$100,000 H-1B fee and J-1 waiver physicians: Key considerations for healthcare employers | Viewpoint

Healthcare employers in underserved areas often rely on the J-1 waiver program to recruit international medical graduates.

Under this program, employers sponsor physicians who have completed U.S. residency training in J-1 visa status and who agree to practice in a federally designated Health Professional Shortage Area or Medically Underserved Area for at least three years. During this commitment period, employers must sponsor the physician for H-1B status. As a result, recent developments affecting H-1B filing costs have significant implications for healthcare employers that depend on the J-1 waiver program.

On September 18, 2026, President Trump signed an executive order that extended a fee of $100,000 for certain H-1B nonimmigrant visas through September 2027. The rule, which was initially announced in September 2025, applies only to H-1B petitions that require consular notification, with some exceptions.

Multiple Courts have blocked enforcement of the policy and U.S. Citizenship and Immigration Services (USCIS) is currently barred from collecting the fee. While the fee is not being collected at the time of publication, litigation continues and so collection could resume in the future.

Given the ongoing litigation and resulting uncertainty, employers sponsoring J-1 physicians should understand whether their H-1B petitions may be subject to the fee—and what steps they can take to avoid it.

Do employers sponsoring J-1 waiver physicians owe the $100,000 H-1B fee?

The answer depends on whether the physician can obtain H-1B status through a change of status within the United States. H-1B petitions approved through a change of status from J-1 to H-1B generally are exempt from the fee.

To qualify for a change of status, the employer must file the H-1B petition while the physician is still in valid J-1 status. While this sounds straightforward, it requires careful planning to avoid delays that could cause the petition to be subject to the fee.

Below are key strategies employers should consider. Because timing is often the determining factor, employers should consider several proactive steps to preserve eligibility for this exemption:

Start the J-1 waiver process early. J-1 waiver applications must be approved by multiple agencies before the H-1B petition can be filed. The process begins at the Interested Government Agency or State Health Department administering the Conrad 30 program, then moves to the Department of State, and finally to the Department of Homeland Security for ultimate approval. Starting early provides a buffer against unanticipated delays, such as requests for additional evidence, agency backlogs, or government shutdowns.

Extend J-1 status when appropriate. Many J-1 physicians can extend their J-1 status to sit for board exams, which provides additional time for the employer to file the H-1B petition. This can be a helpful safety net, but timing is critical. J-1 status cannot be extended after certain steps in the waiver process.

Track medical licensing progress. Delays in medical license issuance are among the most common factors that hold up H-1B filings. Employers should work proactively with physicians to ensure licensing requirements and timelines are understood and to ensure applications are submitted well in advance of H-1B filing deadlines.

Plan travel carefully. Many physicians plan to travel home after completing training before starting work. However, leaving the U.S. at the wrong time can affect eligibility for a change of status and trigger the $100,000 fee. Physicians should consult with immigration counsel before booking any international travel to ensure coordination during the waiver and H-1B process.

The physician shortage in rural America is a persistent and growing problem, and the J-1 waiver program remains an effective tool for recruiting highly trained physicians to underserved areas.

Although the future of the $100,000 H-1B fee remains uncertain and potential fee increases raise concerns about the cost of this hiring pipeline, employers who plan proactively can navigate the J-1 waiver process, avoid the $100,000 fee in most cases, and explore alternative visa strategies when needed to meet their recruitment goals.

Nora Katz, an attorney at Bass, Berry & Sims, counsels employers in all aspects of immigration law.