Health care leaders in Texas say new rules for a visa for skilled workers could add strain to the state’s health care workforce.
Last month, Gov. Greg Abbott directed public universities and state agencies to freeze any new H-1B visas. The freeze comes a few months after the Trump administration increased the application fee from $5,000 to $100,000 – which some experts say could disrupt Texas’ economy.
Dr. Jayesh Shah, president of the Texas Medical Association, said it’s concerning for providers, but he doesn’t want anyone to panic.
“Have patience,” Shah said. “We are working directly with the governor’s office trying to provide a timely solution. …We are kind of working for an amicable solution so that the physicians who are here don’t have to go anywhere.”
What is an H-1B visa?
The H-1B program is for highly educated, high-skilled workers like researchers, physicians and engineers.
Organizations that want to hire someone from another country on an H-1B visa have to attest they haven’t been able to find American workers with similar skills. In addition, the organization must establish the employee will earn a similar salary to what a worker from the U.S. would earn.
Each year, Congress issues H-1B visas through a lottery, with a cap of 85,000. Texas has more than 10,000 workers on an H-1B visa, the second highest number of H-1B employees in the country.
“Workforce shortages have long been a struggle in health care, particularly since the pandemic,” a spokesperson for the Texas Hospital Association said in a statement to KERA. “Hospitals have implemented new, innovative routes to fill slots that can’t otherwise be filled by U.S. workers, and visas are one piece of that overall strategy.”
Effect of changes on Texas health care
The changes affect new and renewing visa holders, Shah said.
“Maybe, it’s making a physician feel uneasy who are already here,” he said. “There already starting to look for a job outside of the state.”
Abbott’s freeze extends to the end of the next legislative session. It was accompanied by a call from the governor to launch an investigation into “abuse” of the H-1B program.
The Texas Hospital Association spokesperson said it is supportive of measures to reduce “abuse of programs that help connect patients to care.”
Shah said the new rules have created confusion and even fear for some providers.
“For new people who are coming in as a [medical] resident or fellow on H-1B…it takes three to four months for paperwork. It’s not as quick as you think. So, they get a little uneasy whether the job they have accepted – are they going to be able to start on July 1?” he said. “It’s becoming a big issue for a lot of physicians and for a lot of academic centers.
“I’ve heard from most of the deans and universities in Texas and they’re all feeling that this is going to affect them quite a bit.”
But the new rules at the state and federal level may affect different hospitals in unique ways.
Challenges for academic institutions
Abbott’s freeze only applies to public universities and state agencies, which means some hospitals may not be barred from applying. For hospitals attached to a public university, like UT Southwestern Medical Center, this could limit their ability to utilize the H-1B program.
UT Southwestern declined to comment when KERA reached out.
Stephen Love, president and CEO of the Dallas-Fort Worth Hospital Council, said H-1B employees represent critical expertise that makes Texas a powerhouse in medicine and research.
“The other thing that this brings up is the current H-1B holders in North Texas are unaffected for now as the freeze only applies to new applicants,” Love said. “But, I’m wondering, any of the people that have visas that expire before May of 2027, are they going to face any kind of challenges if they have to apply for a new visa? There are some questions that are still unanswered.”
In addition, Texas’ health care infrastructure includes several teaching hospitals and medical schools. Love said the new rules for the H-1B visa could affect the expertise available to students as they’re being trained.
Challenges for rural hospitals
While all hospitals will feel the effects of a higher visa application fee, Love said smaller, rural hospitals will likely hurt the most.
“Generally, not always, but many of the foreign-born doctors often help staff low-income urban and rural clinics,” Love said. “The H-1B workforce in many cases helps alleviate some of those physician shortages.”
In 2025, the Texas Legislature passed a law to encourage physicians trained in other countries to practice in rural areas. The "Doctor Act" sought to address Texas’ physician shortage by making it easier for foreign-trained physicians to become licensed in the state.
Despite the potential progress from the new law, Love said the change to the H-1B visa process could make it harder for rural hospitals to fill those gaps.
Texas has 156 rural hospitals, according to the Center for Healthcare Quality and Payment Reform. Love said about a third of those hospitals have “less than 10 days cash on hand,” which means they may not be able to absorb the higher application fee for the H-1B visa.
Love said rural hospitals are an integral part of the overall delivery of health care, “not just in North Texas, but throughout the state.”
‘Don’t panic’: Advice from health care leaders
Shah said access to health care is a critical issue, especially in Texas, which is why TMA is asking for a health care exemption to the state and federal changes. The American Medical Association also requested an exemption for physicians. Shah said there is already a “backlog” that leads to long wait times for certain medical services throughout the state, and this has the potential to make it worse.
“I just want physicians to know that we are really putting a lot of effort here to make sure that there's a continuity of care and physician workforce is preserved in Texas,” Shah said.
Love said it’s too early to know how the changes will affect providers and the industry as a whole. But he said he doesn’t want people to move away from the state.
“Let's wait and see how this plays out,” Love said. “Let's have discussions with the state, whether it be at the legislative level or the executive level. …We do need the research and the development and…expertise.”
Abigail Ruhman is KERA’s health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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