ASCs look abroad for staffing, but new $100,000 visa fee threatens access to global talent

Editor's Note

Ambulatory surgery centers (ASCs) are increasingly recruiting international healthcare workers to offset ongoing physician and nursing shortages, yet rising visa costs and regulatory hurdles are making the process more challenging, Ambulatory Surgery Center News October 30 reports. Ann-Rose Johnson-Lewis, director of legal services at WorldWide HealthStaff Solutions, told the outlet that relying solely on domestic workers is no longer realistic. Immigrants account for 27% of US physicians, with 19% as naturalized citizens and 8% as noncitizens, and many outpatient roles are filled through visa-linked staffing.

As detailed in the article, common visa pathways include the EB-3 for permanent residency, the H-1B for specialized roles, and the J-1 for medical graduates. These programs have helped place thousands of clinicians, particularly in medically underserved areas through mechanisms like the Conrad 30 waiver. However, visa availability, long processing times, and new legislative changes are slowing recruitment. A new $100,000 fee per H-1B application, imposed in September 2025 for applicants abroad, has sparked backlash. Johnson-Lewis noted its potential impact on rural hospitals and nonprofit systems unable to absorb the cost.

The American Hospital Association has urged exemptions for healthcare workers, warning the fee will worsen staffing in underserved communities. Legal challenges are underway, including lawsuits by the US Chamber of Commerce and healthcare coalitions. Health systems like Henry Ford Health are evaluating how the fee will affect operations, especially at high-volume ambulatory sites.

Per the outlet, visa sponsorship remains critical for ASCs grappling with shrinking domestic talent pools. Fewer US nursing graduates are passing licensure exams, and visa processing can take up to 2 ½ years, requiring long-term planning. Despite the obstacles, international workers continue to pursue US positions for better pay, family ties, and quality of life.