$100,000 H-1B fee proposal raises concerns amid US doctor shortage

A heated congressional hearing on America’s deepening physician shortage has opened a contentious debate over immigration policy — one that could have significant implications for Indian medical graduates aspiring to build careers in the United States.

At the centre of the discussion is a proposal to impose a $100,000 supplemental fee on new H-1B visas, a dramatic increase over current employer-paid processing costs. Lawmakers debated whether such a steep hike would discourage rural hospitals and underserved communities from hiring foreign-trained doctors at a time when the US healthcare workforce is under mounting strain.

The issue surfaced during a hearing of the House Ways and Means Health Subcommittee on expanding graduate medical education (GME) and strengthening rural healthcare delivery.

Congressman Adrian Smith warned that the country faces “a very real problem, a rapidly depleting health care workforce.” He cited projections that by 2037, the US could see a shortage of 187,000 physicians, with nearly half of all practising doctors expected to retire within the next decade.

The crisis is particularly acute in rural America. “Eighty-three million Americans live in an area with too few primary care physicians,” Smith noted, adding that only 2 per cent of residency positions are located in rural communities.

While lawmakers from both parties expressed support for expanding Medicare-funded residency slots, immigration policy quickly emerged as a flashpoint.

Congresswoman Linda Sánchez raised concerns about the proposed visa fee hike and questioned whether it would disproportionately affect underserved areas that rely heavily on international medical graduates. Dr Andrew Racine, president of the American Academy of Pediatrics, cautioned that “anything that’s going to decrease the supply is going to have an impact on our ability to serve the needs of children.”

Several lawmakers acknowledged that foreign-trained physicians make up a substantial share of residency programmes and rural healthcare systems. Although India was not explicitly mentioned during the hearing, Indian nationals historically represent one of the largest groups of international medical graduates (IMGs) in the United States, particularly in internal medicine, family medicine and other primary care specialities.

Many Indian doctors serve in rural and medically underserved regions through visa arrangements tied to service obligations. Lawmakers warned that a sharp rise in visa costs could make recruitment financially unviable for small community hospitals already operating on thin margins.

Jason Shenefield, chief executive of Phelps Health in Missouri, told lawmakers his rural health system anticipates “close to about $100,000 loss per resident” under existing financial structures. Additional immigration-related expenses, members suggested, could further strain such institutions.

However, some Republican lawmakers argued that immigration reforms should not substitute for domestic medical training expansion. Congressman Greg Steube said American medical graduates were losing residency slots to foreign-trained doctors and indicated he would introduce legislation to address the issue.

Beyond immigration, the hearing also focused on expanding Medicare-funded residency positions. A bipartisan proposal seeks to add 14,000 slots over seven years, with priority given to rural and underserved areas. Medicare currently spends roughly $22 billion annually on GME, but caps imposed in 1997 continue to limit the distribution of residency positions.

For Indian medical students pursuing US licensure — a rigorous pathway that involves clearing American medical licensing examinations and securing accredited residency placements — the debate introduces fresh uncertainty.

As Congress weighs workforce expansion, funding reforms and immigration policy, the hearing underscored how deeply interconnected US domestic health priorities and global medical mobility have become.

With IANS inputs