The New $100,000 H-1B Fee Rule: What Physicians Should Know

Meet Vaishnav
35 minutes ago
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Recently, the U.S. government introduced a significant change in H-1B policy: for many new H-1B visa petitions, employers must now pay a $100,000 supplemental payment. This change could have important consequences for hospitals, clinics, and international physicians. Below, we explain what the rule says, how it works, and what doctors and medical institutions should watch.

What the U.S. Government Says: Key Provisions

Based on official U.S. Citizenship and Immigration Services (USCIS) guidance and the Proclamation text:

Starting 12:01 a.m. Eastern Time on Sept. 21, 2025, new H-1B petitions must be accompanied by a $100,000 payment, or else they cannot be decided or approved. (Source)
This requirement applies only to new petitions filed on or after that effective date.(source)
The rule does not apply to:
1. Petitions filed before Sept. 21, 2025(source)
2. Already approved H-1B visa holders seeking renewal or extension of status under existing petitions(source)
USCIS confirms that the fee is a one-time payment for the new petition (not recurring annually under current guidance). USCIS
The Proclamation includes a mechanism for “national interest” exemptions. That is, the government may permit certain petitions to be processed without the $100,000 fee if the employment is deemed in the national interest.(source)
The restriction is targeted especially to foreign nationals outside the U.S. seeking entry under an H-1B petition.
The Proclamation directs that the Departments of Homeland Security and State coordinate so that visa issuance or entry is refused if the payment has not been made.(source)

Because this rule is new and significant, many questions remain about its implementation, enforcement, and scope.

How H-1B Works Today: Context & Baseline Data

To see how drastic this change is, here are key facts about H-1B use and how doctors currently participate.

Overall H-1B Volumes & Education

In FY 2023, USCIS received 386,559 H-1B petitions. USCIS+1
Of these, 386,318 were approved. USCIS
Among approved petitions in FY 2023, about 8% held doctorate degrees and ~4% had professional degrees. USCIS
The H-1B annual cap remains at 65,000 for standard petitions + 20,000 for U.S. master’s or higher. USCIS+1

Physicians Participating via H-1B

A 2016 study showed 10,491 Labor Condition Applications (LCAs) certified for physician roles across ~2,156 sponsoring employers.(source)
That represented about 1.4% of the active physician workforce at that time.(source)
Many international medical graduates (IMGs) use alternate visa paths like J-1 + waiver, O-1, or green card routes, partly because H-1B has practical constraints in pure clinical roles.

Given this baseline, layering an extra $100,000 charge on new petitions alters the calculus significantly.

Implications for Doctors & Healthcare Employers

Here’s how physicians, hospitals, and medical recruiters should think about this change, along with open issues and strategies.

Potential Impacts

High Cost for New H-1B Sponsorship Hospitals or clinics seeking to hire international doctors via H-1B would need to pay the additional $100,000. For smaller or resource-constrained institutions, this could be prohibitive.
Barrier for Physicians Outside U.S. The restriction is especially for those outside the U.S. seeking entry under a new petition, which may reduce opportunities for foreign-trained doctors seeking to join U.S. clinical or academic practices.
Shift Away from H-1B in Medicine Many institutions may prefer other visa routes (e.g. J-1 waiver, O-1, EB classification) that are unaffected by this rule, making H-1B less attractive in clinical hiring.
Exemption Cases May Be Key The “national interest” exemption is possibly the only path for many medical roles. If regulators define these broadly (e.g. for underserved rural physicians), some hospital sponsorships might still proceed without the fee.
Uncertainty for Travel & Consular Processing Physicians on valid H-1B visas currently inside the U.S. may generally renew, but if they travel or need visa stamping abroad after the effective date for roles based on petitions filed after Sept. 21, the rule may affect consular visa issuance.(source)
Legal Risks & Challenges Because this rule is sweeping and imposes a large new financial burden, lawsuits and regulatory pushback are likely. Implementation may be delayed or modified.

What Remains Unclear / Questions

Will “transfers” (changing employers) or “change of status” be treated as new petitions and thus subject to the fee?
If a physician is already in the U.S. and later travels abroad for visa stamping, will the fee apply?
How will the government collect the payment at petition filing, approval, or consular stage?
How will the national interest exemption process work? Who applies, when, and what is the standard?
Will the rule remain in effect beyond its initial 12 months, or be extended, rescinded, or revised?

What Doctors & Medical Institutions Should Do

Given the uncertainty and high stakes, here are strategic steps to consider:

For Physicians & International Medical Graduates

Monitor official sources such as USCIS and Department of State for final regulation, guidance, and exemption criteria.
Explore non-H-1B visa paths (J-1 waiver, O-1, EB-2/EB-NIW) as potential alternatives.
Negotiate with prospective employers in advance and ask whether they will absorb the new fee or only hire via alternative visa strategies.
Time decisions carefully if you can enter or file before the effective date, that may allow an exemption.

For Hospitals, Clinics & Healthcare Employers

Advocate for exemptions medical associations (state, national) should push for broad “healthcare/physician” carve-outs under the national interest provision.
Assess financial viability new physician hires via H-1B may become much more costly; adjust hiring budgets and models accordingly.
Leverage alternative visa routes use J-1 + waiver, O-1 hires, cap-exempt institutions, or direct green card sponsorship where possible.
Delay or stagger hires where feasible, postpone new international hires until final regulation or litigation resolves some of the ambiguity.

Conclusion

The U.S. government’s introduction of a $100,000 supplemental payment requirement for new H-1B visa petitions is a sweeping change that could reshape how international physicians enter U.S. clinical and academic practice. While many details remain unsettled especially around exemptions, transfers, and implementation logistics, the rule’s high cost may deter many new H-1B sponsorships in medicine.

Doctors, hospitals, and medical recruiting firms should act proactively: stay abreast of official guidance, devise fallback visa plans, and engage in advocacy to protect critical healthcare staffing needs. If the rule is applied strictly without broad exemption, it risks reducing access to care in underserved areas and making the H-1B pathway much less viable for physicians.