Health Care Professionals Sponsored for H-1B Visas in the US

Abstract

This national study evaluates the percentage of US health care professionals sponsored for H-1B visas in fiscal year 2024 across occupation groups and county characteristics.

The H-1B visa program allows US employers to hire non–US citizen workers in occupations that require specialized knowledge, including physicians and other health care professionals (HCPs). On September 19, 2025, an executive order increased the fee for new H-1B petitions from approximately $3500 to $100 000,¹ which could undermine the health care workforce. The potential effect of this change on HCPs and communities they serve is unknown. This study evaluated the percentage of US HCPs sponsored for H-1B visas in fiscal year (FY) 2024 across occupation groups and county characteristics.

Methods

Data from all certified Labor Condition Applications (LCAs) supporting H-1B visas in FY 2024 were obtained from the Department of Labor. Most H-1B petitions (94%) were ultimately approved in FY 2024.² The LCAs were categorized as sponsoring physicians, advanced practice providers (APPs: physician assistants, nurse practitioners, nurse anesthetists, and nurse midwives), dentists, or other health care workers (OHCWs; podiatrists, chiropractors, and optometrists) according to established Standard Occupational Classification system codes. Resident physicians and fellows were included but are more frequently admitted via J-1 visas.³

In this cross-sectional study, total number of HCPs sponsored for H-1B visas in FY 2024 was aggregated at the county level, using information about location of the primary worksite from LCAs. Annual percentage of H-1B–sponsored HCPs was calculated across counties, using a denominator of all HCPs obtained from the 2023-2024 Area Health Resources File.⁴ Population-weighted linear regression models were used to compare percentage of HCPs sponsored for H-1B visas across county-level poverty level, rurality, and region. Analyses were performed with R version 4.4.3 (R Foundation for Statistical Computing) between September 29, 2025, and October 10, 2025; 2-sided P < .05 defined statistical significance. Institutional review board approval was not required because of use of publicly available deidentified data.

Results

In FY 2024, H-1B–sponsored HCPs accounted for 0.97% of physicians (11 080 of 1 138 056), 0.02% of APPs (122 of 641 605), 0.40% of dentists (1004 of 251 551), and 0.07% of OHCWs (132 of 181 495). Their geographic distribution is shown in the Figure.

Figure. Geographic Distribution of Health Care Professionals Sponsored for H-1B Visas.

^aIncludes all active physicians with doctor of medicine and doctor of osteopathic medicine degrees.

^bIncludes physician assistants, nurse practitioners, nurse anesthetists, and nurse midwives.

^cIncludes podiatrists, chiropractors, and optometrists.

Across 3240 counties, those with the highest poverty level had a significantly higher percentage of H-1B–sponsored physicians than those with the lowest (2.0% vs 0.54%; difference, 1.3%; 95% CI, 1.1%-1.5%; P < .001) (Table). Similar patterns were observed among H-1B–sponsored APPs and OHCWs. Rural counties also had a higher percentage of H-1B–sponsored physicians than urban counties (1.6% vs 0.95%; difference, 0.48%; 95% CI, 0.29%-0.66%; P < .001). A higher percentage of OHCWs was sponsored in rural counties, whereas the percentage for APPs in rural counties was slightly lower. Northeastern counties (1.4%) had a higher percentage of H-1B–sponsored physicians relative to Midwestern (1.2%), Southern (0.82%), and Western counties (0.53%). The same was observed for APPs, dentists, and OHCWs.

Table. Health Care Professionals Sponsored for H-1B Visas by County-Level Characteristics.

	Physiciansa			Advanced practice providersb			Dentists			Other health care workersc
	No./total No. (H-1B, %)	Difference, % (95% CI)d	P value	No./total No. (H-1B, %)	Difference, % (95% CI)d	P value	No./total No. (H-1B, %)	Difference, % (95% CI)d	P value	No./total No. (H-1B, %)	Difference, % (95% CI)d	P value
Poverty level quartile
1 (Lowest poverty level)e	2106/393 643 (0.54)	Reference		25/192 454 (0.01)	Reference		371/95 504 (0.39)	Reference		44/72 576 (0.06)	Reference
2	2632/239 771 (1.1)	0.59 (0.42 to 0.76)	<.001	27/159 511 (0.02)	−0.00 (−0.01 to 0.01)	.81	204/54 684 (0.37)	0.02 (−0.11 to 0.15)	.77	35/44 648 (0.08)	0.02 (−0.00 to 0.05)	.12
3	3732/347 140 (1.1)	0.56 (0.40 to 0.72)	<.001	45/195 320 (0.02)	0.01 (−0.00 to 0.02)	.10	300/71 900 (0.42)	0.05 (−0.07 to 0.18)	.39	34/46 767 (0.07)	−0.00 (−0.03 to 0.03)	.92
4 (Highest poverty level)f	2601/129 859 (2.0)	1.3 (1.1 to 1.5)	<.001	23/84 588 (0.03)	0.02 (0.00 to 0.03)	.008	128/24 548 (0.52)	0.15 (−0.01 to 0.31)	.06	19/14 476 (0.13)	0.07 (0.03 to 0.11)	<.001
Ruralityg
Urban	10 083/1 059 885 (0.95)	Reference		117/565 823 (0.02)	Reference		915/226 459 (0.40)	Reference		125/158 909 (0.08)	Reference
Rural	997/61 998 (1.6)	0.48 (0.29 to 0.66)	<.001	5/66 681 (0.01)	−0.01 (−0.02 to −0.00)	.02	89/21 902 (0.41)	0.03 (−0.11 to 0.16)	.71	7/20 654 (0.03)	0.05 (0.02 to 0.08)	.002
Region
Midwest	2995/243 806 (1.2)	−0.27 (−0.48 to −0.06)	.01	20/138 135 (0.01)	−0.01 (−0.03 to −0.00)	.03	213/52 385 (0.41)	−0.24 (−0.40 to −0.09)	.002	24/45 895 (0.05)	−0.12 (−0.16 to −0.09)	<.001
Northeast	3579/256 300 (1.4)	Reference		50/127 242 (0.04)	Reference		308/48 336 (0.64)	Reference		53/32 882 (0.16)	Reference
South	3189/388 169 (0.82)	−0.60 (−0.78 to −0.40)	<.001	32/261 094 (0.01)	−0.02 (−0.03 to −0.01)	<.001	261/82 342 (0.32)	−0.32 (−0.46 to −0.18)	<.001	23/56 256 (0.04)	−0.14 (−0.18 to −0.11)	<.001
West	1313/249 602 (0.53)	−0.78 (−0.99 to −0.57)	<.001	20/115 051 (0.02)	−0.02 (−0.03 to −0.00)	.02	221/68 436 (0.32)	−0.27 (−0.42 to −0.11)	<.001	32/46 430 (0.07)	−0.10 (−0.13 to −0.06)	.008

^a Includes all active physicians with doctor of medicine and doctor of osteopathic medicine degrees.

^b Includes physician assistants, nurse practitioners, nurse anesthetists, and nurse midwives.

^c Includes podiatrists, chiropractors, and optometrists.

^d All estimates were obtained from population-weighted univariable linear regression models.

^e Lowest proportion of persons with income below the federal poverty level.

^f Highest proportion of persons with income below the federal poverty level.

^g 2023 Rural-Urban Continuum Codes were used to classify counties as urban (1-3) or rural (4-9).

Discussion

Over 11 000 physicians were sponsored for H-1B visas in FY 2024, representing 1% of the US physician workforce. H-1B–sponsored APPs, dentists, and OHCWs accounted for a smaller share. The percentage of H-1B–sponsored physicians was nearly 2 times higher in rural compared with urban counties and nearly 4 times higher in the highest- vs lowest-poverty counties.

The prohibitive increase in H-1B application fees will disproportionately affect rural and socioeconomically disadvantaged communities, which already experience the greatest health care workforce shortages.^4,5 Physicians on H-1B visas are far more likely than their domestic counterparts to fill critical gaps in health care delivery systems, such as primary care and psychiatry.³ As demonstrated by disruptions to J-1 visa interview scheduling this past spring, even temporarily reducing the flow of non–US citizen HCPs can severely strain clinical capacity, leave residency and fellowship positions vacant, and impede patient care.

One study limitation is that relying on H-1B application data may overestimate the number of HCPs who ultimately enter the US on H-1B visas, although nearly all applications were approved in FY 2024.²

Many US counties depend on H-1B–sponsored HCPs; increasing visa fees could exacerbate workforce shortages and worsen access to care, particularly in rural and high-poverty communities. These findings support the proposed implementation of national interest H-1B fee waivers for physicians and extension of such waivers to other HCPs.

Supplement 1.

Data Sharing Statement