Hundreds of foreign doctors about to complete their training in the United States will have to leave the country if the federal government does not quickly process their visa waiver applications, which have been languishing since the fall and winter, immigration attorneys say.
The waiver program, administered by the Department of Health and Human Services, allows doctors who are not U.S. citizens to remain in the country while transitioning from the visa they used during their training to temporary worker status. In exchange, the doctors agree to work in underserved areas for at least three years.
“It will be the patients who will suffer the most because in about three months there will be hundreds of places that will not have the doctor they should have,” said a psychiatrist surprised at the delay.
The doctor, whom KFF Health News agreed not to identify because he fears government retaliation, was among hundreds who applied for a J-1 visa waiver through the HHS Exchange Visitor Program this year.
If they receive one, the psychiatrist, who attended medical school in his home country in Europe before coming to the U.S. for his residency and fellowship, would work with vulnerable and disadvantaged patients in New York.
In recent years, the HHS program reviewed waiver requests in one to three weeks, according to two immigration attorneys.
But it currently has a backlog of hundreds of applications, which still must be reviewed by the State Department and approved by U.S. Citizenship and Immigration Services, according to four attorneys interviewed by KFF Health News.
They said foreign doctors will likely have to return to their home countries if their applications are not advanced to USCIS by July 30.
To re-enter the US, your employers would have to pay a new $100,000 fee associated with the H-1B work visa. It's a cost that many hospitals and clinics in rural and underserved areas say they can't afford. “That's the cliff this train is heading toward,” said Charles Wintersteen, a Chicago-based attorney who specializes in healthcare-related immigration.
HHS spokeswoman Emily Hilliard did not answer questions about the number of pending applications or explain what caused the delays. But he said the Exchange Visitor Program has reviewed all J-1 clinical waiver applications from fiscal year 2025, as well as some from fiscal year 2026.
The department is “implementing key process improvements to avoid future delays” and “working diligently” to evaluate the remaining applications before the July 30 deadline, he said.
The psychiatrist in limbo said employers who hire J-1 waiver doctors must prove they were unable to fill positions with American workers. If the doctors they planned to hire can't show up on time, or can't show up on time, patients will have to wait even longer to fill those vacancies, they said.
Wintersteen said graduate medical education positions are largely funded through Medicare and that “taxpayers who pay for that training will not benefit from it.”
Doctors and immigration attorneys said HHS has not explained the delays to them or told them what to expect with their applications.
“Why would HHS want to take a program that is working – a program that places hundreds of U.S.-trained international doctors each year in highly underserved parts of the country – and slowly bring it to non-existence,” Jennifer Minear, a Virginia-based healthcare immigration attorney, said in an email. “How does that benefit public health? It's baffling.”
Deviated exemptions
The American health system relies on foreign-born professionals to fill its ranks of doctors, nurses, technicians and other health providers, particularly in chronically understaffed facilities in low-income rural and urban communities.
Nearly a quarter of doctors in the U.S. went to medical schools outside the U.S. or Canada, according to 2025 licensing data.
Once noncitizens complete their graduate education in the United States, which typically ends June 30, they must return to their home country and wait two years before applying for an H-1B work visa. Or they can apply for a J-1 waiver, which allows them to remain in the US with H-1B status in exchange for working for three years in a supplier shortage area.
Attorneys said they are seeing delays only in the Exchange Visitor Program, not the other federal or state J-1 waiver programs.
The HHS clinical care program received 750 waiver applications last year, Minear and Wintersteen said, and is reserved for doctors who work in pediatrics, psychiatry, family and internal medicine, or obstetrics and gynecology.
The program typically needs to submit recommendations to the State Department by mid-March, according to a letter from John Whyte, executive director of the American Medical Association.
Minear said HHS stopped processing applications in late September or early October before starting sending them out again a few months ago.
“But the pace is dramatically slower” than usual, he said.
Minear said the State Department typically takes two to three months to review HHS recommendations and must submit them to USCIS by July 30 for most doctors to remain in the country.
If they don't meet that deadline, Wintersteen said, doctors will have to leave the country unless they obtain another type of visa, obtain a J-1 waiver through another program or extend their current visa by taking board exams or undergoing additional training.
The psychiatrist, who is supposed to start work on July 1, said they requested a waiver to remain in the United States with their partner and because it would allow them to help the most vulnerable mental health patients. They said their future clients would likely include trafficking survivors, homeless people and prison or jail inmates. “That's the population I want to work with,” they said.
Waiver delay resolves H-1B visa dilemma
President Donald Trump issued a proclamation in September criticizing the tech industry's use of H-1B work visas. The order created a $100,000 fee that applies to workers in all fields (not just technology) who live outside the United States. The payment does not apply to those who are already in the country.
As of Feb. 15, employers had paid the fee for 85 workers, according to a USCIS court filing. It is unclear whether any of those payments went to doctors or other medical providers.
The psychiatrist said officials at the hospital that plans to hire them said they cannot afford to bring them back to the United States if they must return home.
“Many hospitals that hire J-1 waiver physicians are located in underserved areas, so they treat Medicare and Medicaid patients,” they said. “By definition, for the most part, they are not wealthy hospitals.”
Barry Walker, a Tupelo, Mississippi, attorney focused on healthcare-related immigration, said employers have already spent money on recruiters and attorneys like him to help with the waiver process.
Adding the H-1B fee is “just a deal breaker, especially for small rural hospitals,” he said.
Lawyers said most employers will sponsor doctors who need an H-1B visa only if they work in lucrative specialties, such as cardiology or orthopedics, where they can recoup the cost of the fee.
They said health care centers are much less likely to pay the fee to hire foreign nurses, lab technicians and other health professionals who are more likely than doctors to complete their training outside the U.S.
Employers can apply for fee waivers, but attorneys said they have not heard of any hospitals or clinics receiving one.
Fighting on two fronts
Doctors, hospital leaders, lawmakers and immigration experts are trying to draw attention to J-1 waiver delays at HHS as they hope to repeal or limit the new H-1B fee.
The Trump administration has not acted on letters from hospitals, medical societies and rural health organizations requesting an exception to the $100,000 fee for doctors or all health care workers.
In March, a bipartisan group of lawmakers introduced a bill that would create a health care exemption. He has not had a hearing yet.
At least three lawsuits — from the U.S. Chamber of Commerce, a group of 20 states and a coalition of plaintiffs that includes a company that hires foreign nurses and a union representing medical graduates — seek to end the fee entirely.
Regarding delays to the J-1 waiver, the executive director of the American Medical Association asked the Exchange Visitor Program to use “emergency batch processing” to get doctors on contracts to start working this summer.
Efrén Manjarrez, president of the Society of Hospital Medicine, which represents doctors who work in inpatient units, also called for emergency measures.
“Every day that this delay persists is a day that hospitalized patients in these communities face increased risk,” he wrote in a letter to the program.
Meanwhile, Canadian hospitals have been recruiting foreign doctors who complete their training in the United States, the psychiatrist said. They said one of their friends accepted an offer and withdrew his HHS waiver application to head north.
The psychiatrist said that if they must leave the United States, they will be separated from their partner and out of work for months while they work to obtain a license in their home country.
Even if their employer could pay the H-1B fee, they aren't sure they want to return.
“This entire process has been incredibly painful and heartbreaking,” they said. “I would prefer to go to a country that would appreciate my motivation to work with patients.”
