Washington: A contentious congressional hearing on the United States’ growing physician shortage has triggered fresh uncertainty for Indian medical graduates seeking careers in America, as lawmakers debated a proposal to impose a $100,000 supplemental fee on new H-1B visas.

The proposed hike, significantly higher than current employer-paid visa processing costs, was discussed during a Ways and Means health subcommittee hearing focused on expanding graduate medical education (GME) and strengthening rural healthcare in the US. Lawmakers raised concerns that such a steep visa fee could discourage rural hospitals from hiring foreign-trained doctors at a time when the country faces mounting workforce shortages.

Congressman Adrian Smith warned that the US healthcare system faces “a very real problem, a rapidly depleting health care workforce”. He said the country could see a shortage of 187,000 physicians by 2037, with nearly half of all practising doctors expected to retire within the next decade.

The strain is particularly acute in rural America. According to Smith, around 83 million Americans live in areas with insufficient primary care physicians, while only 2 per cent of residency positions are located in rural regions.

Amid bipartisan calls to expand Medicare-supported residency slots, immigration policy emerged as a flashpoint. Congresswoman Linda Sanchez questioned whether the proposed increase in H-1B visa fees would disproportionately affect underserved communities that rely heavily on international medical graduates.

Dr Andrew Racine, president of the American Academy of Paediatrics, cautioned that “anything that’s going to decrease the supply is going to have an impact on our ability to serve the needs of children”. Several lawmakers acknowledged that foreign-trained physicians form a critical component of US residency programmes and rural healthcare systems.

While India was not explicitly mentioned during the hearing, Indian nationals historically constitute one of the largest groups of international medical graduates in the United States. Many Indian doctors specialise in internal medicine, family medicine and other primary care fields, often serving in rural and medically underserved areas under visa arrangements tied to service obligations.

Lawmakers noted that a substantial rise in H-1B visa costs could make recruitment financially unviable for small community hospitals already operating under tight margins. Jason Shenefield, chief executive of Phelps Health in Missouri, told the panel that his rural health system expects “close to about $100,000 loss per resident” under current financial structures. Additional immigration-related costs, members suggested, could further burden such facilities.

However, some Republican lawmakers argued that immigration policy should not substitute for reforms in domestic medical training. Congressman Greg Steube said American medical graduates were losing residency opportunities to foreign-trained doctors and indicated plans to introduce legislation addressing the issue.

Beyond the visa debate, lawmakers also discussed expanding Medicare-funded residency positions. A bipartisan proposal seeks to add 14,000 new residency slots over seven years, prioritising rural and underserved communities. Medicare currently spends approximately $22 billion annually on graduate medical education, but caps introduced in 1997 continue to limit the distribution of training positions.

For Indian medical students pursuing US licensure — a process requiring clearance of US medical licensing examinations and securing accredited residency placements — the proposed H-1B visa fee hike adds a layer of uncertainty.

As Congress weighs healthcare workforce expansion, immigration reform and funding structures, the hearing highlighted the increasingly complex intersection between US domestic health policy and global medical mobility.

IANS