Academy objects to visa changes limiting primary care workforce

Oct. 2, 2025, News Staff—The Academy has cautioned the administration that two policy changes affecting international medical students, residents and physicians jeopardize patient care and the primary care workforce. 

“We strongly oppose this change, as it would disrupt the training of thousands of physicians who hold J-1 visas—physicians who have already been thoroughly vetted, are carefully monitored and are actively serving U.S. patients and communities,” the Academy said. “These proposed changes would not accomplish the administration’s goal of reducing visa overstays and instead would undermine our nation’s health care workforce.”

A Sept.29 letter to DHS signed by the AAFP as part of a broad coalition of health care stakeholders pointed out that the proposed rule is cumbersome and would transfer some of its burdens onto the health care workforce, which would negatively affect patients.

“The rule acknowledges large new costs and processing burdens of approximately $400 million annually, noting potential enrollment reductions and significant administration impacts on sponsors and employers,” the groups wrote. “These burdens translate directly into risks for physician enrollment and patient access. Any extension-of-stay denial or delay beyond the proposed 240-day continuation would force trainees to stop clinical duties immediately—jeopardizing continuity of care, hospital coverage and patient well-being.”

Physician exemption to $100,000 H-1B fee

In a Sept. 29 letter to DHS, the Academy noted that the H-1B fee contradicts the administration’s stated interest in stemming chronic conditions.

“Despite the overwhelming evidence to support primary care as the solution to the chronic disease crisis, it is projected that the U.S. will face a shortage of up to 40,000 primary care physicians by 2036,” the AAFP said. With about 14,000 physicians with H-1B visas practicing in the United States as of 2022—including many in safety-net hospitals, rural communities and states with low physician density—a reduction of such visa holders would threaten patient care, the letter added.

“We strongly recommend that DHS create an exception to the $100,000 H-1B application fee for physicians, especially those committed to practicing primary care, assign favorable weighting to these applications and fast-track their processing,” the Academy wrote. “Doing so will help maintain a robust pipeline of international medical graduates and support the health and well-being of communities across America.”

In a separate Sept. 25 letter to DHS, the Academy, the AMA and dozens of other medical societies repeated the call for a physician exemption to the fee.

“Nearly 21 million Americans live in areas of the U.S. where foreign-trained physicians account for at least half of all physicians aligning with the fact that states with a higher percentage of H-1B physicians are often those with lower physician density,” the letter said. The Academy and its co-signatories added that DHS should “categorically consider H-1B physicians’ entry into the U.S. to be in the national interest of the country, and waive the new application fee, so that H-1B physicians can continue to be a pipeline that provides health care to U.S. patients.”

International medical graduates ‘indispensable’

Across all of the letters to DHS the Academy has signed so far, the AAFP has emphasized that international medical graduates (IMGs) are crucial to patients in rural and underserved areas, where U.S. medical graduates are less likely to practice.

“Considering that nearly 16,000 physicians with J-1 visas train in dozens of medical specialties and subspecialties, any disruption to IMGs’ ability to remain in training or continue serving the public post-residency is guaranteed to undermine continuity of care in the U.S,” the Academy added.

“Family medicine is one of the most IMG-dependent specialties, comprising nearly one-third of current family medicine residents. If fewer IMGs can enter or remain in the U.S., clinics and hospitals in these areas may face staffing crises, which will reduce patients’ access to primary care.”

Family medicine residents need more time, less regulatory burden

Most family medicine residency programs take three years, but physicians who need extra time (to pursue research or move into a fellowship, for example) would, under the proposed J-1 rule, have to apply for an extension of stay (EOS). Previously, a J-1 visa was renewable throughout a student’s enrollment in school.

The Academy said this new layer of bureaucracy would interrupt medical training while burdening residents and physicians. A delayed or denied EOS could leave an applicant out of status and unable to continue training legally, the AAFP added, “leaving both the physician and the training program in a difficult predicament.”

Any final version of the rule, the AAFP said, should exempt those pursuing medical studies, training, practice or professional activities such as medical research from having a fixed-time admission assigned to their visa.

AAFP continues longtime Conrad 30 advocacy

The Academy reminded DHS that an existing J-1 waiver for physicians is also vital to delivering primary care where it’s most needed.

Under the Conrad 30 program, state health departments can sponsor up to 30 waivers a year for physicians with J-1 visas, allowing them to stay in the U.S. if they agree to practice in a health professional shortage area or a medically underserved area for at least three years.

The AAFP has steadily urged Congress to expand Conrad 30. The Academy asked DHS to work with lawmakers toward such an expansion, calling the program “an impactful opportunity” for IMGs.