By Michael Johnson, Esq.
Founder of Michael Johnson Legal LLC
On the heels of a new White House proclamation, many physicians on H-1B visas are understandably alarmed by reports of a new $100,000 H-1B fee. The proclamation, which came with little warning, has already generated intense concern on social media, particularly among international physicians in training or preparing for job transitions.
To help physicians better understand what’s really happening, I sat down with physician immigration lawyer Sid Chary of charylaw.com for an IG Live discussion on September 22, 2025. Here’s a breakdown of what we know so far and what physicians should do next.
Note: This blog is current as of September 22, 2025; however, the situation is fluid. Future updates will be coming.
First: It’s Too Early to Know the Real-World Impact
This policy is brand new. As of our conversation, the proclamation had been in effect for just a couple of days. While the text outlines a $100,000 fee on certain H-1B applications, there are more questions than answers at this point, including:
- Will this fee apply to extensions and transfers?
- Will it affect change-of-status filings (like J-1 to H-1B)?
- How will USCIS or DHS verify the fee was paid?
- When exactly does it go into effect?
For now, don’t make drastic career or immigration decisions. Both Sid and I agree: it’s too early to predict the practical consequences with any certainty.
Sid’s advice? Stay off Reddit. Echo chambers of worst-case scenarios won’t serve you right now. Stick with qualified legal sources, such as immigration attorneys who work directly with physician clients. Clickbait headlines don’t help you gain insight into what’s happening.
Should You Delay Travel Outside the U.S.?
If you’re currently on an H-1B visa and considering travel outside the United States, pause before you go. Sid recommends staying put unless absolutely necessary. Although some have recently re-entered without issue, the new policy is so recent that individual border agents and consular officers may still be learning how to apply it. There is a risk of misinterpretation or inconsistent enforcement.
If you don’t need to travel, don’t. Avoid unnecessary disruption while the system catches up to the policy. This won’t last forever.
A Built-In National Interest Exemption May Offer Protection
Here’s the most encouraging news: the proclamation already includes an exemption for occupations in the national interest. Here is the actual text from the proclamation:
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Accordingly, by the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered:
Section 1. Restriction on Entry. (a) Pursuant to sections 212(f) and 215(a) of the Immigration and Nationality Act (INA), 8 U.S.C. 1182(f) and 1185(a), the entry into the United States of aliens as nonimmigrants to perform services in a specialty occupation under section 101(a)(15)(H)(i)(b) of the INA, 8 U.S.C. 1101(a)(15)(H)(i)(b), is restricted, except for those aliens whose petitions are accompanied or supplemented by a payment of $100,000 — subject to the exceptions set forth in subsection (c) of this section. This restriction shall expire, absent extension, 12 months after the effective date of this proclamation, which shall be 12:01 a.m. eastern daylight time on September 21, 2025.
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(c) The restriction imposed pursuant to subsections (a) and (b) of this section shall not apply to any individual alien, all aliens working for a company, or all aliens working in an 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.
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And it’s hard to argue that physicians, especially those practicing in underserved or rural areas, are not deserving of special consideration.
Sid explained that the exemption is not something we have to lobby for or create from scratch. It’s already in the text. What’s needed now is thoughtful legal argument and proper documentation in individual filings to demonstrate that a particular case qualifies for the national interest carveout.
This could apply to:
- J-1 waiver physicians
- Physicians joining FQHCs or rural practices
- Specialists in shortage areas
- Hospital-employed physicians in medically underserved zones
That said, we won’t know how USCIS or consulates will apply the exemption until more cases are filed and processed. We don’t have any examples yet.
Will This Really Apply to Physicians?
The spirit of the proclamation appears to be focused on the tech industry, rather than healthcare. The examples and rhetoric surrounding the policy suggest a political and economic message aimed at Silicon Valley, not rural health clinics.
For example, the text of the proclamation cites instances where a software company was approved for 5,000 H-1Bs and subsequently laid off 15,000 employees. It speaks to examples where American workers were required to train foreign workers who were taking their jobs, and then were required to sign NDAs upon termination. There is further discussion about targeting relatively low-wage H-1 B employees who displace higher-paid American workers in the tech industry.
Sid and I both believe there’s a strong common-sense and policy rationale to argue that physicians should not be included and were not the intended target. The U.S. healthcare system is already experiencing a shortage of physicians, particularly in rural and underserved communities. Saddling these critical providers with $100,000 filing fees would make little sense and likely result in broad-based opposition. While we in the firm sometimes see healthcare employers offering lower-than-market compensation to J1 visa waiver applicants, we don’t believe this practice is as widespread or drastic as in other industries.
We believe the intent was not to target physicians, and we expect future clarification or legal challenges will reflect that reality.
What About J-1 Physicians, Residents, and Fellows?
This policy has raised particular concern among:
- Residents on J-1 visas planning to apply for H-1B status during fellowship
- J-1 waiver physicians transitioning to H-1B employment
- Fellows or attending physicians applying for a change of status or new positions
While it’s too early to say how the policy will apply to these scenarios, Sid emphasized that change-of-status filings from within the U.S. may be unaffected. The greatest risk may be for physicians applying from outside the U.S. or seeking visa stamps after initial approval.
What Should You Do Right Now?
Here’s the current guidance for physicians:
- Stay calm. Avoid Reddit and clickbait headline-driven panic.
- Don’t make sudden changes. Don’t alter your immigration plans, cancel your job search, or scrap your waiver timeline without legal guidance from an immigration lawyer who regularly works with physicians.
- Delay international travel in the very short term unless absolutely necessary.
- Work with an immigration lawyer experienced in physician visa issues.
- If you’re an employer or recruiter, stay in close communication with your counsel about how to document national interest arguments.
- Continue filing H-1B petitions as usual unless directed otherwise by legal counsel.
Legal Challenges Are Likely
We expect that lawsuits are coming. Legal challenges could clarify (or halt) some portions of the rule, especially if the implementation appears arbitrary or overly burdensome.
However, don’t rely on the courts to fix things right away. Individual case strategy matters now. Work with immigration lawyers experienced in healthcare who can argue for exemptions, handle documentation correctly, and help you avoid unnecessary exposure.
Final Thoughts
This proclamation has created a moment of confusion, but not an immediate crisis for physicians. Most details remain unclear. The exemption for national interest is promising. But until more data becomes available through filed cases, travel attempts, and agency memos, it’s wise to stay alert, informed, and legally supported. We’ll be watching this closely in the weeks ahead.
Contact: Michael Johnson Legal LLC
Immigration counsel referral: Sid Chary, Esq. – CharyLaw.com
