H1B Visa for 100k and how it might affect EM

[Pudortu]

---

Members do not see this ad.

POTUS had an Executive Order that I believe goes into effect midnight tonight. H1B visa employers now have to pay 100k/year.

I suspect the H1B Visa situation will lead to a few different pathways as it affects EM. With the downfall of EM as a competitive specialty, we are more and more becoming FMG filled. I had a few random thoughts on the subject and how it might affect us in the downstream.

FMG residents will go the J1 visa route and hope that rural facilities pay for the H1B visa. But in exchange, hospitals or CMGs will pay EM docs a lot less per hour to make up for it. They may see this as a cost (whether the 100k goes to pay or goes to the government, it's tax deductible regardless). They will sell it as a "take it or go back to your country" situation. These grads will be desperate and do this until they can become green card holders. This will push down the average EM Doc pay.

Alternatively, hospitals could even refuse to mess around with this. My understanding is the 100k H1B is just for the application. It does not even guarantee the doc will stay and it must be paid by the employer from what I read. Hospitals could just decide to not mess around with it and hire more midlevels. I doubt this leads to better pay for us unfortunately.

In the end, this will likely be challenged by hospitals and tech in courts. Assuming the EO on H1B visas stay, do you all foresee this going in other directions?

 

[Pudortu]

It also appears based on a last minute clarification that this will not apply to existing H1B visas but rather new applicants.

https://www.politico.com/news/2025/09/20/donald-trump-h1b-visas-overhaul-00574345

 

[EctopicFetus]

It also appears based on a last minute clarification that this will not apply to existing H1B visas but rather new applicants.

https://www.politico.com/news/2025/09/20/donald-trump-h1b-visas-overhaul-00574345

Plenty of docs already. Minimal impact on EM. Other specialties i think more so.

 

[gro2001]

I think the most likely thing is that medical H1Bs will be exempt, in a similar way to how they are currently exempt from the H1B cap. If that's the case, then it will not significantly affect the job market or anyone's decisions to hire FMGs or for FMGs to come to the US.

One could imagine only certain medical H1Bs being exempt, such as for example H1Bs for primary care specialists or ones from rural/underserved areas (extending the logic of the Conrad 30 program). In that case I would imagine it would shift things a little more. FMGs will even more heavily skew towards primary care fields, but that is a relatively small change as that is roughly what happens already. The change would be even smaller if the restriction was geographic, as FMGs would aim to get a green card before the 6 year lifetime H1B limit (challenging, as the EB1/EB2 process can only start after they are done with training, so it would not leave time for fellowship while on an H1B; so folks who would want to do a fellowship after doing residency training on an H1B would need to either wait till their green card is approved or get a green card in some other way (likely through marriage to a US citizen)).

If there are no exemptions for medical H1Bs, then:

-in the short term it would be harder for FMGs in lower revenue specialties to find employment, as they would need their new employer to pay the fee since it would be a new petition. That is small potatoes if you are hiring a neurosurgeon bringing in >$5M revenue (not too many neurosurgeons on H1Bs, but you get the point), but becomes a more substantial consideration if you are hiring a hospitalist and expecting maybe $1M revenue.

-in the long term it would drastically decrease the amount of FMGs in the US. Training programs would not shell out the cash for that, so they would offer J1 or nothing. The J trained physician would either have to leave or find an employer who is both eligible for a waiver spot (usually through Conrad 30) AND willing to pay $100k. Even if it's doable, the path seems so uncertain that it would dissuade anyone who wasn't already planning to return to their home country after completing training. Some of the gap in physicians would be made up by currently unmatched US MD graduates. But I would expect that there would still be ~10% fewer physicians entering the work force.

What would that mean for practicing US physicians? More competitive pay (ye olde supply and demand)? More workload without increase in pay (because the labor supply is not that flexible ie what else are you really going to do instead)? More automation (instead of paying you more we spent money on this AI note writing tool, you are welcome). More APPs (if there are too few docs to hire, why not just hire some more NPs)? My guess is that we will see a mix of all of the above, apart from the increased pay.