A recent increase in U.S. visa fees has the potential to trigger a significant medical brain drain in America’s rural regions.
Researchers reported Oct. 29 in the Journal of the American Medical Association that rural areas employ nearly double the percentage of medical professionals working under H-1B visas compared to urban counties.
The research also revealed that the percentage of H-1B doctors in impoverished counties is nearly four times higher than in affluent areas.
Lead researcher Dr. Michael Liu, a resident physician in the Mass General Brigham Department of Medicine in Boston, stated: “Our findings suggest that the most socioeconomically vulnerable communities will be hit hardest in terms of health care worker recruitment and care access by the recent visa application policy change.”
Liu emphasized in a news release: “Foreign health care workers fill critical gaps in health systems such as primary care and rural health, and millions of Americans depend on them to receive timely and high-quality health care.”
Background notes from researchers indicated that in September, President Donald Trump issued an executive order raising the fee for an H-1B visa to $100,000, up from an average of $3,500.
According to researchers, the H-1B visa program enables U.S. employers to recruit foreign workers in occupations requiring specialized knowledge, including the medical field.
For this research, investigators examined data on all H-1B visa applications in fiscal year 2024 from the U.S. Department of Labor.
“Our findings suggest that the most socioeconomically vulnerable communities will be hit hardest in terms of health care worker supply and care access by the recent visa application policy change,” said lead researcher Dr. Michael Liu, a resident physician in the Mass General Brigham Department of Medicine in Boston.
“Foreign health care workers fill critical gaps in health systems such as primary care and rural health, and millions of Americans depend on them to receive timely and high-quality health care,” Liu added in a news release.
According to the study’s background information, President Donald Trump issued an executive order in September that raised the application fee for an H-1B visa to $100,000 — a dramatic increase from the previous average cost of about $3,500.
The H-1B program enables employers in the United States to recruit foreign professionals for roles that require specialized expertise, which includes a broad range of medical positions.
For their analysis, the research team reviewed all H-1B visa applications submitted to the U.S. Department of Labor during fiscal year 2024.
Their findings indicate that more than 11,000 practicing physicians in the United States were working under H-1B sponsorship, representing nearly 1% of all doctors nationwide.
The study also revealed that rural regions rely more heavily on H-1B physicians, with about 1.6% of their doctor workforce sponsored under the program, compared with less than 1% in urban counties. Other health care professionals on H-1B visas — including podiatrists, chiropractors and optometrists — were likewise more commonly employed in rural areas.
Similarly, counties facing the highest poverty rates showed a much larger share of H-1B physicians, with 2% sponsored under the program compared with roughly 0.5% in the nation’s wealthiest counties.
“Our study provides evidence supporting proposed exemptions from H-1B visa fee increases for physicians, along with their extension to other health care workers,” senior researcher Dr. Rishi Wadhera said in a news release. Wadhera serves as associate director of the Richard A. and Susan F. Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center in Boston.