Higher H-1B visa costs could worsen surgeon shortages in the communities that already have the fewest options for care, a new JAMA Surgery research letter suggests.
The piece serves as a warning with implications for ambulatory surgery centers (ASCs) as they compete for physicians and expand access to outpatient services.
Researchers found that 662 surgeons were sponsored for H-1B visas in fiscal 2024, accounting for 0.37% of the nation’s 176,616 surgeons. While a small share of the overall workforce, those surgeons are disproportionately concentrated in poorer and more rural parts of the country, the researchers pointed out.
“Although H-1B-sponsored surgeons represent a small fraction of the national surgical workforce, they are over-represented in underserved communities,” the authors wrote.
For ASC operators, the findings add to a broader labor concern already facing the sector. Growth in outpatient surgery depends not only on site-of-care migration and reimbursement policy, but also on the availability of surgeons willing and able to practice in new markets.
The JAMA Surgery letter comes after a recent executive order substantially increased the fee for new H-1B visa applications from an average of $3,500 to $100,000, according to the study. That jump has fueled concern among policy experts and professional groups that the added cost could further strain surgical capacity, particularly in areas with limited staffing.
The new analysis found that counties with the highest poverty levels had a statistically significantly higher share of H-1B-sponsored surgeons than the lowest-poverty counties, 0.66% versus 0.16%. Rural counties also had a higher share than urban counties, 0.79% versus 0.36%.
“The prohibitive increase in H-1B visa application fees (now $100,000 per surgeon) poses a substantial threat to surgical care access, particularly in underserved communities that rely heavily on H-1B-sponsored surgeons and already experience worsening surgeon shortages,” the authors wrote.
The number of surgeons sponsored for H-1B visas also increased over the study period. Researchers found an average increase of 33 H-1B-sponsored surgeons annually between fiscal 2016 and fiscal 2024, with the total reaching more than 650 in the most recent year studied.
The issue is not ASC-specific. The letter examined the broader surgical workforce, not ambulatory centers in particular, and it does not break out surgeons by specialty or care setting.
Still, the findings matter for ASC operators, especially those in rural or underserved markets where physician recruitment can determine whether new service lines launch at all.
“[ASCs] rely on H‑1B visas to hire physicians, nurses, and other allied health care professionals,” Ann-Rose Johnson-Lewis, director of legal services for WorldWide HealthStaff Solutions, told ASC News. “Like other health care providers, ASCs are confronting the issue of affordability. The exorbitant cost imposed by the $100,000 fee is not sustainable. Regardless of how critical the staffing shortages may be, the fee has effectively excluded health care organizations from utilizing the H‑1B visa program.”
What’s more, the findings come at a time when new data is painting a clearer picture of health care supply-and-demand economics.
Just days ago, the National Resident Matching Program reported that the 2026 Main Residency Match was the largest in its history, with more than 44,000 residency positions offered and 38,354 applicants matching into PGY-1 slots, up 687 from 2025.
Additionally, even with a bigger pipeline on the front end, federal workforce projections released by the Health Resources and Services Administration (HRSA) in December estimated an overall shortage of 141,160 physicians by 2038, with non-metro areas expected to face a 58% physician shortage.
With this context in mind, higher H-1B costs could matter less as an immigration footnote than as another constraint on a workforce that is already struggling to keep pace with demand.
Ultimately, policy changes may be needed to avoid further disruption, researchers concluded.
“Policy proposals that exempt surgeons and other health care professionals from the substantial increase in H-1B visa application fees will be critical to preventing further erosion of surgical capacity and preserving access to lifesaving surgical care,” the authors wrote.
Emerging legislation
A bipartisan bill introduced on March 17, dubbed “The Physicians and the Healthcare Workforce Act,” would remove the $100,000 H-1B visa fee for health care workers.
The bill is sponsored by Reps. Mike Lawler (R-N.Y.), Sanford D. Bishop Jr. (D-Ga.), Maria Elvira Salazar (R-Fla.) and Yvette Clarke (D-N.Y.). It is backed by the American Hospital Association (AHA) and the American Medical Association (AMA).
The AHA asked the Trump administration in September 2025 to exempt health care workers from the fee.
“The Physicians and Healthcare Workforce Enforcement Act, which has bipartisan support, represents a promising step forward, though advancing legislation with political implications remains a complex and time-consuming process,” Johnson-Lewis said. “The bill seeks to exempt health care workers, as defined under federal law, from the $100,000 H‑1B fee. Passage of this legislation would provide urgently needed relief to health care organizations that have been effectively barred from pursuing new H‑1B hires since the H‑1B Proclamation took effect.”
