Hundreds of foreign-trained physicians finishing U.S. training could be forced to leave the country unless the federal government expedites a backlog of J-1 waiver recommendations, immigration lawyers and affected doctors warn. The backlog threatens to disrupt care in rural and low-income urban communities that depend on these clinicians.
The Department of Health and Human Services runs an Exchange Visitor Program that recommends J-1 waiver petitions for physicians who trained in the U.S. on J-1 visas. Those recommendations allow doctors to switch to H-1B status if they commit to at least three years of service in federally designated underserved areas. In prior years the office typically turned around clinical waiver requests in one to three weeks; this year it has fallen far behind, leaving hundreds of cases awaiting review by the State Department and approval by U.S. Citizenship and Immigration Services.
Attorneys say many files must be forwarded to USCIS by July 30 or the physicians will be required to depart after their training ends — usually around June 30 — and generally wait two years before seeking an H-1B. Returning later would trigger a new $100,000 H-1B fee created by a 2025 presidential proclamation that applies to workers who reenter from abroad. Many community and safety-net hospitals say they cannot absorb that cost.
One psychiatrist caught in the delay, who requested anonymity, said the backlog could leave dozens of clinics without doctors this summer and would force personal disruptions, including separation from partners and months without paid work. Lawyers report that HHS largely paused processing clinical waiver applications in late September or early October, resumed several months ago but at a much slower pace, and has not explained the cause of the slowdown.
HHS spokesperson Emily Hilliard said the agency has completed reviews of all fiscal year 2025 clinical J-1 waiver applications and some from fiscal year 2026, and is implementing process improvements while evaluating remaining cases ahead of the July 30 deadline. She declined to provide figures on pending petitions.
The clinical care waiver is commonly used by physicians in specialties with shortages — pediatrics, psychiatry, family and internal medicine, and obstetrics and gynecology. Attorneys estimate the Exchange Visitor Program received roughly 750 clinical waiver applications last year. They say the delays are confined to HHS’s Exchange Visitor Program and have not affected other federal or state J-1 waiver routes.
If the agency does not forward recommendations in time, affected doctors must either qualify for another visa, obtain a waiver through a different program, extend their J-1 by pursuing further training or exams, or depart. Even when hospitals want to sponsor H-1Bs, the $100,000 outside-the-U.S. fee is a prohibitive barrier: a USCIS court filing says employers had paid the fee for only 85 workers nationwide as of Feb. 15, and it’s unclear how many were healthcare professionals.
Hospitals that rely on J-1 waiver physicians typically serve Medicare and Medicaid populations and operate on tight budgets. Immigration attorneys and hospital leaders warn that the combination of processing delays and the new fee could prompt many hospitals to lose physicians they already recruited. Nearly a quarter of U.S. physicians attended medical school outside the U.S. or Canada, according to 2025 licensing data, and the J-1 waiver has been a key pathway for placing U.S.-trained international physicians in shortage areas.
Healthcare organizations, hospital associations, medical societies, and rural health groups have urged the administration to exempt health workers from the H-1B fee. A bipartisan bill introduced in March would create such an exemption but has not advanced. Multiple lawsuits are also challenging the fee, including suits by the U.S. Chamber of Commerce, a coalition of 20 states, and a group that includes a recruiter of foreign nurses and a union representing medical graduates.
Physician groups are urging HHS to take emergency steps. The American Medical Association asked the Exchange Visitor Program to use “emergency batch processing” for doctors with contracts starting this summer, and the Society of Hospital Medicine called for rapid action, warning that each day of delay risks patient care in affected communities.
Some doctors are already considering alternatives abroad; a doctor in limbo said Canadian hospitals actively recruiting physicians finishing U.S. training have lured colleagues away. Advocates fear that persistent delays and new fees will send international clinicians to countries that place a higher value on their service to underserved patients.
Physicians, hospital officials, lawmakers and immigration experts continue to press HHS for clarity and speed while challenging the fee through legislation and litigation. Meanwhile, patients in rural and low-income urban areas face the real possibility of unfilled physician positions this summer unless the backlog is cleared.