News India Times

www.newsindiatimes.com – that’s all you need to know News India Times (December 13, 2025 - December 19, 2025) December 19, 2025 6 Special Report Rural America Relies On Foreign Doctors. Trump’s Visa Fee Shuts Them Out -SHELBY, N.C. T he overworked kidney doctors in this small town were supposed to get reinforcement this fall with the arrival of a new colleague from India. Patients already had appointments scheduled with the incoming nephrologist. Then the Trump administration demanded that com- panies pay a $100,000 visa fee to bring highly skilled workers from abroad, including doctors and medical professionals urgently needed in health care deserts. Nephrology Associates of the Carolinas could no longer afford to sponsor the Indian kidney specialist, and it has not found an American well suited for the job. Two months after President Donald Trump signed the executive order restricting H-1B visas, soaring costs are roiling rural health care facilities that have long struggled to find staff. The fee increase for visa applicants, coupled with broader crackdowns on legal pathways for foreign-born workers, threatens a growing industry and jeopardizes patients who need timely care, according to labor experts and immigration lawyers. In Shelby, about an hour’s drive west of Charlotte, the three kidney doctors came from abroad, two working on H-1B visas. But retaining talent in a rural region can be hard: Another H-1B doctor decamped to Los Angeles last summer, increasing the others’ workload. José Mena, who came to the practice from Ecuador on an H-1B visa, hopes to stay long-term in Shelby with his wife and young daughter. But Mena, 35, said he is taxed by frequent week-long on-call rotations, which involve phone consultations and hospital visits through- out the night, depriving him of family time. “If someone else leaves from the practice, I’ll just leave too,” Mena said. The new nephrologist, Vijaya Chelikani, 30, remains with her parents in Hyderabad, India, while the practice awaits a response to its request for the Trump adminis- tration to waive the fee under a vague “national interest” exemption. “I’m stuck right now,” Chelikani said. “I want to start my job.” In a statement, White House spokeswoman Taylor Rogers said the visa fee discourages companies “from spamming the system and driving down wages” and gives certainty to those who want to “bring high-skilled workers into our great country but have been trampled on by abuses of the system.” DESPERATE RURAL NEED The H-1B visa program allows U.S. employers to hire workers with specialized training from abroad for up to six years if they cannot find American workers to fill the jobs. Previously, the fees had typically ranged between $460 and $1,000 for nonprofit health care facilities. Companies often sponsor those workers for permanent residency. Some of Trump’s supporters have asserted that the program takes jobs from American workers, while left-leaning critics allege that companies exploit the workers for lower wages. Nearly 400,000 new or renewed H-1B visas were granted last fiscal year, according to federal immigra- tion data, mostly to Indian immigrants. About 17,000 of those work in the health sector. These legal workers fill crucial gaps in rural and underserved regions, according to medical associa- tions and health care researchers. Iowa, North Dakota andWest Virginia – states that overwhelmingly voted for Trump in the last three elections – lead the nation with the highest percentage of physicians who hold H-1B visas, according to a study published this year. Last year, the percentage of H-1B-sponsored doc- tors in rural counties was nearly twice the share in urban ones, according to research published in JAMA in October. Impoverished counties also had a signifi- cantly higher percentage of H-1B physicians, said lead author Michael Liu, a resident physician at Brigham andWomen’s Hospital. Liu himself works on a trainee visa from Canada and hopes to eventually remain in the United States on an H-1B visa. The most visible aspects of Trump’s sweeping immigration policies have targeted undocumented immigrants, but the policies are also reshaping legal immigration. TheWhite House implemented a travel ban on people from certain countries and has increased scrutiny of visa applications. Last month, the State Department said visa applicants can be denied over obesity, diabetes or cancer. The crackdown comes as rural hospitals are bracing for cuts to Medicaid, the health insurance program for the poor run by states and the federal government. The administration’s policies will devastate hospitals already burdened by complex visa rules and costly legal fees, predicted Mira Mdivani, an immigration lawyer in Overland Park, Kansas, who represents Midwest medical providers. Qualified doctors, nurses and other medical professionals are in demand worldwide, and “the U.S. is becoming less and less attractive because we have these incredible hurdles,” she said. As immigration rules tighten, the consequences are rippling through sectors already struggling with labor shortages, especially in rural areas. Those include North Dakota, where communities have not attracted enough U.S.-born candidates, said Alfred Sams, president of the Rough Rider Network, an association of 22 independent rural hospitals in the state. “My hospital is 10 miles away. The nearest stoplight is 80 miles away,” said Sams, who lives in Bottineau, near the Canadian border. “We also have winters that are 30 below zero.” Rough Rider hospitals rely on foreign-born health care professionals and operate on slim or negative mar- gins, Sams said, making the $100,000 fee for one worker insurmountable. It’s not just doctors. For decades, the United States has lacked enough nurses. But visas typically used by foreign-born nurses have a years-long backlog – mak- ing H-1B visas a quicker option, said Karen Tumlin, an attorney with the Justice Action Center, a nonprofit representing companies suing to overturn the fee. One health system in Louisiana involved in the lawsuit had more than 200 H-1B nurses lined up, which now would cost more than $20 million in fees, Tumlin said. “It’s just not doable,” she said. The American Hospital Association and dozens of medical associations have lobbied the Trump adminis- tration to exempt health workers from the fee. Neither the Department of Homeland Security, which can grant exemptions, nor theWhite House answered questions about the trade groups’ request. Simon Hankinson, a senior immigration research fellow at the conservative Heritage Foundation and an H-1B critic, called the fee a “step in the right direc- tion” toward reforming a program that he described as a crutch for industries to hire cheap labor. Long term, he said, the measure will push U.S. students toward the medical field and incentivize schools to expand pro- grams. “The American labor market has to be able to adjust,” Hankinson said. Colleen F. Molner, who leads the health care practice at Garfinkel Immigration Law Firm in Charlotte and represents Nephrology Associates of the Carolinas, said Trump’s proclamation and the guidance that U.S. Citi- zenship and Immigration Services (USCIS) issued for it are vague on exemptions. She is arguing that several of her clients qualify for exemptions based on the short- ages of health care professionals in their communities, while other companies are pausing their sponsorships. “It’s definitely having a chilling effect,” Molner said. UNCERTAINTY IN NORTH CAROLINA In North Carolina, health systems say they are in dire need of medical technologists, who analyze blood, urine and other bodily fluids for abnormalities. Iredell Health System – serving Iredell County’s mix of rural communities, suburban neighborhoods of Charlotte commuters and upscale lakefront homes – is asking USCIS to waive fees for a medical technologist from the Philippines. The woman would join a fel- low Filipina technologist, April Joy Castañeto, 30, who By David Ovalle PHOTO:DAVID OVALLE/THEWASHINGTON POST PHOTO:SPUTNIK/GRIGORY SYSOEV/POOLVIA REUTERS Muhammad Alam, a kidney doctor and owner of Nephrology Associates of the Carolinas, hails from Bangladesh and started practicing medicine in Shelby, North Carolina, in 2004. The practice wants to hire a fourth kidney specialist from India but cannot afford the Trump administration’s new $100,000 visa fee for highly specialized workers. April Joy Castañeto, 30, a medical technologist from the Philippines, works the overnight shift testing blood samples at Iredell Health System in Statesville, North Carolina. - Continued On Page 7