The Trump administration is moving ahead with a visa rule change that will require some medical trainees to seek government approval to remain in the country long enough to finish their programs.
The Department of Homeland Security’s policy change for F, J and I nonimmigrant visas was floated as a draft last August and finalized last week with a Sept. 15 effective date.
Medical educators and hospitals say the shift away from the current system—which is referred to as “duration of status” and allows nonimmigrant students to stay for the duration of their education programs—could disrupt physician training, bring new administrative burdens and impact current and future care delivery. About one in 10 of all physicians in U.S. residency and fellowship programs do so under a J visa.
“We strongly believe there is no compelling need to change the current visa system for international students, trainee and postdoctoral scholars,” the Association of American Medical Colleges said in a Friday statement. “By ending current [duration of status] admissions in favor of a fixed-term period of stay framework, the final rule does not take into account the breadth of complexities of graduate, postdoctoral, and medical residency programs, many of which often take longer than four years to complete.”
DHS has described the longstanding duration of status system as a loophole that permitted foreign students to stay in the country indefinitely by “perpetually enrolling in courses to avoid departure.”
“By implementing clear, finite limits on these visas, the United States is reclaiming its ability to properly screen, vet, and monitor individuals within our borders,” DHS Secretary Markwayne Mullin said last week in a statement. “This final rule ensures that foreign students remain focused on their primary purpose: completing their studies and returning home.”
The new policy trades out duration of status for a maximum period of four years, or potentially shorter based on the duration of their specific program. Students with longer academic programs must apply for an Extension of Stay with the government, which DHS said “transitions oversight from university staff back to federal authorities and subjects applicants to biometric vetting, background checks and fraud screenings.”
Shortly after the draft version of the rule was unveiled, medical societies and associations called for DHS to either change course or outline an exemption for physicians.
They said the current approach in which an entity called Intealth sponsors J-1 physicians for the duration of their program, up to a maximum of seven years. That process, which allowed annual renewals, ensured appropriate accountability while offering flexibility for unexpected extensions and avoiding training interruptions “due to unpredictable processing times (historically ranging up to 19 months).” The American Hospital Association (AHA), in a comment letter submitted last year, emphasized “extensive” screening and requirements currently enforced by Intealth and specific training programs that “has resulted in minimal instances of widespread misuse or overstays.”
The organizations, in the various letters and messages, noted administrative costs and burdens that would stem from duplicate data collection efforts plus the fees and legal costs associated with filing an extension application, which are borne by the trainees and their programs. They also underscored the impact new interruptions or restrictions could have on care delivery in both high-need specialties and underserved regions.
“J-1 physicians both learn about and contribute significantly to care delivery in the U.S.,” AHA’s comment letter reads. “Their presence reduces wait times, ensures continuity of care and strengthens local health systems.”
There were nearly 17,500 J-1 physicians in residency and fellowship programs who were sponsored by Intealth in 2025 and working at nearly 780 teaching hospitals, a 76% increase over the past decade, according to the organization.
A study of J-1 visa trends published this month in Health Affairs, which put the tally at more than 14,000 for the 2023-2024 school year, found reliance on these trainees varied widely state by state—but was highest in North Dakota (29% of all physicians-in-training), Connecticut (17%) and West Virginia (17%).
Geographic regions that heavily relied on these foreign trainees, including the Upper Midwest, Northern Plains and Appalachia, “already faced severe physician shortages, … [suggesting] that J-1 physicians play an important role in helping sustain the physician training workforce in regions of the U.S. where shortages persist and physician recruitment remains most challenging,” according to the study. The finding was similar for medical specialties with strained training pipelines.
J-1 physicians are required to return to their home country for at least two years upon program completion, after which they may apply for an H-1B visa. They may also apply for a waiver of that obligation, which requires a signed employment contract to work in an area federally designated as having a shortage of providers. Provider groups that have advocated against the changes noted that a substantial number of J-1 physicians do eventually deliver care in these types of underserved areas after their training.
Intealth, in an online notice, said it will be changing one of its required forms from an annual requirement to a multi-year requirement for those it sponsors, though “annual visa sponsorship renewal with Intealth remains required.” It added that it plans to continue its advocacy and guidance as it reviews the final rule, and will continue working with stakeholders including the government to understand the rule’s implications and identify opportunities to mitigate potential impacts on J-1 physicians and the institutions that train them.”
AAMC, in its Friday statement, also cited 2023 National Science Foundation data outlining more than 26,000 international graduate students and 11,000 postdoctoral scholars in biological and medical sciences, “many of whom relied on F and J visas” impacted by the final rule.
“At a time when the nation is facing a shortage of physicians and growing international competition for its top scientific minds, it is inadvisable to actively reduce our capacity to effectively train the health care workers and biomedical researchers that Americans rely on,” AAMC said.