On September 19, President Trump issued a proclamation titled “Restriction on Entry of Certain Nonimmigrant Workers,” which imposes a $100,000 fee on employers for each initial H-1B visa application filed after September 21. In addition, the Trump administration has proposed changes to the J-1 visa process, requiring applicants to navigate a new Department of Homeland Security system that may introduce recurring delays for the graduate medical education (GME) workforce.

The American College of Physicians (ACP) is deeply concerned that these policy changes will create substantial barriers to hiring international medical graduates (IMGs) who require H-1B or J-1 visas. These barriers threaten to exacerbate existing physician workforce shortages and compromise patient care across the country.

IMGs—many of whom hold J-1 or H-1B visas—make up approximately 25% of the U.S. physician workforce. They are disproportionately represented in underserved and rural communities, where healthcare access is already limited. Their contributions are essential to maintaining care in these high-need areas.

The proclamation grants the Secretary of Homeland Security authority to exempt certain international workers from H-1B visa fees if their employment serves the national interest and poses no threat to U.S. security or welfare, and ACP believes that physicians, medical residents, and fellows clearly meet this standard.  Under the new policy, exemptions must be granted on a case-by-case basis, which is impractical given the volume of medical visa applications and the time involved in case-by-case review.

ACP has actively engaged with both the administration and Congress to advocate for exemptions for affected IMG physicians. The College has submitted letters to the Department of Homeland Security requesting categorical exemptions from H-1B and J-1 visa policy changes for medical residents, fellows, and physicians, emphasizing the essential role IMGs play in  the U.S. healthcare system.

How You Can Help

ACP urges its members to take action:

• Respond to ACP’s Action Alert to call on Congress to address this issue:
• Share your story about how these policy changes affect you or your institution through ACP’s anonymous survey.

Help us protect the physician workforce.