The Trump administration recently issued a proclamation that restricts entry of aliens seeking to enter as H-1B (specialty occupation) nonimmigrants, unless their petition is accompanied by a one-time payment of $100,000. Employers must retain documentation proving this payment and U.S. consular/immigration authorities will verify payment before approving petition or visa issuance.
Who Is Affected
The restriction applies to aliens currently outside the United States seeking to enter under an H-1B petition filed after Sept. 21. It does not apply to current H-1B holders inside the U.S. (i.e., people already in the U.S. on H-1B visas will not be forced to depart). The proclamation empowers the Secretary of Homeland Security to grant exemptions, on a case-by-case basis, if hiring is in the national interest and does not threaten U.S. welfare or security.
Duration & Additional Rulemaking
The restriction is to last 12 months from the effective date (i.e. until Sept. 21, 2026), unless extended. Within 30 days after the first H-1B lottery following the proclamation, the Department of Homeland Security (DHS), State Department and Department of Justice (DOJ) must recommend whether to extend or renew the restriction.
The Department of Labor (DOL) is directed to initiate rulemaking to revise prevailing wage levels consistent with the proclamation’s goals. The DHS is directed to begin rulemaking to prioritize high-skilled, high-paid aliens in future H-1B adjudications.
Impact on Rheumatology
The magnitude of the proclamation’s impact depends heavily on how broadly the exemption clause is applied. If physicians and other healthcare workers are automatically declared exempt or the bar for national interest is low, the disruption may be minimal.
The ACR recently joined the American Medical Association in a letter that urged the Trump administration to categorically consider H-1B physicians’ entry into the U.S. to be in the national interest and waive the new application fee for this group, allowing H-1B physicians to continue to be a pipeline providing healthcare to U.S. patients. To date, the Trump administration has given little indication of whether or how it will dole out exemptions beyond the broad discretion given to the DHS in the proclamation the president signed.
If physicians are not exempt, current gaps in healthcare access will be exacerbated. First, rheumatology, like many medical specialties, is vulnerable to physician shortages, especially in rural or underserved regions. Any barrier to recruiting international physicians or trainees could exacerbate those shortages.
Second, a big jump in cost and administrative complexity associated with H-1B petitions may dissuade some institutions from sponsoring foreign rheumatologists, unless the exemption is robust and reliable. Over time, this could slow the growth or replenishment of the rheumatology workforce, possibly increasing pressure on existing providers and extending wait times.
The ACR will monitor the proclamation’s implementation and serve as an educational resource for members on its provisions and the impact they will have on rheumatology. For further information about the ACR’s regulatory advocacy efforts, ACR/ARP members should email the ACR’s advocacy team at [email protected]. ACR/ARP members can also schedule a time to meet directly with the ACR’s advocacy team to discuss issues and challenges you are facing.
