The $100,000 H-1B Fee: What It Means for Indian Doctors?
- Sunil Khattri
- Sep 24
- 5 min read
On September 19, 2025, President Trump announced a proclamation imposing a $100,000 fee on new H-1B visa petitions, effective for applications filed after September 21, 2025. While the rule applies broadly to all H-1B applicants, for Indian doctors, who form a significant portion of international medical graduates (IMGs) in the U.S., the impact could be especially significant.
In this blog we cover what is H1b Visa, what is its purpose, the applicability, non-applicability and exemption of the new fee rule and its implications.
What is an H1-B visa?
The H-1B visa is a non-immigrant visa that allows U.S. hospitals, universities, and clinics to temporarily employ foreign professionals in “specialty occupations.”
For doctors, this usually means roles that require:
Advanced medical knowledge and clinical expertise.
At least a bachelor’s degree in medicine (MBBS) and often postgraduate training.
What is its purpose ?
The purpose of the H-1B visa is to let U.S. employers bring in skilled foreign workers. It helps fill gaps in industries like technology, engineering, finance, education, and healthcare.
By taking an H-1B visa, Indian doctors can:
Work in U.S. hospitals, universities, or clinics if they have cleared exams like USMLE and met state licensing requirements.
Take up teaching or research positions in medical schools.
Work in shortage areas (many rural or underserved regions in the U.S. depend on foreign doctors).
Build experience in advanced medical technologies and treatment.
Applicability of the New $100K H-1B Fee
As of September 19, 2025, the U.S. President signed a proclamation that imposes a one-time supplemental fee of US$100,000 on new petitions filed after Sept 21, 2025 (except for some exemptions). This fee is required in addition to all existing visa / petition filing fees. It is set to last for 12 months unless extended or modified.
The fees is applicable to :
Fresh International Medical Graduates (IMGs)
Doctors in India who have cleared USMLE and secured a residency match in the U.S. but have not yet filed their H-1B petitions.
Many residencies offer only modest stipends. Hospitals may hesitate to pay $100,000 on top of salaries and training costs.
These doctors are the hardest hit, as opportunities could shrink dramatically.
Indian Doctors Seeking Fellowships or Subspecialty Training
Those applying for cardiology, oncology, infectious diseases, pediatrics, psychiatry, etc. fellowships via H-1B visas.
Academic centers often operate on tight budgets and a fee of $100,000 could make them think twice about H-1B sponsorship.
Indian Medical Researchers and Postdocs
Early-career researchers in U.S. universities or labs who depend on H-1Bs for their appointments.
Universities may decide not to hire international researchers if they must pay such a high entry fee.
When the New $100K H-1B Fee Does Not Apply
If you are already practicing in the U.S. on H-1B, your regular renewal or extension won’t trigger the $100K fee.
If your petition was filed and approved before Sept 21, 2025, the fee is not applicable.
If you are inside the U.S. and just switching hospitals or universities (without leaving the country), you likely won’t face the extra fee. Guidance from USCIS is still pending, so there’s uncertainty here.
Additionally, spouses and children of H-1B visa holders (on H-4) are not affected by the new fee. They can continue living, studying, or working (if they have work authorization) in the U.S. as before.
Exemptions for Indian Doctors
As per the recent reports, doctors and physicians are likely to be among those eligible for exemptions from the new $100,000 H-1B visa fee under the “national interest” clause.
National interest exemptions likely: Physicians and medical residents may qualify for waivers if their work is deemed critical to U.S. healthcare needs.
Reports from India suggest that doctors are among the most likely groups to be exempted from the $100K fee, recognizing their essential role.
Unclear details: It remains uncertain whether exemptions will be automatic or only granted on a case-by-case basis, and which specialties or roles will qualify.
Indian doctors are more protected than many other professionals, but they should not assume blanket exemption as their petitions may still need to demonstrate “national interest.”
H-1B vs J-1 Visa: What’s the Difference for Doctors?
While most discussions focus on the H-1B visa, it’s important to know that there is another pathway many doctors use that is the J-1 visa.
Below, we outline how the two differ, so doctors can better understand their options. Both the
H-1B and J-1 visas allow foreign doctors to come to the U.S., but they serve very different purposes.
H-1B Visa
A work visa that lets U.S. hospitals, universities, or clinics employ foreign doctors directly.Usually requires the doctor to have cleared USMLE exams and obtained a state medical license (if doing clinical work).
Initial validity: 3 years, extendable up to 6 years.
Can sometimes lead to a green card (permanent residency) if the employer sponsors it. No mandatory return requirement after the visa ends.
J-1 Visa
A training visa for doctors who come mainly for residency, fellowship, or exchange programs.
Sponsored through the Educational Commission for Foreign Medical Graduates (ECFMG).
Comes with a 2-year home residency requirement that the doctors must return to their home country for at least 2 years before they can apply again for a U.S. work visa or green card (unless they get a waiver).
Waivers are sometimes granted if the doctor works in a shortage area in the U.S. for 3 years.
H-1B is better for long-term work and career building in the U.S. healthcare system.
J-1 is useful for training and specialization, but the return rule makes it less flexible unless you plan to come back to India or secure a waiver.
What are the implications?
For Indian doctors, who make up a significant part of the U.S. healthcare workforce, the implications are serious:
Residency and Fellowship Applicants: Hospitals may hesitate to sponsor Indian doctors for training positions because of the added $100,000 cost, reducing opportunities for new graduates.
Researchers and Postdocs: U.S. universities and labs already face budget constraints, and many may avoid hiring international researchers under these conditions.
J-1 to H-1B Conversions: Indian doctors currently training in the U.S. on J-1 visas often switch to H-1Bs to continue working. This pathway may now become more expensive or unavailable.
Healthcare Access in the U.S.: With fewer Indian doctors entering the system, shortages in rural and underserved communities could worsen, leading to longer wait times for patients.
Final words
The new $100,000 H1B fee marks a turning point in US immigration policy. While positioned as a broad measure, its real impact will be felt unevenly, hitting hardest those just starting their medical journeys in the US such as international medical graduates, fellows, and young researchers.
Yes, exemptions under the “national interest” clause may shield some physicians, but the lack of clarity means that every new petition carries risk. Beyond the numbers, the bigger concern is whether this policy will discourage hospitals and universities from sponsoring Indian doctors at all, at a time when US healthcare already faces critical shortages.
In the end, the H1B visa remains a vital lifeline for Indian doctors to practice, train, and contribute to the US healthcare system. But with the new fee, the path forward is no longer just about qualifications and exams, it is about navigating policy, cost, and politics as well.
The Author :
Dr. Sunil Khattri
+91 9811618704
Dr Sunil Khattri MBBS, MS(General Surgery), LLB, is a Medical doctor and is a practicing Advocate in the Supreme Court of India and National Consumer Disputes Redressal Commission, New Delhi.
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