Trump's $100K visa fee will be bad for heart patients
President Trump's presidential proclamation implementing a $100,000 fee for H-1B visa applications did not go over well with the American College of Cardiology (ACC) or other cardiovascular health societies. The groups believe this new policy will cut off the flow of foreign doctors into the United States at a time when there is already a growing physician shortage.
Cardiology groups were among more than 50 medical societies that shared their concerns in a Sept. 25 letter to Kristi Noem, secretary of the Department of Homeland Security. The letter urged the Trump administration to exempt docs from a newly announced $100,000 visa fee. The primary concern of the medical groups is that by not creating a waiver for physicians, the fee will create a barrier that will accelerate the shortage of physicians.
The letter, available here, was signed by the ACC, American Society of Echocardiography (ASE), American Society of Nuclear Cardiology (ASNC), Heart Rhythm Society (HRS), Society for Cardiovascular Angiography and Interventions (SCAI), Society for Cardiovascular Computed Tomography (SCCT), Society of Thoracic Surgeons (STS) and Society for Vascular Surgery (SVS).
The White House suggests restricting access to the U.S., “except for those aliens whose petitions are accompanied or supplemented by a payment of $100,000.” The White House order applies to the H-1B visa program, created to bring temp workers into the country to perform “additive, high-skilled functions.” However, the administration contends the program has been “deliberately exploited to replace, rather than supplement, American Workers with lower-paid, lower-skilled labor.”
“The large-scale replacement of American workers through systemic abuse of the program has undermined both our economic and national security,” the proclamation claims.
But cardiology groups say the cost barrier will directly harm the ability of hospitals, especially rural hospitals, to staff their facilities.
"This is a terrible idea and it will impact healthcare. This also will impact doctors who are already here treating patients," explained Enrique Garcia-Sayan, MD, chair of the ASE Advocacy Committee and director of the echocardiography laboratory and non-invasive cardiology at Baylor St. Luke’s Medical Center, in an interview with Cardiovascular Business.
He said about 23% of U.S. physicians are from foreign countries that came to the U.S. under the J-1B or CONRAD 30 visas. Garcia-Sayan said they often take jobs in locations that Americans do not want, including remote rural areas and in low-income, underserved areas. Garcia-Sayan himself came into the U.S. from Peru under a J-1B visa. He accepted a job at a hospital of Chicago's West Side, which is one of the roughest neighbors in the city where he saw a steady stream of patients coming in with gunshot wounds. But even to get that job, it took him seven years through the J-1B visa program.
"The first thing I thought when I saw this was, we need to make a statement, and many medical societies signed on quickly," Garcia-Sayan explained. "There is already a deficit of doctors in the U.S., and this will make it worse."
He said the Trump administration's goal with the new immigration barrier is aimed at the tech industry to employ more American workers, rather than importing talent from overseas. But the impact of the policy will be strongly felt across healthcare.
"We do not have enough U.S. physicians to replace the foreign-born doctors. We would be shooting ourselves in the foot by not giving them a visa," Friederike K. Keating, MD, health policy chair for ASNC and UVM Health's director of nuclear cardiology, said in an interview with Cardiovascular Business.
She explained that many foreign medical students come to the U.S. for residency programs, and many decide to stay and practice in the U.S. using J-1B visas. Most of these medical resident positions are also funded through Medicare to ensure a steady supply of new physicians for the U.S. healthcare system. Over the past decade, there have been repeated calls from various medical societies, including the ACC and the AMA, to expand the number of residency positions, but there has been resistance because it would mean increasing the Medicare budget. Now with the new immigration rules, Keating said doctors trained in U.S. residency programs will not be able to afford to stay and practice in the U.S.
"It is sort of insane that they are putting up hurdles for doctors," Keating said.
As the shortage of physicians grows in the U.S. and demand on the healthcare system is increasing, it is getting even harder to fill cardiology positions in rural America. Some recruiters for rural health systems told Cardiovascular Business at ACC.25 they have had some cardiology positions open for years.
Keating added that one of her current residents from Ecuador is in the U.S. here on a J1 student visa and is now in the middle of deciding what to do next under the new Trump policy. Due to turmoil in his own country, we would prefer to stay in the U.S. under an H-1B visa, but he said that may no longer be possible because of the massive cost barrier.
Primary immigration visas for doctors
There are several immigration visas doctors can use to enter and practice in the U.S.
The J-1 visa is used by non-immigrant students participating in U.S. education, including medical residency programs. These medical students need to renew their visas every year. When their program ends, they are required to leave the country for two years before coming back under an H-1B visa to work in the U.S. as a practicing doctor. However, there is cap on how many people can receive a H-1B visa, and the waiting period for one can be years.
Doctors can also get enter the U.S. through the CONRAD 30 waiver program to practice in underserved or rural areas where there is a shortage because the locations are undesirable for U.S. doctors and positions are very difficult to fill. However, as the name implies, it only allows 30 doctors in per year, per state. States are also very selective. Health systems hiring doctors under the CONRAD 30 visa also need to show need for foreign doctors because they are unable to find U.S. doctors who want too take these positions.
"We don't have a flood of foreign doctors flowing into the country. It is a very limited process and a very stringent process," Garcia-Sayan said.
Getting a H-1B visa can be challenge, as Congress caps how many people can get these visas each year, and the annual cap is often reached six months in advance of the year foreign physicians are applying for. The U.S. Citizenship and Immigration Services (USCIS) announced July 18 it had already reached the cap on applications for 2026. There are only 20,000 H-1B visas allowed each year under the cap for advanced degree exemptions, which includes physicians and other highly educated individuals.
The O-1 non-immigrant visa is designed to go to individuals who possess extraordinary abilities in the sciences, arts, education, business or athletics. These are much harder visas to get, but there are some foreign-trained cardiologists who came to the U.S. under an O-1.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]