The number of surgeons sponsored for H-1B visas in the US increased over the past decade, and these physicians were more concentrated in rural and high-poverty counties, according to a research letter published in JAMA Surgery.
The H-1B visa program allows US health care organizations to hire non-US citizens for specialized positions, including surgery. Researchers said a recent Executive Order increased fees for new H-1B visa applications from about $3,500 to $100,000, raising concerns about whether higher costs could worsen surgical workforce shortages, particularly in communities already facing limited access to care.
Researchers analyzed certified Labor Condition Applications supporting H-1B visas that were filed with the US Department of Labor from fiscal year 2016 through fiscal year 2024. They identified surgeons using standard occupational classification codes that included general surgeons and surgical subspecialists. To examine geographic patterns, they aggregated the most recent year of data, fiscal year 2024, at the county level and compared sponsored surgeons with the total surgical workforce.
Over the study period, the number of surgeons sponsored for H-1B visas increased by an average of 33 each year. In fiscal year 2024, there were 662 surgeons sponsored for H-1B visas nationwide.
Even with that increase, sponsored surgeons represented less than 1% of the total US surgical workforce in 2024.
Researchers found higher shares of H-1B-sponsored surgeons in counties with the highest poverty levels than in counties with the lowest poverty levels. Rural counties also had a higher share than urban counties.
By contrast, the share of H-1B-sponsored surgeons did not differ meaningfully between counties with a high proportion of Black and Hispanic residents and other counties. Regional differences across the US were also limited.
In the discussion, the researchers said H-1B-sponsored surgeons appear to be overrepresented in underserved communities. They also noted that international medical graduates make up 20% of active general surgeons in the US and said the H-1B pathway may be especially important because it allows sponsored surgeons to work while pursuing lawful permanent residence.
The researchers cautioned that the study used application data rather than confirmed employment records, which may overestimate the number of surgeons who ultimately enter the US workforce. They also said the analysis could not separate surgical subspecialties.
The findings suggest that visa-sponsored surgeons may play an important role in preserving access to surgical care in rural and high-poverty communities, and that higher application costs could have implications for workforce distribution.
Disclosures: Rishi K. Wadhera, MD, reported receiving personal fees from Chamber Cardio and Abbott outside the submitted work. Thomas C. Tsai, MD, reported receiving grants from Arnold Ventures and The Commonwealth Fund and personal fees from Johnson & Johnson MedTech outside the submitted work. No other disclosures were reported.
Source: JAMA Surgery
