H-1B Visas & Healthcare: Impact of Policy Changes on US Workforce Shortages

Immigrants, including those on H-1B visas, significantly contribute to the U.S. Health care workforce and its capacity. H-1B workers are foreign workers temporarily authorized to work in the U.S. In specialized roles. The Trump administration has implemented policies likely to reduce the supply of H-1B workers, including a $100,000 entry fee for new H-1B visas and enhanced vetting procedures—including “online presence” reviews—that have caused delays in visa processing.

Background

The H-1B visa program supplies high-skilled workers to the U.S. Workforce, including physicians, particularly in lower-income areas and within research universities. The program allows U.S. Employers to temporarily employ foreign workers in specialized fields. According to the American Hospital Association, physicians account for almost half of approved H-1B visas for medical and health occupations.

Research indicates that counties with the highest poverty levels have a higher percentage of H-1B-sponsored physicians and other health care workers (2.0% vs. 0.5%) compared to those with the lowest poverty levels. Similarly, rural counties have a higher share of H-1B physicians and health care workers than urban counties (1.6% vs. 1.0%). Top employers of H-1B health care and social assistance workers in fiscal year 2025 included the Cleveland Clinic in Ohio, St. Jude Children’s Research Hospital in Tennessee and Memorial Sloan Kettering Cancer centre in New York.

The H-1B visa program is capped at 65,000 visas annually, with an additional 20,000 reserved for those with a U.S. Master’s degree or higher. While the cap was temporarily increased between 1990-2000 and 2001-2003, it reverted to 65,000 in 2004 and has remained there since, though the number of visas granted often exceeds the cap due to exemptions for institutions of higher education, government research organizations, and certain nonprofits.

The Trump administration has enacted changes expected to reduce the number of H-1B workers in the U.S. These include a Proclamation issued on September 19, 2025, imposing the $100,000 entry fee, which is currently being legally challenged by 20 states. The Department of labour launched Project Firewall in September 2025, increasing scrutiny of worksites. The U.S. Department of State began enhanced vetting and “online presence” reviews of all H-1B and H-4 visa applications starting December 15, 2025, leading to significant delays and cancellations of visa interviews.

Recent Trends in H-1B Visa Approvals

Analysis of data from U.S. Citizenship and Immigration Services (USCIS) shows that new and continuing H-1B visas for the health care and social assistance industries increased by over 8% from just under 18,000 in FY 2022 to over 19,000 in FY 2025. The Bureau of labour Statistics defines health care and social assistance industries as establishments providing health and medical care, as well as social assistance, including hospitals, clinics, and nursing homes.

Did You Know? Physicians account for almost half of all approved H-1B visas for medical and health occupations.

New York (14%), Massachusetts (9%), California (8%), Pennsylvania (6%), and Ohio, Tennessee, and Florida (5% each) accounted for over half (52%) of new and continuing H-1B visas for the health care and social assistance industries approved in FY 2025. These states are home to many research universities and medical centers, which are major employers of H-1B workers.

Expert Insight: The increasing reliance on H-1B workers in the health care sector, particularly in areas with limited resources, highlights the potential for significant disruption if policies substantially reduce the availability of this workforce. This could exacerbate existing shortages and impact access to care.

Implications

The data suggest that H-1B workers play an increasingly large role in the health care and social assistance industries. Reductions in the H-1B workforce could create gaps and worsen existing health care worker shortages. The Trump administration’s actions, including the $100,000 entry fee and enhanced vetting, are anticipated to reduce the number of H-1B workers in the U.S.

A decline in H-1B workers could disproportionately impact states employing the largest numbers of these workers, lower-income areas, rural areas, and smaller employers. Research universities and affiliated medical centers, already facing funding cuts, are also likely to be affected. These shortages could increase barriers to health care access.

These actions occur alongside increased immigration enforcement and other restrictions on lawful immigration, which have reduced the flow of immigrants into the country and increased fears among those already here. Researchers project that restrictive policies could reduce legal immigration by 33% to 50% over four years. This could affect the health care workforce, given the significant role immigrants play as physicians, nurses, and long-term care workers. These reductions may be compounded by a projected decline in the U.S.-born labour force.

Frequently Asked Questions

What is the H-1B visa program?

The H-1B program allows U.S. Employers to temporarily employ foreign workers for jobs requiring specialized skills or knowledge.

How have H-1B visa approvals for the health care industry trended recently?

New and continuing H-1B visas for the health care and social assistance industries increased by over 8% from FY 2022 to FY 2025.

What changes has the Trump administration made to the H-1B program?

The Trump administration implemented a $100,000 entry fee for new H-1B visas, launched Project Firewall for increased worksite scrutiny, and began enhanced vetting procedures for visa applicants.

As the landscape of immigration policy continues to evolve, what impact will these changes ultimately have on the accessibility and affordability of health care services across the nation?