Hundreds of foreign-trained physicians about to finish U.S. training may have to leave the country unless the federal government quickly clears a backlog of J-1 visa waiver applications, immigration attorneys and affected doctors say.
The Department of Health and Human Services runs an Exchange Visitor Program that recommends J-1 waiver petitions allowing doctors who trained in the U.S. on J-1 visas to switch to H-1B status if they agree to work at least three years in federally designated underserved areas. In recent years the HHS program typically reviewed waiver applications in one to three weeks, attorneys said. This year, however, the office has amassed a backlog of hundreds of applications that still must be reviewed by the State Department and approved by U.S. Citizenship and Immigration Services.
Physicians and attorneys warn that many applicants must have their files sent to USCIS by July 30 or they will be required to return to their home countries after their training ends — usually June 30 — and generally wait two years before seeking an H-1B. Reentering the U.S. later would trigger a new $100,000 H-1B fee established by a 2025 presidential proclamation and applied to workers living outside the country. Many rural and safety-net hospitals say they cannot afford that payment.
“It will be the patients that suffer the most because in about three months, there’s going to be hundreds of places that are not going to have a physician that should have,” said one psychiatrist caught in the delay, who asked not to be named for fear of government reprisal. The doctor had applied for an HHS J-1 waiver to remain in the U.S. and begin serving vulnerable mental health patients in New York; without the waiver they face separation from their partner and months without work while they seek options.
Attorneys say HHS stopped processing Exchange Visitor Program clinical waiver applications in late September or early October, resumed work a few months ago, but at a much slower pace. HHS spokesperson Emily Hilliard said the program has reviewed all fiscal year 2025 clinical J-1 waiver applications and some from fiscal year 2026, and that the department is “implementing key process improvements to prevent future delays” while working to evaluate remaining applications ahead of the July 30 deadline. She did not provide numbers of pending applications or explain what caused the slowdown.
The HHS clinical care waiver applies to physicians in specialties such as pediatrics, psychiatry, family and internal medicine, and obstetrics and gynecology. Attorneys estimate the Exchange Visitor Program received roughly 750 clinical J-1 waiver applications last year. They say the delays are limited to HHS’s Exchange Visitor Program and not seen in other federal or state J-1 waiver programs.
If HHS does not forward recommendations in time, attorneys say, many doctors will have to leave the country unless they qualify for another visa, obtain a waiver from another program, or extend their J-1 by taking additional training or board exams. Even when employers want to sponsor physicians for H-1B visas, the $100,000 outside-the-U.S. fee is a major barrier. As of Feb. 15, employers had paid the fee only for 85 workers nationwide, according to a USCIS court filing; it’s unclear how many, if any, were medical professionals.
Hospitals that rely on J-1 waiver physicians tend to be in underserved areas and often serve Medicare and Medicaid populations, leaving them with limited financial resources. “That’s the cliff that this train is headed for,” said Charles Wintersteen, a Chicago attorney who focuses on health workforce immigration. Barry Walker, an attorney in Mississippi who handles similar cases, said employers already spend money on recruiters and immigration counsel; adding the H-1B fee is “just a deal killer, especially for small, rural hospitals.”
Clinicians and advocates say the U.S. health system depends on foreign-trained professionals. Nearly a quarter of U.S. physicians attended medical school outside the U.S. or Canada, according to 2025 licensing data. The J-1 waiver program has been a key pathway for placing U.S.-trained international physicians in areas with shortages.
Healthcare groups, hospital associations, medical societies, and rural health organizations have urged the administration to exempt health care workers from the fee. A bipartisan bill introduced in March would create a healthcare exemption, but it has not had a hearing. At least three lawsuits seek to end the fee entirely — including suits from the U.S. Chamber of Commerce, a coalition of 20 states, and a group of plaintiffs that includes a recruiter of foreign nurses and a union representing medical graduates.
Meanwhile, physician groups have pushed HHS to take emergency steps. The American Medical Association’s CEO asked the Exchange Visitor Program to use “emergency batch processing” for doctors with contracts to start work this summer, and the Society of Hospital Medicine urged urgent action, warning that every day the backlog persists raises risks for hospitalized patients in affected communities.
Some foreign doctors are already pursuing alternatives. The psychiatrist in limbo said Canadian hospitals have been actively recruiting physicians finishing U.S. training; a friend accepted a Canadian offer and withdrew a waiver application. That dynamic underscores the broader concern among advocates: delays and burdensome fees could push international clinicians to seek work in countries that better value their willingness to serve underserved patients.
Physicians, hospital leaders, lawmakers, and immigration experts continue to press HHS for clarity and speed on the waivers while also fighting the H-1B fee through legislation and litigation. In the meantime, patients in rural and low-income urban areas face the prospect of unfilled physician vacancies this summer if the backlog is not cleared.