Dr. Mahesh Anantha is one of the few interventional cardiologists serving the Batesville area in Arkansas, a rural region surrounded by farmland and small industries. Batesville, with a population of about 11,000, acts as a medical and economic hub for nearby villages and smaller towns. Dr. Anantha’s work is vital because there are no other medical facilities within an hour or two’s drive, making his often lifesaving care indispensable to the community.
A gold medallist from Madras Medical College in southern India, Dr. Anantha exemplifies the thousands of immigrant doctors who practice in small and remote towns across the United States. Approximately one in four doctors in the US is foreign-trained, with many choosing to work in underserved rural areas where American medical graduates are reluctant to go. These immigrant doctors often work under H-1B visas, some spending their entire careers on these temporary permits while waiting for green cards. This situation leaves them vulnerable to job losses and long-term instability.
Recently, the Trump administration announced a dramatic increase in the fees for skilled-worker H-1B visa applications, raising the cost for new applicants to $100,000 (£74,359). This sudden hike sparked fear and anxiety among roughly 50,000 Indian-trained doctors working in the US, many of whom felt uncertain about their future in the country despite having established careers and communities over many years. Initially, there was little clarity on how this new fee would impact medical professionals, fueling widespread concern.
Following a public outcry, the White House clarified in late September that potential exemptions exist for physicians and medical residents. US officials later confirmed that the new fee does not apply to any previously issued and currently valid H-1B visas, providing some relief to those already working in the US under such visas. However, questions remain about the future supply of Indian medical professionals willing or able to come to the US under these new, more expensive visa conditions.
The executive order that introduced the fee hike does allow for waivers if the Secretary of Homeland Security determines that hiring certain workers is “in the national interest.” Yet, medical organizations have pointed out that no official exemption has been granted for any category of workers, including doctors. Many fear that increased costs for hospitals to hire H-1B doctors could have ripple effects throughout the healthcare system, potentially discouraging hospitals from recruiting these essential foreign-trained physicians.
More than 50 organizations, led by the American Medical Association (AMA), wrote to the Secretary of Homeland Security to stress that the fee hike could severely restrict hospitals’ ability to hire H-1B doctors. This limitation could disrupt the pipeline of future medical professionals and reduce patients’ access to care, particularly in communities that depend heavily on immigrant doctors. Dr. Bobby Mukkamala, president of the AMA and the son of Indian immigrant doctors, emphasized hearing from health systems that the fee increase would be devastating. Research shows that one in five immigrant doctors in the US is of Indian origin, highlighting the critical role this community plays in American healthcare.
Supporters of the visa fee hike argue that tightening immigration policies is necessary to protect jobs for American citizens. However, research from the University of California San Diego’s School of Global Policy and Strategy suggests that relaxed visa requirements do not negatively affect the employment prospects of US medical graduates. Instead, these policies enable more foreign-trained doctors to serve in remote and low-income areas where native graduates are less likely to work. The AMA echoes this sentiment, stating that international medical graduates are “not taking jobs from US physicians” but rather “filling critical gaps in care.”
The US has long grappled with a shortage of doctors and nurses, a problem projected to worsen. The UCSD study forecasts a shortfall of 124,000 doctors by 2034. This shortage will be felt most acutely in rural areas, as most American medical graduates prefer to work in larger cities that offer better amenities and higher salaries. Dr. Satheesh Kathula, president of the American Association of Physicians of Indian Origin for 2024-25, explains that economics widen this gap, with wealthy urban hospital systems able to outbid struggling rural hospitals for medical talent.
Medical students raised in rural areas, like Stanford’s Geeta Minocha, highlight that rural hospitals already face financial strain, and any increase in visa fees would further hinder their ability to recruit foreign doctors. The impact isn’t limited to rural towns; many metropolitan areas including Washington D.C., Michigan