specialties in areas less attractive to U.S.‑trained doctors making the program a lifeline for rural hospitals. Leading systems including Mayo Clinic, Cleveland Clinic, and St. Jude Children’s Research Hospital are among top H‑1B sponsors; Mayo alone has 300+ approved visas, meaning the fee could add millions in labor costs without exemptions. Shares of major hospital operators ticked higher after signals of a medical exemption, reflecting reduced risk to staffing and operating costs.
Doctor shortage context
More than 76 million Americans live in federally designated primary‑care shortage areas, amplifying the stakes of any policy that restricts physician inflows. AMA President Bobby Mukkamala warned the fee “risks shutting off the pipeline of highly trained physicians,” underscoring international graduates’ central role in the U.S. physician workforce. Medical groups say even short‑term uncertainty could disrupt recruitment cycles for residencies and specialist roles in community and safety‑net facilities.
Indian IT and broader workforce effects
Indians make up a large share of H‑1B professionals, and the abrupt fee shift sparked anxiety across tech and services sectors reliant on this pathway for specialized roles. Industry watchers say the cost shock could squeeze startups and mid‑sized firms, and prompt companies to reassess hiring strategies or keep employees from international travel during the transition. Commentary from U.S. officials frames the fee as a corrective to discourage underpaid placements and prioritize higher‑wage, higher‑skill entries, projecting substantial revenue gains for the Treasury.
What’s confirmed so far
- The $100,000 fee is in effect for new H‑1B filings from Sept 21 and is a one‑time charge.
- The White House indicates potential exemptions that may include doctors and medical residents; formal case handling will follow proclamation language and DHS determinations.
- Hospitals and medical associations continue to lobby for clear, categorical relief to avoid disrupting care in shortage areas.
