Peter A. Kahn, MPH, ThM1; Tova M. Gardin, MPP

The Trump administration has proposed policy changes to the H-1B visa program, which allows immigrants to work temporarily for a specific employer. An analysis of 2016 data from the US Department of Labor Office of Foreign Labor Certification (OFLC) reveals that US employers were certified to fill approximately 10 500 H-1B physician positions nationwide.1 This study investigated which states and hospitals or physician groups employ large numbers of physician visa holders to assess the potential effect of changes to the visa program.

Methods

Data from 2016 on H-1B visa labor condition applications were obtained from the OFLC website.1 Approximately 80% of certified labor condition applications are included in H-1B visa applications ultimately approved by the US Citizenship and Immigration Services.2 Data were imported into Tableau, version 10.1.4, for analysis. All job titles were reviewed by the authors for consistency with involvement in the medical profession as physicians and were verified against the Standard Occupational Classification system codes.3 Residents and fellows were included, although they are frequently admitted with J visas. Applications were tabulated by state and sponsoring employer (ie, hospitals, physician groups). Active patient care physician data by state were collected from the Association of American Medical Colleges 2015 State Physician Workforce Data Book4 and used to calculate the percentage of visa applicants as a proportion of physicians in each state.

Results

A total of 10 491 labor condition applications were certified for use in physician H-1B positions by 2156 sponsoring employers in 2016. Nationwide, applicants to the H-1B program represented 1.4% of the active physician workforce. New York state had the largest number of applicants (n = 1467; 14.0%), followed by Michigan and Illinois. North Dakota had the highest percentage of the physician workforce comprised of H-1B applicants (n = 1602; 4.7%) (Table 1). Twenty-four states had less than 1% of applications. The top 3 states represented 31.0% of applications. The top 4 sponsoring employers with certified H-1B applicants for physicians were William Beaumont Hospital (n = 470; 4.5%), Bronx-Lebanon Hospital Center, the Cleveland Clinic Foundation, and Presence Saint Francis Hospital (Table 2), representing 10.0% of applications.

Discussion

Applicants to the H-1B visa program accounted for 1.4% of all active patient care physicians. Certain states and employers relied heavily on the H-1B program whereas others seldom, if at all, used it.

In 2015, 24.2% of active physicians across the nation were international medical graduates.4 Incorporation of international medical graduates into the workforce has been aided by the H-1B visa program and the program cap exemption5 for certain employers who are affiliated with nonprofit research entities, government research organizations, or institutions of higher education. Consequently, physician H-1B visas have had a high probability of being awarded and some hospitals have come to rely on large numbers of international medical graduates and H-1B visa holders to provide medical services, particularly in medically underserved areas.6

The study was limited by the lack of individual-level data regarding H-1B visa approvals by the US Citizenship and Immigration Services, as well as the lack of overall 2016 H-1B approval data. As such, this study potentially overestimates the number of physicians who will eventually enter the United States with an H-1B visa.

The elimination, restriction, or modification of the H-1B program may affect hospitals and states that employ large numbers of visa holders.

JAMA