If you’re an international medical graduate (IMG) currently working in the U.S., recent changes to H-1B filing fees may suddenly feel like an urgent career concern. In September of 2025, the federal government announced a one-time $100,000 filing requirement for new H-1B petitions, and federal agencies have since issued guidance to clarify when it applies. The proclamation could significantly impact healthcare employers’ ability to sponsor H-1Bs, but what does it mean for physicians currently on H-1B visas, as well as medical residents and fellows hoping to obtain H-1Bs? As Regional Vice President of Recruitment for the Jackson Physician Search Eastern division, my team has been hearing from concerned IMGs asking these very questions, so let’s take a closer look. While I am certainly not an immigration expert, I can share my interpretation of what’s underway.
What Do the New H-1B Fees Mean for IMGs in the U.S.?
If you are already working in the U.S., you’ll be relieved to hear that the one-time fee only applies to new H-1B petitions, not to existing H-1B holders. USCIS has clarified that the $100k charge applies when the beneficiary is outside the U.S. at the time of filing and does not already hold a valid H-1B visa. There are additional technical situations (such as consular notification and change-of-status complications) where USCIS says the fee may apply. I read this as meaning the fee is most likely to affect future H-1B applicants living outside the U.S. when the petition is filed. (Fredrickson)
For physicians training in the U.S. on a J-1 visa, in order to remain in the U.S. immediately following residency or fellowship, an employer must file for a J-1 visa waiver on your behalf. This removes the need for the J-1 visa holder to return to their home country for the two-year minimum before applying for a new visa. If a waiver is obtained, the J-1 visa holder can remain and work, and the employer may eventually petition for a change of status to an H-1B visa. According to interpretations of the clarified guidance, this change of status will not be subject to the new fees (UT Southwestern).
What Do the New H-1B Fees Mean for IMG Physician Hiring?
While IMGs currently in the U.S. will not be directly impacted by the new fees, going forward, it could mean fewer opportunities for IMGs to work in the U.S.. Hospitals and health systems already operate on thin margins (especially rural or safety-net facilities), and a sudden $100k additional cost per hire is large enough to change behavior. A recent Beckers article highlights how several organizations throughout the country are responding. For now, the most common position seems to be “wait and see,” but there is speculation that some employers may decide not to sponsor H-1Bs at all, shift to hiring U.S. citizens or green card candidates, or opt to pursue waivers for IMGs on J-1 visas. Some experts predict increased reliance on advanced practice providers, when available, to avoid the immigration issue altogether.
The Significant Role of IMGs in U.S. Healthcare
Major healthcare associations, including the American Medical Association and the American Hospital Association, have publicly warned that this fee could worsen existing shortages, particularly in underserved areas. And the numbers give legitimacy to their concerns.
The AMA cites 2024 data indicating 23% of currently practicing physicians are IMGs, 64% of IMGs practice in medically underserved or health professional shortage areas, and more than 20 million Americans live in areas where more than half of physicians are IMGs. Rural areas rely on IMGs to fill gaps that might otherwise leave patients without care. These are the very roles that hospitals struggle to fill, and policies that discourage hiring IMGs threaten to deepen existing physician shortages — especially outside of major metro areas.
The Pushback on New H-1B Fees in Healthcare
The new fees are intended to protect American workers and curb a perceived misuse of H-1Bs, primarily by tech firms. The potential for the fees to worsen the physician shortage is an unintended consequence, and the industry is advocating for a widespread exemption for healthcare providers. For now, however, exemptions to the fees are said to be “rare” and on a case-by-case basis (USCIS). Expect vigorous policy and legal pushback, as well as practical short-term effects on hiring decisions. Don’t assume a favorable fix will happen quickly. Plan for the present while tracking developments.
Patience Over Panic
If you are an international medical graduate already working in the U.S., the new H-1B fees should not affect your future plans. Resist the urge to panic and take comfort in the knowledge that U.S. healthcare relies on you, and solutions for future IMGs hoping to come to the U.S. are likely forthcoming. In the meantime, stay proactive, ask informed questions, and lean on your network of mentors, program directors, and legal advisors to help you navigate any uncertainties.
At Jackson Physician Search, we work with hospitals and health systems nationwide that continue to value and support international medical graduates. We encourage you to stay informed, flexible, and confident in the skills and dedication that make you such a vital part of the U.S. physician workforce.
If you need help with your physician job search, reach out to the physician recruitment team at Jackson Physician Search today, or search for physician jobs online now.
About Neal Waters
Neal’s career in retained physician search began more than 15 years ago. Early on, he recognized the strain an entire community feels when there is a shortage of physicians to meet patient demand. Since his first successful placement, Neal’s passion for identifying the best providers for each healthcare organization with which he recruits has grown.
Neal serves as Regional Vice President of Recruiting. In his role, he serves as a mentor to a growing team of Jackson Physician Search recruiters. He also enjoys collaborating with in-house recruiters who are dedicated to optimizing their physician recruitment and candidate acquisition strategies. Likewise, Neal specializes in helping physicians, especially residents and those early in their careers, advance their professional careers by finding the right fit.
