Have a question?
Contact us
Log in to get started and contribute your insight to this year’s data.
The Association for Advancing Physician and Provider Recruitment (AAPPR) is redefining recruitment to retention and is the only professional organization where physician and provider recruitment leaders and others who influence recruitment, onboarding and retention can connect, learn and advance their careers.
Every March, Match Week and Match Day shine a spotlight on the future of medicine. For medical students, it marks the culmination of years of hard work and the training years ahead. In 2025, the Match was the largest in the National Resident Matching Program’s history, with 43,237 positions offered. It was an important milestone, and one worth celebrating.
But for physician and provider recruitment leaders, Match Day should also prompt a bigger question: is the system creating enough training opportunities to meet workforce needs in the years ahead? Matching into residency is a major step, but it is only one step in the physician pipeline. If there are not enough residency positions, or if those positions are not located in the specialties and communities where need is greatest, shortages will continue to affect both recruitment efforts and access to care.
Graduate medical education (GME) is the bridge between medical school and independent practice. Federal policy plays a major role in determining how many residency slots are available, which means policy decisions directly shape how many physicians can move through the pipeline and into practice.
This has been a challenge for years. The Balanced Budget Act of 1997 capped the number of Medicare-funded residency positions, and although some additional slots have been added in recent years, growth has not kept pace with need. At the same time, medical school enrollment has grown by more than 35% since 2002. The result is a bottleneck at one of the most important stages of physician training.
This challenge is not only about the total number of physicians entering the workforce. It is also about where those physicians train and where they ultimately practice.
Primary care remains one of the clearest pressure points, with psychiatry and some surgical specialties also facing growing strain. Rural and underserved communities are especially affected, where shortages are often more severe and recruitment is already more difficult. These communities should be central to the story, not a side note.
Where physicians train matters, too. Residency location is often a strong predictor of where physicians ultimately practice. That means residency slot policy has a direct impact not only on the size of the workforce, but also on whether high-need communities gain access to care.
For physician and provider recruiters, this challenge is not abstract. It shows up in longer searches, more competition for the same candidates and persistent difficulty filling roles in high-need specialties and markets.
It also comes at a time when demand for care is rising and much of the current physician workforce is nearing retirement age. By 2036, the population age 65 and older is projected to grow by 34%, while 20% of today’s clinical physician workforce is already 65 or older and another 22% is between 55 and 64. In other words, recruitment teams are feeling the effects of both a constrained pipeline and an aging workforce at the same time.
That broader context matters. Recruitment leaders may not control federal policy, but they are often among the first to feel its impact.
AAPPR is paying close attention to this issue because GME policy has a direct effect on physician recruitment and access to care. AAPPR has supported federal efforts to expand residency training, including legislation designed to add Medicare-supported GME positions and strengthen rural residency programs.
This is also an area where members’ voices matter. Physician and provider recruiters bring an important perspective to the conversation because they see, every day, what happens when physician supply does not keep pace with patient need. Their experience helps connect policy decisions to the real-world challenges facing healthcare organizations and the communities they serve.
Match Day will always be an important milestone as it represents the promise of a new generation of physicians entering training, but it should also serve as a reminder that strengthening the physician workforce requires more than successful matches. It requires enough residency capacity, smart distribution of training opportunities and continued investment in the communities that need physicians most.
For AAPPR members, that makes GME policy more than a policy issue. It is a workforce issue, a recruitment issue and, ultimately, an access issue. AAPPR will continue following and advocating on the policy decisions that shape the physician pipeline and the future of physician and provider recruitment.
Last Updated: March 23, 2026
As we covered in the March Legislative Update, after several bipartisan letters from Congress regarding exempting health care workers from the $100,000 H-1B fee, AAPPR worked alongside national medical organizations, including the American Medical Association and American Hospital Association, to secure the bipartisan introduction of the H-1Bs for Physicians and the Healthcare Workforce Act.
We applaud Reps. Mike Lawler (R-NY), Sanford D. Bishop, Jr. (D-GA), Maria Elvira Salazar (R-FL), and Yvette Clarke (D-NY) for their leadership on this important bipartisan effort.
The legislation would exempt all physicians and other healthcare workers from the new $100,000 H-1B filing fee upon enactment. The legislation defines “healthcare worker” to include, but not be limited to, physicians, nurses, nurse practitioners, primary care providers, preventive medicine physicians, optometrists, ophthalmologists, physician assistants, pharmacists, dentists, dental hygienists, other oral healthcare professionals, and other allied health professionals.
Under the Presidential Proclamation, the Secretary of the Department of Homeland Security (DHS) has the authority to exempt certain individuals, or entire professions, when it is in the national interest. Unfortunately, no physicians or other healthcare workers have been granted exemptions to date.
By introducing this legislation, we are hopeful Congressional support will coalesce around this bill and demonstrate to the Administration that exempting healthcare workers is in the national interest and does not undermine the broader policy goals of the Administration. We are encouraging Members of Congress to cosponsor the legislation. Please reach out if you have any questions.
Outside of this legislative effort, we await an update in the Global Nurse Force litigation. During a hearing last month on a motion for preliminary injunction, the government argued that the new fee is not a tax, while the plaintiffs argued that Congress authorized immigration fees only to cover the costs of administering the programs. We expect an update in the next few weeks.
You can read our previous updates from October 28, 2025, December 22, 2025, and Janurary 6, 2026.
AAPPR is aware and closely following the hold on HHS Clinical Waivers and its impact on physician recruitment. The HHS Exchange Visitor Program allows foreign-trained physicians on J-1 visas to remain in the United States without returning to their home country for two years, provided they agree to serve in underserved areas. Since fall 2025, the Office of Global Affairs (OGA) at HHS, which is responsible for issuing the recommendation letters necessary to advance waiver applications, paused the process with hundreds of cases now in the backlog. HHS has reportedly stated that changes are being made to the criteria for the clinical waiver program, but no timing for those changes has been shared.
The consequences of this freeze are serious and far-reaching. The waiver process operates on a tight timeline and physicians generally must have their recommendations forwarded to the State Department by mid-March to complete the transition to H-1B status by the typical July 1 start date. It is not clear if physicians whose J-1 status expires before their waiver is processed will have to leave the country, further disrupting their path to employment.
Given the severity of this issue, we are engaging congressional offices to share our concerns with the Administration and urge immediate action to resume processing. If you are experiencing these delays or have any follow-up questions, please reach out and let us know.
Get up to speed on the latest issues AAPPR is tracking on Capitol Hill, from H-1B visa fee developments to changes to student loan rules. The confirmation of a new Department of Homeland Security Secretary presents a unique opportunity to raise concerns surrounding the H-1B fee, and the FY27 appropriations process should also highlight health workforce challenges and funding questions. AAPPR is engaged with numerous bipartisan offices to elevate key priority issues, which you can read more about in this month’s update.
The Trump Administration’s $100,000 H-1B visa fee remains in effect and continues to pose recruitment challenges for healthcare organizations seeking international physicians and other providers. We appreciate you reaching out to share your experience navigating the fee, including the unfortunate reality of pausing recruitment of candidates who would require payment of the H-1B fee. This feedback helps us advocate for policies that matter to you, including an exemption for healthcare workers from the $100,000 H-1B fee.
AAPPR has been working alongside national health stakeholder groups and a bipartisan group of lawmakers to secure introduction of the H-1Bs for Physicians and the Healthcare Workforce Act. The bill would exempt all physicians and other healthcare workers from the new $100,000 H-1B filing fee upon enactment. The legislation defines “healthcare worker” to include, but not be limited to, physicians, nurses, nurse practitioners, primary care providers, preventive medicine physicians, optometrists, ophthalmologists, physician assistants, pharmacists, dentists, dental hygienists, other oral healthcare professionals, and other allied health professionals. We are hopeful that this bipartisan legislation sends a clear message from Congress about the need to exempt healthcare workers from the fee. AAPPRS thanks Reps. Mike Lawler (R-NY), Bishop (D-GA), Salazar (R-FL), and Clarke (D-NY) for leading this important bipartisan effort.
For more details on the legislation, click here.
On the litigation front, we are awaiting an update in the Global Nurse Force case. During a hearing last month on a motion for preliminary injunction, the government argued that the new fee is not a tax, while the plaintiffs argued that Congress authorized immigration fees only to cover the costs of administering the programs. We expect an update in the coming weeks.
On February 3, 2026, the Department of Education published a proposed rule implementing student loan provisions of the One Big Beautiful Bill Act (OBBB), with significant implications for the nursing workforce pipeline. The proposed rule explicitly excludes Master of Science in Nursing (MSN) and Doctor of Nursing Practice (DNP) degrees from the definition of “professional degree,” meaning nursing students will be subject to the lower graduate student loan limits: $20,500 annually and $100,000 in aggregate, rather than the $50,000 annual and $200,000 aggregate limits available to medical, dental, and other professional students. This classification change will reduce federal loan access for advanced practice nursing students and other providers.
On March 2, 2026, AAPPR submitted a comment letter expressing concerns about the proposed rule’s adverse effect on the healthcare workforce pipeline. In comments, AAPPR urged the Department to adopt a broad, inclusive definition of “professional student” that encompasses advanced nursing degrees alongside other allied health programs, warning that the reclassification could reduce the number of advanced practice providers entering the workforce and intensify the recruitment competition that hospitals and health systems already face. The new rules are expected to take effect July 1, 2026. Please stay tuned for more updates.
AAPPR has signed on in support of the Rural Residency Planning and Development Act of 2025 (H.R. 6468), joining a broad coalition of healthcare organizations urging Congress to authorize dedicated funding for the Rural Residency Planning and Development (RRPD) pilot program. Since its launch in 2019, the RRPD program has worked to address persistent physician shortages in rural communities by supporting the creation and sustainability of rural residency programs, including funding for start-up costs, accreditation, faculty development, and recruitment.
This would ensure the continuity and expansion of the program, strengthening the long-term sustainability of healthcare access in rural areas across the nation.
The next few weeks are going to be tumultuous on Capitol Hill. There are positive signs of movement on issues important to AAPPR and all of you, but they are caught between debates on issues garnering national attention. Stay tuned for updates on the H-1B visa, the Conrad 30 program, and other policy-related items between now and the Advancing Connections 2026 AAPPR Conference next month!
Since 2011, we have asked our members each year to participate in two surveys, the Recruitment Team Compensation Survey and the Physician and Provider Search Survey, that directly power our annual Physician and Provider Recruitment Benchmarking Report. These surveys are not standalone exercises. The data collected becomes the foundation for the benchmarking insights members use to evaluate compensation, assess workload and performance, and support strategic conversations with organizational leadership.
Participation is what ensures the Benchmarking Report reflects the realities recruitment teams are navigating today. When participation is broad and consistent, the data is stronger, more representative and more useful for decision-making across the profession.
Participation for the 2026 Benchmarking Surveys is now underway. The Recruitment Team Compensation Survey opened on February 10, 2026 and the Physician and Provider Search Survey opens March 17, 2026.
Here are five reasons why member organizations should participate in the surveys:
The quality and usefulness of the Benchmarking Report depends entirely on the breadth and accuracy of member participation.
When organizations of varying sizes, regions and structures contribute data, the resulting benchmarks better reflect the realities of today’s recruitment environment. Participation ensures the data captures meaningful variation rather than a limited snapshot, making the benchmarks more reliable for real-world decision-making.
Participation is not just about contributing data. Organizations that complete the surveys receive complimentary access to the corresponding Benchmarking Report and the Benchmarking Portal.
These resources allow members to explore detailed tables, compare results and use tools and calculators to analyze their own data against industry benchmarks. Participation ensures members can immediately apply the insights to compensation planning, workload assessment and operational strategy.
Benchmarking data provides external context that recruitment leaders need when engaging with finance, HR and executive stakeholders.
The data generated through these surveys supports:
• Compensation and role design discussions
• Budget and headcount planning
• Goal setting and performance evaluation
• Forecasting future recruitment needs
Participation strengthens the credibility of these conversations by ensuring the benchmarks reflect current market conditions.
Each survey answers a different set of strategic questions.
The Recruitment Team Compensation Survey focuses on the people behind recruitment operations, including roles, responsibilities and compensation structures.
The Physician and Provider Search Survey focuses on recruitment activity and outcomes, including search volume, demand trends and performance metrics.
Participation in both surveys helps create a comprehensive picture of how recruitment teams are structured and how effectively they operate.
Our Benchmarking Report is a shared resource built by members, for members. Broad participation ensures the data remains relevant over time and continues to evolve alongside the profession.
By contributing to the surveys, members help establish benchmarks that support best practices, inform workforce planning and advance physician and provider recruitment as a whole.
Industry-wide participation strengthens the accuracy and impact of AAPPR’s benchmarking data—making it a trusted resource for physician and provider recruitment teams everywhere. Both AAPPR members and nonmembers are welcome to participate in the Recruitment Team Compensation Survey (opened February 10) and the Physician and Provider Search Survey (opening March 17).
As a thank-you, all survey participants will receive a free copy of the report for the survey they completed.
To learn more about the Benchmarking Report, please visit aappr.org/research/benchmarking.
We are roughly six weeks into the year and Congress has spent more time finishing 2025 than laying the groundwork for 2026. Still, there’s a lot of activity impacting the physician pipeline and health care employers. We expect the year to take shape in the coming weeks as Congress returns from its recess, the President delivers his State of the Union, and the next appropriations cycle gets underway. We continue to work with stakeholders and Congressional offices to elevate key issues like H-1B visa fees, Conrad 30 improvements, and other administrative actions impacting healthcare costs and delivery.
The Trump Administration’s $100,000 H-1B visa fee, implemented in September 2025, remains in effect and continues to pose recruitment challenges for healthcare organizations seeking international physicians and providers. While the administration has indicated it may consider national interest exemptions, no exemptions have been granted in the healthcare sector to date. Three federal lawsuits are currently pending, with a DC Circuit appeal expected this month following a December 2025 district court ruling that upheld the fee. On the legislative front, bipartisan congressional pressure is mounting: a letter led by Representatives Yvette Clark (D-NY) and Mike Lawler (R-NY) garnered 100 bipartisan signers and the support of 40 national healthcare organizations, including AAPPR, and new bipartisan legislation to exempt healthcare workers from the fee is expected ahead of the H-1B cap lottery registration.
Healthcare employers should closely monitor these legal and legislative developments, as favorable rulings or passage of an exemption could provide near-term relief. In the meantime, the Conrad 30 J-1 Visa Waiver Program remains a viable alternative pathway for physician recruitment, as international medical graduates transitioning from J-1 to H-1B status are not subject to this fee. We encourage you to assess recruitment timelines and consider engaging with congressional champions to educate them on the implications of this policy.
On February 3, 2026, the Department of Education published a proposed rule implementing student loan provisions of the One Big Beautiful Bill Act (OBBB), with significant implications for the nursing workforce pipeline. The proposed rule explicitly excludes Master of Science in Nursing (MSN) and Doctor of Nursing Practice (DNP) degrees from the definition of “professional degree,” meaning nursing students will be subject to the lower graduate student loan limits: $20,500 annually and $100,000 in aggregate, rather than the $50,000 annual and $200,000 aggregate limits available to medical, dental, and other professional students. The Department of Education justified this exclusion by reasoning that nurses are already licensed when entering these programs and that nurse practitioners in many states cannot practice independently without physician supervision.
This classification change, combined with the OBBB’s elimination of Graduate PLUS Loans for new borrowers effective July 1, 2026, will substantially reduce federal loan access for advanced practice nursing students. Healthcare organizations should be aware that this policy shift may create financial barriers to nursing education, potentially affecting the supply of nurse practitioners and other advanced practice nurses entering the workforce in coming years. Comments on the proposed rule are due by March 5, 2026. Please reach out if you have any questions.
If you or your organization are encountering challenges related to the H-1B visa fee, Conrad 30 program, or any other issues affecting your ability to recruit and retain physicians and providers, we want to hear from you. Please don’t hesitate to reach out as your insights help us make the case to policymakers and shape effective solutions.
The Association for Advancing Physician and Provider Recruitment (AAPPR) is proud to announce Aya Healthcare as a Signature Partner, strengthening a strategic collaboration focused on advancing physician and provider recruitment through innovative technology, data-driven insights, and shared industry expertise.
As a Signature Partner, Aya Healthcare will play a leading role in supporting AAPPR’s mission to elevate recruitment practices across healthcare organizations nationwide. This expanded partnership reflects a shared commitment to providing recruitment professionals with comprehensive, scalable solutions that address today’s increasingly complex workforce challenges.
“Aya Healthcare’s elevation to Signature Partner underscores the value they bring to the physician and provider recruitment community,” said Carey Goryl, CEO of AAPPR. “Their investment in technology, analytics, and recruiter support aligns seamlessly with our goal of advancing the profession and strengthening healthcare systems.”
Through this partnership, Aya Healthcare will continue to collaborate with AAPPR on initiatives designed to:
Aya Healthcare’s physician and advanced practice solutions includes key offerings such as:
Aya Healthcare’s Signature Partner status also reinforces its long-standing commitment to helping healthcare organizations adapt to evolving recruitment demands while improving efficiency, transparency, and outcomes.
“We’re honored to deepen our partnership with AAPPR as a Signature Partner,” said Mike York, EVP of Digital Advertising & Recruitment Technology at DocCafe. “Together, we’re focused on empowering recruitment professionals with smarter tools, clearer insights, and the support they need to build stronger care teams.”
Each AAPPR partnership is tailored to fulfill the company’s unique business objectives and marketing goals. Partners receive invaluable visibility with more than 2,500 AAPPR members, including sourcing, recruiting, contracting, credentialing, certifying and onboarding professionals, who play critical roles in influencing the advancement of their health care systems.
For more information about Aya Healthcare or the Partner program, visit www.aappr.org or email info@aappr.org. For more information about Aya Healthcare’s physician and advanced practitioner solutions, visit https://www.ayahealthcare.com/physicianrecruitment.
About The Association for Advancing Physician and Provider Recruitment (AAPPR)
The Association for Advancing Physician and Provider Recruitment (AAPPR) is a nationally recognized leader in health care provider recruitment, onboarding, and retention. For more than 30 years, AAPPR has empowered physician and advanced practice provider recruitment leaders to transform care delivery in their communities by providing best-in-class practices, up-to-date industry knowledge, and evolving innovative approaches for hiring, onboarding, and retaining exceptional clinical talent. To learn more or to become an organizational member of AAPPR, please visit https://aappr.org/join-now.
About Aya Healthcare
Aya Healthcare is the leading healthcare talent software and staffing company in the United States. Aya operates the world’s largest digital staffing platform delivering every component of healthcare-focused labor services, including travel nursing and allied health, per diem, permanent staff hiring, interim leadership, locum tenens and non-clinical professionals. Aya’s AI-enabled software solutions, which include vendor management, float pool technology, provider solutions and predictive analytics, combined with its digital talent marketplaces, provide hospital systems greater efficiencies, superior operating results and reduced labor costs. While technology drives efficiency and scale, Aya’s 6,000+ global employees power the company to deliver unparalleled accountability and exceptional experiences for clients and clinicians. Aya’s company culture is rooted in giving back and supports organizations around food security, education, healthcare, safe shelter and equity. To learn more about Aya Healthcare, visit www.ayahealthcare.com.
Happy New Year and welcome back. Congress is in session this month to address, at a minimum, government funding, but there are signs that other healthcare provisions could be included if a deal comes together. It is looking less likely that extending Affordable Care Act tax credits will happen, despite a three-year extension passing in the House, while there are ongoing negotiations around funding for community health centers and reforming pharmacy benefit managers. In this month’s update, we focus on the latest on H-1B visa fees and state activities around health workforce issues.
There are growing calls for an exemption from the $100,000 H-1B visa fee for health care workers following last month’s court decision. In December, a federal court rejected a request to strike down the Administration’s $100,000 entry fee for H-1B visa holders, upholding the Administration’s authority to condition H-1B visa approval on this payment. The case heads to the US Court of Appeals for a hearing in February, but it is clear a resolution may be months away.
This is problematic for the upcoming match in March when medical students learn their residency placements. The Match relies heavily on international medical graduates (IMGs), who filled nearly 17% of program year 1 (PGY-1) positions in 2025. Without any further guidance this could affect how residency programs handle applicants who require H-1B sponsorship. It also puts more emphasis on J-1 visa pathways, since visa holders already in the country when applying for the H-1B are not subject to the fee.
Members of the New Democrat Coalition sent a letter this month to the Department of Homeland Security to exempt health care workers from a new H-1B visa fee. This is a welcome letter, but it will likely not be taken seriously by the Administration unless it is bipartisan. We are working on identifying Republicans who may be willing to lead a letter on this topic, given the mounting pressure on hospitals and other providers who rely on IMGs, not to mention the patient access concerns.
At this time, the Administration has indicated they will only consider exemptions to the fee on a case-by-case basis. AAPPR is working with other national health care stakeholder organizations on pursuing individual exemptions while also securing a broad exemption for healthcare workers. If you are navigating the H-1B process for candidates or have questions on best practices, we are ready to assist you.
It is no secret that healthcare shortages present an urgent threat to patient access. We are monitoring what states are doing to identify trends or successful efforts that can be replicated or used to leverage action at the federal level. In Pennsylvania, State Rep. Kathy Rapp, Republican Chair of the Houe Health Committee, wrote a letter to Dr. Mehmet Oz, the Administration of the Centers for Medicare & Medicaid Services (CMS), asking him to accelerate funding due to hospitals ceasing labor and delivery services. In her letter, she highlighted the Conrad 30 program as a solution to help address shortages, in addition to increasing the number of residency slots.
In Alabama, lawmakers introduced a bill to overhaul the state’s existing rural physician tax credit by increasing the annual incentive from $5,000 to $10,000. Beginnning in 2027, eligible physicians who live and practice in rural communities could receive this credit for up to four years.
In Mississippi, an article appeared in the Mississippi Independent highlighting the importance of foreign doctors across the state, and the potential risks to patient access should the H-1B fee remain in effect. It is important to see articles like this because it creates an opening to discuss with lawmakers the importance of international physicians to patient access.
AAPPR is working on a state grant program that would award grants to employers who secure a J-1 visa waiver through the Conrad 30 program, to support the recruitment and retention of that physician.
The House has passed a three-year extension of ACA premium tax credits, but Senate talks have stalled over abortion-funding (Hyde) language, leaving little room for compromise. Even if negotiators reach a deal, it would still need broad Senate support, a House vote if amended, and White House sign-off, as marketplace open enrollment ends today with initial enrollment down by 1.4 million. Lawmakers have floated extending open enrollment if a deal materializes, but with the Senate leaving town and end-of-January deadlines for other priorities, prospects are dimming by the day.
On January 22nd, tune in to hear from Sungchul Park, Associate Professor at the Department of Health Policy and Management at Korea University, to discuss healthcare workforce shortages and patient outcomes at Stanford University. He will discuss how an 18-month nationwide walkout by South Korea’s trainee doctors led to worse patient outcomes, fewer hospital and clinic visits, and higher costs per hospital stay. The study highlights how vulnerable health systems are to staffing disruptions and the need for stronger workforce resilience.
Last Updated: January 6, 2026
Just before the holidays, a federal court rejected a request to strike down the Administration’s $100,000 entry fee for H-1B visa holders, upholding the Administration’s authority to condition H-1B visa approval on this payment. U.S. District Judge Beryl Howell found that the President has broad statutory authority to regulate both immigrant and nonimmigrant entry. The Chamber of Commerce, who are leading this particular this case, requested the US Court of Appeals consider this decision and expedite its review, setting up oral arguments for February.
While additional lawsuits remain pending, including one filed by 20 states last month, the ruling marks an early validation of the policy and leaves employers facing increasing questions and pressures for a clear resolution.
We will continue to pursue a clear exemption for health care workers given the uncertainty following this latest court decision and encourage you to reach out with questions or issues as you navigate the H-1B process. You can read our two previous updates from October 28, 2025 and December 22, 2025.
Separately, the Department of Homeland Security last month finalized a rule overhauling the H-1B selection process. Instead of equal odds for all registrants, the new lottery weighs selection by wage level, granting the highest wage tiers more entries and thus better odds. The regulation will apply to the fiscal year 2027 registration period, meaning petitions filed before that date will follow the current lottery rules. The wage-weighted lottery will tilt selection toward higher-paying roles and employers, potentially undermining entry-level or lower-paid clinical positions. While some employers may be cap-exempt and outside the lottery, these pressures will likely shift recruiting strategies and priorities in the new year.
We will cover this change in more detail in the January legislative update but encourage you to reach out with any questions in the meantime.
Last Updated: December 22, 2025
For more background on this policy, review our previous update HERE.
On December 19, 2025, U.S. District Judge Beryl Howell heard from the U.S. Chamber of Commerce and Association of American Universities in their case challenging the Administration’s $100,000 fee on new H-1B visas. During the court proceeding, Judge Howell questioned the employer groups to demonstrate that the Administration is violating federal law, noting the President has broad powers to regulate immigration, including restricting entry of foreign workers.
While employers argued that the policy is disrupting recruitment plans for employers, Judge Howell sought to better understand how the groups are impacted by the policy, when the impact is more directly felt by prospective H-1B candidates. The Justice Department argued that the Administration is permitted to add preconditions to entry without consulting Congress.
While this would appear to be a setback, there have been other developments ratcheting up pressure on the Administration over this policy. This month, 20 states joined together to sue the Trump Administration over this policy, with California Attorney General Rob Bonta arguing that the Administration cannot rewrite immigration law. A broad coalition of schools and health providers also submitted two legal filings in federal court against this policy this week. This comes on the heels of an initial lawsuit led by a nurse staffing company challenging the Administration’s H-1B restrictions this fall.
Since Judge Howell did not offer any concrete timeline for a decision, we are continuing to work with national health stakeholders and Congress to urge the Administration to exempt health workers from the fee. Several members of Congress have reached out to the Administration call for an exemption, and we will continue to seek more outreach until we get a definitive response from the Administration.
AAPPR is exploring whether there is a viable path to relief that leverages the national interest authority with targeted congressional engagement. The Administration’s proclamation states that the Department of Homeland Security could waive the $100,000 fee if it determines the hiring of that H-1B worker is in the national interest and does not pose a threat to national security. That national interest standard provides a practical avenue for employers to seek tailored relief where the fee would impair continuity of care, exacerbate shortages, or otherwise impede access for patients.
AAPPR is already working with hospitals that have submitted H-1B applications and require letters of support highlighting the national interest standard as justification for waiving that fee. We can support your organizations with a similar letter or work with you to engage your Congressional delegation for a similar letter of support. Congressional engagement would be at its most beneficial when requesting an exemption from the fee.
Please share this with your legal counsel if you are encountering candidates eager to move forward or your organization is ready to pursue this pathway given the continuing uncertainty. We are happy to answer any questions.
For more information on this H-1B policy, you can review our last update here.
Congress is close to wrapping up the legislative session for the year. Despite intense focus on health care costs and Affordable Care Act (ACA) tax credits, the drive for consensus has been bumpy and unproductive. After two failed votes in the Senate that would have extended the tax credits, the House GOP is trying to chart a path that appeases moderates key to their majority without upsetting the more conservative wing of the party. Lawmakers are also trying to pass appropriations packages, an effort to make some progress before the end of the year, with the next funding deadline just seven weeks away.
AAPPR’s CEO Carey Goryl and Policy Advisor Eli Greenspan visiting the congressional offices in Washington D.C.
AAPPR’s CEO Carey Goryl and Policy Advisor Eli Greenspan braced the December chill to meet with congressional offices this month. They introduced offices to AAPPR’s mission, membership, and the current state of physician recruitment and retention. It was a great opportunity to highlight our federal priorities, meet with staff to learn what they are hearing about these issues, and how we may be able to partner to improve the physician pipeline considering numerous challenges impacting this field and patients. Carey and Eli met with bipartisan offices from Michigan, Florida, North Carolina, New Jersey, California, and Ohio, with more follow ups into 2026.
This engagement is key to our growing presence in Washinton DC and identifying partners on Capitol Hill positioned to advance issues important to provider recruitment and health care delivery.
As you are likely aware, the Department of Education plans to phase out Grad PLUS and set new loan limits starting July 1, 2026. There will be two caps: up to $20,500 per year (and $100,000 total) for most graduate programs, and up to $50,000 per year (and $200,000 total) for certain “professional” programs.
“Professional” will cover a short list of fields—medicine, dentistry, law, pharmacy, veterinary medicine, optometry, osteopathic medicine, podiatry, chiropractic, theology—and licensure‑leading PsyD/psych PhD programs. It will not include physician assistants, advanced practice registered nurses/nurse practitioners, occupational therapy, or other licensed health programs, meaning many students in high‑need fields could face federal loan limits below typical program costs.
The Department still has to publish a proposed rule (expected in early 2026) with ~30‑day comment period. The new limits would apply only to new federal borrowers after July 1, 2026; current borrowers keep their existing terms. AAPPR is closely monitoring this issue and welcomes your feedback if you have questions or concerns about this policy issue.
In September, the President instituted a policy that imposes a $100,000 fee on certain new H-1B petitions. The fee applies primarily to new H-1B applications who are coming from abroad, but the policy and lack of clarity has had significant effects on the healthcare industry, leading to many institutions simply pausing recruitment of H-1B physicians.
We will be publishing a new update this month, but oral arguments have been scheduled in the U.S. Chamber of Commerce and the Association of American Universities case against the Trump Administration, for December 19th. The plaintiffs have argued that the Trump Administration does not have unlimited authority to set fees.
If the court rules against the Administration, it could provide much needed clarity for health recruiters. Stay tuned for more updates this month.
While on Capitol Hill, Carey and Eli had several productive meetings on Capitol Hill which focused, among other things, on ways to advance the Conrad 30 legislation. The Conrad 30 legislation would extend the program for three years, improve the process for obtaining a visa, and allow for the program to be expanded beyond 30 slots if certain thresholds are met. It also would make the program more attractive to employers and prospective J-1 waiver candidates. We encouraged offices to not just work with us to build support for the legislation, but to explore attaching the bill to an appropriations bill or other moving vehicle. It will be difficult to overcome limited Republican opposition in this current environment, but we were pleased that offices were receptive to a more action-oriented approach to elevating this important issue.
In addition, as we have pointed out in recent months, we are moving closer to seeing the introduction of new legislation that could help boost recruitment of J-1 candidates in lower utilizing states. The idea is that J-1 candidates who miss out on waiver opportunities can opt in to a portal that facilitates information sharing between states with available slots and employers who need help filling gaps in their primary care or specialty workforce. This is an exciting development highlighting the importance of engagement and education to highlight AAPPR’s unique perspective when it comes to healthcare delivery.
Dr. Scott Gottlieb, former FDA Commissioner, published a piece in JAMA on artificial intelligence titled, “How AI Will Help Solve Medicine’s Productive Challenges.” This is worth reading because it shows how smarter AI, clearer FDA rules, and better Medicare payment policies could safely automate routine tasks, improve outcomes, lower costs, and fairly reward doctors.
Thank you for reading throughout 2025 and your continued engagement on policy and advocacy. Looking forward to building on our successes in the new year.
AAPPR uses cookies for functional and analytical purposes. By continuing to browse or by clicking “Accept,” you agree to the storing of cookies on your device to enhance your site experience. To learn more about how we use cookies or how to change your settings, please see our privacy policy.
Accept Close
