A growing administrative backlog at the U.S. Department of Health and Human Services (HHS) is putting hundreds of foreign-trained physicians at risk of deportation. These doctors serve the most medically underserved communities in America. Without urgent federal action, rural hospitals and safety-net clinics face physician shortages that could directly harm vulnerable patients.
What Is the HHS J-1 Waiver Program?
The HHS Exchange Visitor Program issues J-1 visa waivers to foreign physicians who complete their medical training in the United States. In exchange, these doctors commit to working in underserved areas for a minimum of three years. They typically serve in specialties including pediatrics, psychiatry, family medicine, internal medicine, and obstetrics and gynecology.
The program fills a critical gap. Rural hospitals and safety-net clinics often struggle to recruit American physicians because salaries are lower and locations are remote. Foreign-trained doctors who participate in this program bring essential medical care to communities that would otherwise go without.
Last year, the HHS clinical care program received 750 waiver applications, according to immigration attorneys Jennifer Minear and Charles Wintersteen.
How Severe Is the Current Backlog?
Normally, the HHS Exchange Visitor Program reviews waiver applications within one to three weeks. Today, however, hundreds of applications sit unprocessed. These applications still require review by the State Department and final approval by U.S. Citizenship and Immigration Services (USCIS).
Immigration attorneys say HHS stopped processing applications in late September or early October of last year. Although the agency resumed processing a few months ago, the pace remains far slower than usual. Crucially, the delays appear limited to the HHS Exchange Visitor Program. Attorneys note that other federal and state J-1 waiver programs continue to operate without similar disruptions.
One psychiatrist — speaking anonymously to KFF Health News out of fear of government reprisal — represents hundreds of doctors in this situation. This physician trained in Europe, completed residency and fellowship in the U.S., and applied for a waiver to serve vulnerable patients in New York. Their application, like hundreds of others, remains stuck.
The July 30 Deadline: A Critical Cliff
The stakes sharpened by a hard deadline. The State Department must forward its recommendations to USCIS before July 30 for most affected physicians to remain legally in the country.
Typically, the State Department needs two to three months to review HHS recommendations. That timeline, combined with the current processing slowdown, makes it extremely difficult for many physicians to clear all stages in time.
“That’s the cliff that this train is headed for,” said Charles Wintersteen, a Chicago-based immigration attorney who specializes in health workforce cases.
If applications do not reach USCIS by that date, foreign physicians will likely have to return to their home countries. Returning to the U.S. later would require their employers to pursue an H-1B visa — and pay a new fee of $100,000.
Rural Hospitals Face a $100,000 Dilemma
The $100,000 H-1B fee is not a minor expense. For large urban hospitals in lucrative specialty areas, it may be manageable. However, for small rural hospitals and community health centers, it is often simply impossible.
“A lot of hospitals who hire J-1 waiver physicians are in underserved areas, and so they treat Medicare and Medicaid patients,” the anonymous psychiatrist explained. “By definition, for the most part, they’re not rich hospitals.”
Barry Walker, an immigration attorney based in Tupelo, Mississippi, added that the fee is “just a deal killer, especially for the small, rural hospitals.” Attorneys further note that hospitals are more likely to absorb the H-1B cost only for highly paid specialists such as cardiologists or orthopedic surgeons — not for physicians serving disadvantaged communities in primary care or psychiatry.
Moreover, Wintersteen pointed out that postgraduate medical training positions largely receive Medicare funding. If affected physicians must leave, the taxpayers who funded their training will not receive the intended benefit.
Medical Associations Demand Emergency Action
Leading physician organizations are sounding the alarm. John Whyte, CEO of the American Medical Association, sent a letter to the Exchange Visitor Program urging officials to use “emergency batch processing” for physicians with signed contracts set to begin this summer.
Similarly, Efrén Manjarrez, president of the Society of Hospital Medicine, wrote directly to the program calling for emergency intervention. His message was direct: “Every day this backlog persists is a day that hospitalized patients in these communities face greater risk.”
Immigration attorneys share that frustration. “Why would HHS want to take a program that is working — a program that places hundreds of U.S.-trained international physicians in highly underserved parts of the country every year — and slow-walk it into non-existence?” wrote Jennifer Minear, a Virginia-based health workforce immigration lawyer.
Doctors Are Already Leaving for Canada
The uncertainty is already driving foreign physicians to look elsewhere. Canadian hospitals, recognizing an opportunity, are actively recruiting U.S.-trained foreign physicians who face visa limbo.
The anonymous psychiatrist shared that a colleague recently accepted a Canadian offer and withdrew their HHS waiver application entirely. If forced to leave the U.S., the psychiatrist faces months of unemployment while pursuing licensure in their home country — and potential separation from their partner.
“This entire process has been so incredibly painful and just soul-crushing,” they said. “I would rather go to a country that would appreciate my motivation to work with patients.”
What HHS Says About the Delays
HHS spokesperson Emily Hilliard declined to disclose the number of pending applications or explain the cause of the delays. She did confirm that the Exchange Visitor Program has processed all fiscal year 2025 clinical J-1 waiver applications, along with some from fiscal year 2026.
Hilliard also stated that the department is “implementing key process improvements to prevent future delays” and is “working diligently” to evaluate remaining applications before the July 30 deadline.
What Happens Next?
The window for action is narrow. For the program to succeed, HHS must accelerate processing immediately so the State Department and USCIS can complete their reviews in time. Emergency batch processing, as requested by the AMA, offers one path forward.
Without it, the communities these physicians were set to serve — already among the most medically vulnerable in the United States — will wait longer for care. Physicians who trained in the U.S. with the goal of serving underserved populations may instead end up practicing in Canada or returning to their home countries.
The patients, as one doctor put it, “will suffer the most.”
