If you’re an international medical graduate (IMG) hoping to work or train in the United States, the visa landscape just changed — dramatically.
In September 2025, the U.S. government announced a $100,000 filing fee for new H-1B visa petitions, a move that could reshape the pipeline of foreign-trained doctors entering the American healthcare system. While the policy’s stated goal is to reduce abuse of the visa system, its ripple effects will hit hospitals, residency programs, and IMGs the hardest — especially those applying in the 2026 cycle.
What the New Policy Says
- Effective Date: The new $100,000 fee applies to new H-1B petitions filed after September 21, 2025.
- Who It Affects: Any employer sponsoring a new H-1B worker — including hospitals hiring international physicians or residents.
- Who Is Exempt: Current H-1B holders renewing or extending their visa are not affected.
- Potential Exceptions: There are early reports that physicians and healthcare workers may be exempt, but no formal exemption has been confirmed yet.
- Industry Reaction: The American Medical Association (AMA) and major hospital groups have urged the government to exclude doctors, warning that this policy could “choke off a vital pipeline of healthcare talent.”
Why This Matters for IMGs
For thousands of IMGs planning to train or work in the U.S., the H-1B visa has long been the most desirable option because — unlike the J-1 — it doesn’t require returning home for two years after residency. But the new $100,000 employer fee threatens to make that path much narrower.
Hospitals and medical centers may now:
- Avoid sponsoring H-1Bs altogether, switching back to the J-1 visa.
- Limit sponsorship to higher-paying or critical roles, excluding residents and fellows.
- Pass on the costs indirectly through multi-year service obligations or restrictive contracts.
That means fewer programs will offer H-1B sponsorship, and the ones that do may become far more competitive.
The Bigger Picture: An IMG Visa Bottleneck
America already relies heavily on international medical graduates — IMGs make up roughly 25% of the U.S. physician workforce and are especially critical in rural and underserved areas.
But if the new $100,000 H-1B fee stands:
- Many community hospitals and teaching institutions won’t be able to afford sponsorship, worsening physician shortages.
- IMGs will likely face longer waits, more paperwork, and higher risk in the match and hiring process.
- Residency programs may increasingly favor J-1 visas, forcing many IMGs to complete a two-year home residency or find a waiver before returning.
In short: this policy could make the “IMG visa” journey more expensive, more uncertain, and more selective.
What Next Year’s Applicants Should Do
If you’re planning to apply for 2026 rotations, residency, or post-training jobs in the U.S., here’s how to adapt:
- Confirm visa sponsorship early. Ask every program what visa types they will support for next year — some may be dropping H-1B altogether.
- Strengthen your U.S. experience. Clinical rotations through programs like Clerkship America and ACE.MD are now even more valuable. They give you direct exposure and U.S. letters of recommendation that make you a stronger candidate for both J-1 and H-1B sponsorships.
- Use Preceptor Tree to plan strategically. Preceptor Tree connects IMGs with preceptors, mentors, and rotation sites that have experience with visa-sponsoring programs. Knowing which institutions historically sponsor H-1Bs can make the difference between a smooth process and a dead end.
- Understand all your visa options. J-1, H-1B, O-1, or even direct employment-based green cards — each comes with its own rules, timelines, and obligations. You need to know which fits your long-term goals.
- Monitor updates closely. The Department of Homeland Security and USCIS are still defining possible exemptions. It’s possible physicians could be carved out of the $100,000 fee — but that’s not guaranteed.
How Clerkship America and Preceptor Tree Can Help
Both Clerkship America and Preceptor Tree specialize in helping IMGs navigate the complex U.S. training system — now more important than ever.
- Clerkship America offers hands-on U.S. clinical experience, an essential foundation for IMGs pursuing residency or fellowship.
- Preceptor Tree connects IMGs to mentors and preceptors with visa-sponsorship experience, giving applicants a strategic edge as programs tighten their policies.
Together, they help IMGs build a stronger profile, target the right programs, and anticipate visa barriers before they arise.
Final Take
The new $100,000 H-1B fee represents the single most consequential policy change for IMG visas in over a decade. Whether exemptions for doctors are finalized or not, the immediate effect is uncertainty — and for IMGs, uncertainty can mean lost time, lost opportunities, and lost positions.
Next year’s applicants should prepare early, seek out programs familiar with IMG visas, and lean on support networks like Clerkship America and Preceptor Tree to stay competitive.
Even as policy shifts, one thing hasn’t changed: the U.S. still needs international medical graduates — and the smartest IMGs will adapt before the rest.
