By Dr Mahesh Anantha is one of the few interventional cardiologists for miles around Arkansas’s Batesville area, a rural pocket of the US.
Surrounded by farmland and a smattering of small industries and banks, the pastoral town with a population of some 11,000 people serves as a hubfor nearby villages and cities, making Dr Anantha’s often lifesaving practice indispensable.
“There is no other medical facility around for an hour or two’s drive, so people rely on us for everything,” he says.
A gold medallist from Madras Medical College in southern India, Dr Anantha is among thousands of immigrant doctors working in small and remote towns in the US.
One in four doctors providing care in the US are foreign-trained. Recent data shows that most of them practise in the vast underserved rural areas where American graduates are reluctant to work. Many of these doctors are on H-1B visas and some even spend their entire careers on them as they wait for a green card, making them vulnerable to unexpected job losses and long-term instability.
So last month’s announcement by Donald Trump’s administration that it will hike skilled-worker H-1B visa fees for new applicants to $100,000 (£74,359) sparked fear and anxiety among the roughly 50,000 India-trained doctors working in the US. In the days after the move, there was little clarity on how it would affect medical professionals, fuelling uncertainty about their futures, even for those who have spent years building careers and communities in the US.
As outrage spread, a White House spokesperson told Bloomberg via email on 22 September that “the proclamation allows for potential exemptions, which can include physicians and medical residents”. On Monday, US officials announced that the fee “does not apply to any previously issued and currently valid H-1B visas”.
While this clarification may give some relief to doctors who are already working on H1-B visas in the US, there are still questions around whether the steady supply of Indian medical professionals to the US would continue in the future.
The earlier executive order on the visa hike says that the higher fees can be waived if the secretary of Homeland Security establishes that appointing certain workers is “in the national interest”. But the medical industry and groups point out there is no indication that any category of workers, including those in the medical field, has been exempted from this fee.
Many worry that higher costs for hospitals to hire doctors and other workers could ripple through the system. Last month, more than 50 groups led by the American Medical Association (AMA) wrote to Kristi Noem, the secretary of Homeland Security, emphasising that the fee hike could discourage hospitals from hiring H-1B doctors, affecting future supply pipelines and limiting patients’ access to care in communities that need it the most.
“We have heard from health systems who say this fee would be devastating,” says Dr Bobby Mukkamala, president of the AMA. The son of Indian immigrant doctors, Dr Mukkamala is the first Indian-origin doctor to head the AMA.
According to research, one in five immigrant doctors in the US is of Indian origin.
Supporters of the hike argue that tighter immigration policies are necessary to keep American jobs for Americans.
But research from the University of California San Diego’s (UCSD’s) School of Global Policy and Strategy shows that relaxed visa requirements don’t impact the jobs of US medical graduates. In fact, it enables more foreign-trained doctors to practise in remote and low-income areas.
The AMA also emphasises that “international medical graduates are not taking jobs from US physicians”, but are instead “filling critical gaps in care”.
Like several other western countries, the US has long faced a shortage of doctors and nurses. The UCSD study projects that the country will face a shortfall of 124,000 doctors by 2034.
The impactwill be particularly felt in the countryside as most American medical graduates opt for bigger cities with better amenities, says Dr Satheesh Kathula, president (2024-25) of the American Association of Physicians of Indian Origin.
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