What’s the news: The AMA and more than 50 national specialty societies are urging the Trump administration to issue guidance to clarify that international medical graduate (IMG) physicians entering the country using the H-1B visa system will be exempt from a $100,000 fee announced last week.
In a proclamation issued Sept. 19, President Donald Trump ordered that a $100,000 fee be paid by prospective employers of H-1B visa holders upon initial application, beginning Sept. 21.
But the proclamation says the fee can be waived for an individual H-1B worker or for an entire industry “if the Secretary of Homeland Security determines, in the Secretary’s discretion, that the hiring of such aliens to be employed as H-1B specialty occupation workers is in the national interest and does not pose a threat to the security or welfare of the United States.”
In a Sept. 25 letter (PDF) to the Secretary of Homeland Security, Kristi Noem, the AMA and 54 other physician organizations wrote: “As you establish standards to define categories of H-1B workers covered by this exception, we urge you to clarify that all physicians, including medical residents, fellows, researchers and those working in nonclinical settings, are critical to our national interest and exempt from the Proclamation.”
Why it’s important: The Association of American Medical Colleges projects a shortage of up to 86,000 physicians by 2036. That is “a growing need for a larger physician workforce that the U.S. cannot fill on its own,” says the letter from the AMA and others. “H-1B physicians play a critical role in filling this void, especially in areas of the U.S. with high-need populations.”
As of 2024, 23% of licensed physicians in the U.S. were IMGs, according to the Federation of State Medical Boards.
“These H-1B physicians provide vitally needed health care to U.S. patients, especially in areas of the country with higher rates of poverty and chronic disease,” says the letter to Noem, which cites data showing that, as of 2021, about 64% of IMGs practiced in medically underserved or health-professional shortage areas.
More than 20 million Americans live in areas where IMGs account “for at least half of all physicians, aligning with the fact that states with a higher percentage of H-1B physicians are often those with lower physician density,” says the letter to Noem, citing a July 22, 2025, article published in the Journal of General Internal Medicine.
“The U.S. health care workforce relies upon physicians from other countries to provide high-quality and accessible patient care,” the letter adds, urging Noem to waive the new application fee “so that H-1B physicians can continue to be a pipeline that provides health care to U.S. patients.”
Learn more: In a social media post, AMA President Bobby Mukkamala, MD, weighed in on the need for an IMG exemption to the H-1B visa fee.
“My parents were IMGs,” wrote Dr. Mukkamala, an otolaryngologist and the first physician of Indian heritage to lead the AMA. “They could not have moved to Flint, Michigan, if it cost them $100,000 each. My community would not have had the benefit of their service for their entire careers. With this new fee, patients would have to wait longer and drive farther to access care.”
He also wrote an op-ed, published in U.S. News & World Report, explaining how the $100,000 visa fee would make the doctor shortage worse.
The AMA IMG Section gives voice to—and advocates on—issues that affect international medical graduate physicians. The AMA IMG Physician Toolkit (members only) provides comprehensive guidance on various topics, including answers to frequently asked questions about the types of visas available.
Visit AMA Advocacy in Action to find out what’s at stake in clearing IMGs' route to practice and other advocacy priorities the AMA is actively working on.
