How Many U.S. Medical Residency Positions Are Filled by H-1B Visa Holders?

In a move sparking concern among healthcare leaders, President Donald Trump has announced a dramatic increase in H-1B visa fees, raising costs from the current range of $2,000-$5,000 to $100,000 per application effective September 21.

The Trump administration defended the steep fee hike as a measure to prevent American workers from “being replaced with lower-paid foreign labor.” The H-1B program allows employers to temporarily hire foreign workers in specialty occupations requiring technical expertise.

Medical associations responded swiftly, sending a September 25 letter to Homeland Security Secretary Kristi Noem requesting exemptions for physicians and medical personnel. The groups cited critical doctor shortages facing the nation as the U.S. population continues to grow. While the proclamation reportedly allows for industry-specific exemptions, the administration has not yet announced any carve-outs for healthcare or other sectors.

The policy change has triggered debate about its potential impact on the medical workforce. One physician with a popular podcast claimed on social media that “~30% residents are international medical graduates & ~10k of 43k residency spots are filled by docs with H-1B visas,” suggesting the fee increase would be “absolutely devastating” to the medical field.

This assertion, while partially accurate, omits crucial context. According to the 2025 National Resident Matching Program report, approximately 30% of U.S. medical residents are indeed international medical graduates. However, this category includes both foreign nationals and U.S. citizens who graduated from international medical schools. Of international medical graduates who secured first-year U.S. residency positions, 3,108 were U.S. citizens while 6,653 were non-citizens.

The claim that 10,000 residency spots are filled by H-1B visa holders misrepresents available data. This figure comes from a 2017 report analyzing 2016 Labor Department statistics showing the number of working U.S. physicians certified for H-1B visas—not just those in residency programs. More recent Labor Department data from late 2025 indicates approximately 9,000 physicians were certified for H-1B visas across all career stages.

According to the American Medical Association, the J-1 visa—designed specifically for graduate medical education and training—is actually the most common visa utilized by international medical graduates for residency programs. Nancy Nielsen, senior associate dean for health policy at the University at Buffalo, confirmed this distinction, noting that at her institution, only 27 of approximately 830 medical residents hold H-1B visas.

The Educational Commission for Foreign Medical Graduates, which assists international physicians with U.S. training opportunities, reports no centralized data repository exists specifically tracking H-1B physicians in residency programs.

H-1B visas remain available to foreign medical school graduates with appropriate state licensing or authorization, as well as individuals with unrestricted medical licenses or graduates from U.S. medical schools. The visa status typically lasts three years with the possibility of a three-year renewal, with further extensions available if an employer sponsors the worker for permanent residency.

Congress caps new H-1B visas at 85,000 annually, including 20,000 reserved for non-citizens with U.S. advanced degrees. The fiscal year 2025 cap was reached in December 2024.

Daniel Costa, director of immigration law and policy research at the Economic Policy Institute, emphasized that H-1B visa fees must legally be paid by employers, not employees. “The H-1B employees are generally not allowed to pay for the primary fees for visas and processing, they are the responsibility of the employer,” Costa explained.

The substantial fee increase represents the latest in a series of immigration policy changes under the Trump administration, with potential implications for various industries dependent on specialized international talent. Healthcare leaders remain particularly concerned about workforce impacts at a time when physician shortages are already affecting patient access to care across many regions of the country.