Congress is in recess this month but has no shortage of issues when it returns after Labor Day. We are less than three months from the upcoming midterms elections so the expectation when Congress returns is that they will focus on funding the government and then return to the campaign trail. That said, members are angling for key policy issues to be positioned to advance in the lame duck session, which means clearing committee hurdles and or advancing from one chamber to the other before Congress leaves town again.

J-1 Duration of Status Update

The DHS rule ending “duration of status” takes effect September 15, and we are continuing to monitor it closely for potential disruption to the J-1 physician pipeline. A few things worth knowing as of the latest guidance from the State Department and Intealth:

• What is changing: International physicians will no longer be admitted for as long as their training lasts. They will get a fixed end date tied to their program, capped at four years, printed on their entry record.
• Extensions now go through USCIS: What Intealth used to handle internally may become a federal application, with a fee, an in-person appointment, and an extended wait. Approval is not guaranteed and there is no appeal from a denial yet.
• Most residency programs will not be impacted: Four years covers the majority of programs. The pressure lands on longer training, moves from residency into fellowship, and anything that shifts the schedule, such as leave or a period of remediation.
• Intealth is trying to minimize the disruption: They plan to begin issuing multi-year Forms DS-2019 this fall covering a physician’s full training program, rather than annual documents, which should reduce how often extensions are needed. Guidance and materials are still in development.
• One near-term item: For physicians already in the U.S., the State Department has said sponsors can preserve current flexibility by recording a physician’s full expected training end date in their SEVIS record before September 15. Intealth has indicated it is doing this, but it is worth confirming with your GME office that your institution’s physicians are covered, particularly anyone in a program running longer than four years.
• Stand by for more details: No immediate action is needed from physicians or programs beyond that. Intealth has advised everyone to continue current processes and hold off on additional immigration steps until further guidance is issued.

We will keep you posted as federal guidance develops. Please let us know if you have any questions.

H-1B Fee Update

The $100,000 fee on certain H-1B petitions is not being charged right now. A federal court struck it down in June, ruling the government didn’t have the authority to impose it. In July, an appeals court declined to put the fee back in place while the case moves forward. The government has stopped collecting for now, but says it will resume if the ruling is reversed.

While the fee only hit petitions for candidates who were outside the U.S. seeking a H-1B visa, this isn’t over as a different court upheld the fee last December, appeals are still pending, and things could change again.

The proclamation that established the fee in September 2025 expires next month, unless the Administration extends it. We will follow up as we learn whether it will be renewed.

Workforce Shortages in West Virginia

 AAMCNews profiles a WVU Medicine clinic in Glenville, West Virginia, where neurologists drive 90 minutes from Morgantown once a month so that patients across nine rural counties don’t have to make the trip themselves. The piece uses that clinic as a window into the projected shortfall of roughly 70,000 specialty physicians by 2036, and reviews the policy levers in play, from expanding Medicare-funded residency slots to rural residency tracks and greater use of specialist NPs and PAs.