ACP Advocates for Physicians to Be Exempt From Proposed Immigration Policies

Proposed changes to the J-1 and H-1B visa application processes would restrict international medical graduates' ability to train and practice and ultimately affect access to care

Oct. 10, 2025 (ACP) -- The American College of Physicians is working to ensure that physicians are excluded from proposed changes to immigration policies that could have deleterious effects on the U.S. physician workforce.

The Trump administration recently announced a proclamation imposing a $100,000 H-1B visa application fee on employers for each initial H-1B application filed after Sept. 21, 2025. Another proposed rule would replace the long-standing “duration of status” policy with a fixed end date for certain categories of nonimmigrants, potentially resulting in recurring delays for thousands of J-1 physicians, which would prevent them from beginning or continuing their training on time each year.

International medical graduates, including those on J-1 and H-1B visas, comprise approximately 25 percent of the U.S. physician workforce and are disproportionately represented in underserved communities and rural areas, where workforce shortages are the most severe, ACP pointed out in letters to the U.S. Department of Homeland Security (DHS) regarding the proposed rules.

“Restricting their ability to train and practice would further threaten access to care for the communities that need it most,” said Renee Butkus, ACP director of health policy. “The College recognizes the vital role international medical graduates play in the U.S. health care workforce and will continue to oppose any immigration policy changes that negatively affect them or undermine the nation's ability to meet its pressing health care needs.”

Charging steep fees for H-1B visas would discourage employers from hiring international medical graduates, worsen physician shortages, disrupt training programs and jeopardize patient care, she argued.

The proclamation does grant the U.S. Secretary of Homeland Security the authority to exempt certain international workers if their employment is deemed to be in the national interest and does not pose a risk to the security or welfare of the United States. ACP has urged the secretary to provide such a national interest exemption for medical residents, fellows and physicians, according to Butkus.

Under the current policy, J-1 physicians can extend their authorized stay in the United States annually in tandem with their visa sponsorship renewal, which includes a rigorous eligibility review by the Educational Commission for Foreign Medical Graduates, Butkus explained.

The proposed rule, however, would shift this process to limit J-1 physicians to an initial period of up to four years and then require them to apply for Extensions of Status through DHS. This procedure can take several months or longer to complete.

“This extended timeline is misaligned with the operational realities of graduate medical education, where residency and fellowship contracts are typically issued just three to five months before the July 1 start date,” Butkus said. “The change adds costly administrative burdens and uncertainty, potentially discouraging residency and fellowship programs from recruiting and retaining international medical graduates.”

ACP has urged DHS to exempt physicians from the proposed rule. “If retaining ‘duration of status' is not possible, ACP recommends that physician status be aligned with the full length of their residency or fellowship program to ensure continuity of training and prevent disruptions in patient care,” Butkus said.

The public comment period for proposed changes to the J-1 visa recently ended, and DHS is now reviewing feedback before issuing its final rule.

Back to the October 10, 2025 issue of ACP Advocate