U.S. Healthcare · Immigration Policy
Stethoscopes in Limbo:
How Visa Pauses Are Emptying America’s Hospitals
Thousands of foreign-trained physicians can no longer see patients — and the staffing crisis they’re leaving behind is deepening fast.
Since late 2025, U.S. Citizenship and Immigration Services (USCIS) has placed a hold on adjudicating benefit requests for nationals of countries designated as “high-risk” by the Trump administration. The pause covers H-1B and J-1 visa holders — the two categories that international medical graduates (IMGs) rely on most. Doctors from Nigeria, Venezuela, Cuba, Syria, and dozens of other nations — many of them the only specialists in their rural counties — may continue working for up to 240 days after their visa expires if an extension petition is pending, but several have now passed that window with no USCIS decision. For context on how federal funding policy is separately straining medical institutions, see our coverage of the NIH funding cap fight.
What Happens When a Doctor’s Visa Runs Out
Tap each stage to see what foreign-trained physicians are facing in 2026 ↓
Stage 1 — Practising in the United States
International medical graduates (IMGs) account for roughly 25% of all physicians in the U.S., per the American College of Physicians. They are disproportionately concentrated in rural counties and primary care shortage areas — places where American-trained doctors are scarce.
The December 2, 2025, USCIS policy memo (PM-602-0192) placed an adjudication hold on all pending benefit requests for nationals from the 19 designated countries, later expanded to 39 countries effective January 1, 2026. For H-1B holders, there is a statutory 240-day grace period under 8 CFR § 274a.12(b)(20) that allows them to continue working after their visa expires, provided an extension petition is pending — but several doctors have now passed that date with no USCIS decision. A “premium processing” fee of $2,965, normally designed to guarantee a USCIS response within 15 business days, has reportedly not been honoured under the new security screening protocols, with some physicians waiting months without any update, according to USCIS communications shared through congressional liaisons.
A Policy Timeline: How the Crisis Built
Key regulatory decisions from mid-2025 to early 2026
Initial Visa Suspension — 19 Countries
The State Department fully or partially suspended visa issuance for nationals of 19 countries, citing national security and public safety grounds.
State Dept. notice →$100,000 H-1B Petition Fee Introduced
Presidential Proclamation signed September 19, 2025, introduced a $100,000 fee for new H-1B petitions filed for workers located outside the United States without a valid H-1B visa or an approved petition as of September 21, 2025. Workers already in the U.S. on a valid H-1B are generally not subject to the fee. Rural and safety-net hospitals — which rely on international hires — were immediately flagged as at risk by the Texas Hospital Association and the American Medical Association.
White House H-1B FAQ →USCIS Adjudication Hold Begins — 19 Countries
USCIS issued Policy Memorandum PM-602-0192 on December 2, 2025, placing all pending benefit requests — including I-129 H-1B and J-1 petitions — for nationals of the 19 high-risk countries designated under Presidential Proclamation 10949 under a formal adjudication hold. Physicians actively practising in U.S. hospitals were directly affected.
Expansion to 39 Countries — Hold Formalised
Presidential Proclamation 10998, issued December 16, 2025, expanded the restricted list from 19 to 39 countries. USCIS issued a corresponding policy memo (PM-602-0194) on January 1, 2026, extending the adjudication hold to all benefit requests filed by nationals of those 39 countries. USCIS clarified that the hold applied to employer-filed petitions — including I-129s for H-1B workers — and that exceptions for cases serving a U.S. national interest required headquarters-level coordination.
USCIS policy memo summary →AMA, ACP and Hospital Groups Demand Exemption
The American College of Physicians formally wrote to DHS on February 25, 2026, requesting a categorical exemption for physicians who are lawfully present and actively practising. More than 100 bipartisan lawmakers sent a separate letter urging a healthcare exemption from the $100,000 fee.
Society of Hospital Medicine letter →Wage-Weighted H-1B Lottery Takes Effect
DHS published its final rule replacing the random H-1B lottery with a wage-weighted selection system on December 29, 2025. The rule became effective February 27, 2026, in time for the FY 2027 cap registration season opening in March 2026. Under the new system, Level IV wage positions receive four lottery entries; Level I positions receive one — meaning most medical residents and fellows, who typically enter at Wage Level I, face significantly reduced selection probability.
DHS final rule →“The United States has been a place of stability. I spent more than 10 years passing boards, trying to get certifications. I never took a single penny from a social welfare program. And now I need to change my life all out of nowhere.”— A foreign physician, sole specialist in a rural U.S. county, speaking anonymously to POLITICO
“You have a bunch of physicians, well-trained, who are just sitting at home doing nothing. For the first two weeks, I was losing my mind. It’s like being on the bench of a team, watching everyone play, and you can’t play.”— A Pennsylvania physician from Nigeria, whose H-1B visa has expired
The Wage Lottery: Who Gets Selected for an H-1B?
Since February 27, 2026, the DHS wage-weighted system has shifted H-1B selection odds away from entry-level applicants — including most medical residents. Figures below reflect DHS projections published in the Federal Register.
⚠ Percentages are DHS-projected selection probabilities published in the Federal Register (December 29, 2025), based on historical registration distribution patterns. The Conrad 30 Waiver program — which lets J-1 physicians stay if they serve underserved areas for three years — is also facing bottlenecks as subsequent H-1B change-of-status applications remain stalled. See the Conrad 30 program status.
The primary care workforce pressure is not new. The U.S. Health Resources and Services Administration (HRSA) projects a shortage of more than 70,600 primary care physicians by 2038, with roughly 20% of the U.S. population already living in Health Professional Shortage Areas (HPSAs). The current visa disruptions hit these communities hardest — facilities in smaller markets rely disproportionately on international physicians, and when those doctors are sidelined, emergency department boarding increases and elective surgery slots go unfilled.
Samantha Wolfe, an immigration attorney who works with hospitals that hire foreign doctors, told POLITICO: “Every health care client that I work with is experiencing more barriers to hiring than a year ago in a system that’s already overburdened and has struggled to hire.” The American Hospital Association backed bipartisan congressional efforts to exempt healthcare workers from the $100,000 H-1B petition fee. For related context on how immigration policy disrupts healthcare labour in other countries, see our piece on the UK’s occupational salary threshold overhaul.
Affected Physician Populations: Select a Country Group
Tap a group to see the specific situation facing those physicians
Nigerian Physicians in the U.S.
Nigeria is among the countries with the largest number of IMG physicians in the United States, particularly in primary care, internal medicine, and geriatrics in underserved urban and rural areas.
- H-1B and J-1 renewals subject to the adjudication hold since December 2025
- Physicians who have passed the 240-day H-1B grace period are legally unable to practise
- A Pennsylvania-based Nigerian physician described being unable to work, with their H-1B expired
- Canada’s IRCC Express Entry physician category, launched in early 2026, offers a 14-day work permit processing goal for PNP-nominated physicians already working in Canada
Venezuelan Physicians in the U.S.
Venezuelan medical professionals in the U.S. face the visa pause alongside ongoing geopolitical scrutiny of their country of origin.
- Venezuela is listed among the “designated high-risk” countries under the USCIS hold
- Venezuelan doctors are represented in family medicine, paediatrics, and emergency care roles
- For geopolitical context, see our coverage of Venezuela’s Nobel Peace Prize nomination
Cuban Physicians in the U.S.
Cuban-born doctors in the U.S. are often family medicine and internal medicine practitioners, with many serving in Federally Qualified Health Centers (FQHCs) and safety-net clinics.
- Cuba is among the 39+ “high-risk” designated countries
- Cuban physicians are frequently sole providers in low-income community health centres
- The visa hold is disrupting continuity of care for the most economically vulnerable patients
Syrian Physicians in the U.S.
More than 100 Syrian doctors in the U.S. met in early 2026 with immigration lawyers to share experiences and explore legal options — one of the most publicly organised responses to the visa pause.
- Ahmad Keichour, a Syrian orthodontist in Texas, helped lead the group: “It’s not fair for those professionals to get paused while the country has a shortage in the health care industry”
- Dozens of foreign-trained doctors across nationalities have filed federal court lawsuits challenging the delays
- The group expressed cautious optimism about DHS Secretary Markwayne Mullin’s confirmation
Indian Physicians — NMC Re-entry Considerations
Indian doctors displaced from the U.S. who consider returning home to practise face licensing requirements under the National Medical Commission’s Foreign Medical Graduate Licentiate (FMGL) Regulations.
- NMC requires a minimum of 54 months of academic study plus a 12-month compulsory rotating internship for any foreign medical degree to be recognised in India
- Foreign medical graduates must pass the Foreign Medical Graduate Examination (FMGE) or the upcoming National Exit Test (NExT) to obtain an Indian medical licence
- Doctors who completed any part of their medical training via online classes face additional compliance requirements under NMC’s March 2026 clarification
- These requirements apply to returning graduates regardless of the country where they trained — the re-licensing pathway exists but involves time and examination steps
Barb Martin, who directs outpatient care hiring at Mercy — a Midwestern health system with 55 hospitals — said stalled visa petitions have become an “exponential administrative burden.” Of medical fellows in visa limbo, she said: “We’re in a position right now where we don’t have a path to offer them employment, especially the specialists. Physician petitions need to be prioritized.”
The staffing gap has a direct impact on patients in under-resourced areas. A significant share of Americans lack personal vehicle access — when rural hospitals close entire departments, the distances patients must travel to reach alternative facilities can itself become a health risk.
United States vs. Canada: Two Very Different Doors for Foreign Doctors
As U.S. pathways stall, Canada has moved in the opposite direction with its 2026 physician immigration framework.
| Category | 🇺🇸 United States (2026) | 🇨🇦 Canada (2026) |
|---|---|---|
| Visa Processing Time | Months, no defined timeline; premium processing ($2,965) not honoured under hold | 14-day work permit processing goal for PNP-nominated physicians already working in Canada (IRCC, December 2025) |
| H-1B / Work Permit Fee | $100,000 new petition fee (post-Sep 2025) | No comparable fee barrier; standard Express Entry fees apply |
| Lottery System | Wage-weighted lottery (effective Feb 27, 2026); Wage Level I applicants disadvantaged | Points-based Express Entry; physician category-based selection added in 2026 |
| Rural Incentive | Conrad 30 Waiver (J-1 pathway) — active but H-1B change-of-status blocked | Rural and remote physician fast-track; direct permanent residency pathway |
| Target Pool | Domestic graduates preferred; IMGs facing increased vetting barriers | Express Entry physician category (launched early 2026) targets doctors with 1+ year of Canadian work experience; 5,000 additional PNP spaces reserved for licensed doctors with provincial job offers |
Who Is Pushing Back — and What Has Changed
Status of key advocacy efforts as of early 2026
