H-1B Visas

Photo by Carol Highsmith, 7/7/2016

​Wikipedia defines the H-1B visa as “a classification of non-immigrant visa in the United States that allows U.S. employers to hire foreign workers in specialty occupations, as well as fashion models [fourteen year-olds?], or persons who are engaged in Department of Defense projects who meet certain conditions.”  Wikipedia goes on to detail the history, pertinent laws, and usage of the visas.  


The visas are recently in the news because of an executive order increasing the fee for a specialty occupation visa by bunches, to $100,000.  This may be overturned or changed, but that is not my focus.  For good or half-baked reasons, I want us to change the script.


That the current administration is targeting H-1b visas seems baffling, given that big tech companies are reportedly the biggest users of the program. (Qualifying foreign workers have to be sponsored by an employer, the workers are not given the visa on their own.)  The administration wants to support big tech, and some very large campaign donations came from that channel (doesn’t really matter now, does it—the election is over, suckers), so how does that fit?  The administration has a basic anti-immigrant focus; we see that side overcoming a pro-industry stand.


But that is not the focus of this opinion either.  We have benefitted greatly from the contributions of immigrant workers in all fields.  I valued my interactions with foreign workers personally.  The shift in emphasis I want to take here does not mean I want to diminish that program at all.  I just want to say that the impetus for making an H-1b visa worker harder to obtain is a wrong-headed approach to the claimed basic aim of making more jobs available to “Americans”. 


Where I worked, at a state agency, some of my co-workers were from south Asia, here on a work visa.  They came better qualified than other applicants.  Some potential applicants from Texas with better qualifications may have not bothered to apply, as they opted to try for better paying positions at a big, private firm.  Typically, state and federal agencies, as well as smaller businesses and other tech outfits, are constrained in the salaries they can offer.  As an aside, you can get an infusion of new ideas, new ways of looking at a problem, from any new worker, but more so from someone educated in a different system.


But, shift focus.


Let’s say we want more “Americans” hired in the positions now filled in some proportion by foreign-born workers.  (And not to imply that this is an either them or us issue—it can be both.)
You can’t achieve good ends by just cutting out foreign workers.  If you want to fill tech positions with a higher proportion of local talent, you have to give local talent a chance to acquire the skills to do the work.  You can open the tap fully at the sink, but if the valve coming into the house is almost closed, you won’t see a good stream of water.  If we don’t have a good pipeline for supply of young talent, cutting out foreign talent won’t help: we just sink.


That talented young man riding his bike to his part time barista job could become your future surgeon.  But unless one of his professors is insightful and unusually well connected, he’ll never get the chance.  No way would he get into medical school with his background and financial ability, even with reasonable good grades.


That young woman would like to become an full-on engineer, but looks toward engineering work as an assistant, because she can’t afford the cost of the UT program, even though her math and physics grades would let her in.


So, the current administration’s approach to foreign workers is wrong-headed and tainted with the poison that pervades the team.  Don’t stop there.  We should use this as a lever to advocate for less expensive higher education.  


In the case of  people with medical specialties—doctors—there is great concern.  Impacts from the the administration’s bludgeon approach may be severe, especially in rural areas.  This is worthy of consideration in itself.  Foreign-born doctors have been more open to working in rural areas.  Our rural areas have a health crisis.  We are headed in the wrong direction.  (But how to get people to see that perspective, instead of fuming against a mythical medical conspiracy?)


https://en.wikipedia.org/wiki/H-1B_visa


https://www.aamc.org/news/1-5-us-physicians-was-born-and-educated-abroad-who-are-they-and-what-do-they-contribute  
In 2021 approx 1 in 5 physicians practicing in the US were born and attended medical school outside the US.
“That’s important because the United States is grappling with severe physician shortages. Already, the country lacks more than 17,000 primary care practitioners and more than 8,000 mental health practitioners, for example. By 2034, the U.S. is expected to face a shortfall of as many as 124,000 physicians.”


https://www.reuters.com/business/healthcare-pharmaceuticals/trumps-h-1b-visa-fee-increase-raises-us-doctor-shortage-concerns-2025-09-24/


Summary: Foreign-trained physicians fill 20% of US family medicine posts.  There were 5,600 healthcare H-1B visa approvals in 2025.  Physician group says higher costs [of H-1b visas] could choke supply of doctors.  US faces doctor shortfall of up to 86,000 by 2036




https://www.ktsm.com/news/perez-governor-signs-bill-making-it-simpler-for-foreign-doctors-to-practice-in-texas/


Texas Gov. Greg Abbott has signed House Bill 2038 into law which will allow experienced foreign-trained doctors to practice in Texas without having to repeat a U.S. residency, state Rep. Vince Perez’s office announced in a news release.




https://www.forbes.com/sites/emmawhitford/2025/06/13/trumps-visa-ban-is-barring-new-foreign-doctors-from-entering-us/    pause on J-1 visas  means MD’s from 19 countries are not able to enter the US
   “One in four pediatric residents in the USA are international medical school graduates, and they are filling those spots in the most underserved communities that American graduates are not even applying to,” says Sebastian Arruarana, a resident physician at the Brookdale University Hospital and Medical Center in Brooklyn, New York, and an advocate for international medical graduates. “If this is not solved, who will take care of our children?”

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