Beginning September 21, 2025, a major policy shift will reshape how Canadian physicians enter the United States in H-1B status. A new Presidential Proclamation now requires a $100,000 fee for most H-1B petitions filed on or after that date, including those filed under the long-standing Canadian exception, which historically allowed physicians to enter at a port of entry (POE) without visiting a U.S. consulate.
For hospitals already facing staffing shortages, this change is more than bureaucratic; it’s operational, financial, and immediate.
As Managing Partner Rosanna Berardi, Esq. explains, “This new fee dramatically alters the hiring landscape for Canadian physicians. Hospitals can no longer rely on predictable onboarding timelines or low-cost H-1B entry. Every case now requires careful planning.”
Below, our team breaks down what this means for healthcare employers, physicians, and cross-border medical systems.
Understanding the $100,000 H-1B Fee
Who is subject to the fee?
All H-1B petitions filed on or after September 21, 2025, that request:
- Consular notification
- Port of Entry (POE) processing
- Pre-Flight Inspection (PFI)
must now include an additional $100,000 “Proclamation fee”, unless an exception is approved.
Canadian H-1B applicants, who do not obtain visas at U.S. consulates and instead secure H-1B classification at the border, fall squarely within this category.
This means:
- Every Canadian physician entering in H-1B status is affected.
- The fee applies regardless of where the physician resides.
- Even those still completing the INA §212(e) two-year home residency requirement in Canada are not exempt.
Why This Change Matters
Historically, hospitals relied on the Canadian exception to quickly onboard physicians, especially when the candidate was completing their J-1 home-residency requirement in Canada but could legally work in the U.S. using H-1B status.
That pathway has now been disrupted.
National Interest Exceptions (NIEs): A Possible Pathway, But Not a Predictable One
The proclamation gives the Secretary of Homeland Security authority to grant case-by-case exceptions, including for reasons of national interest. But so far, this process is anything but smooth.
No Clear NIE Criteria Yet
DHS has not published criteria outlining what qualifies as a “national interest” exception for healthcare workers.
This leaves hospitals guessing whether documentation such as:
- Physician shortage data
- HPSA/MUA designations
- Recruitment evidence
- Patient safety risks
will meet the government’s expectations.
Expect Delays, Not Quick Decisions
There is:
- No published timeline
- No precedent for physician requests
Early cases show that even robust filings are receiving Requests for Evidence (RFEs) asking for additional proof that no alternative staffing model exists.
Hospitals should plan around unpredictable onboarding dates.
How the Fee Impacts Physicians Subject to INA §212(e)
Many Canadian physicians are still completing the J-1 home-residency requirement but wish to begin U.S. employment using H-1B status while residing in Canada. Under prior rules, this was entirely permissible.
But under the new policy:
- The $100,000 fee is still required, even if the physician will not physically live in the U.S.
- The fee is tied to the H-1B classification request, not residence.
This eliminates what was once a highly efficient staffing solution for Canadian-U.S. medical systems.
What Hospitals Should Do Now
- Prepare for RFEs
USCIS is issuing RFEs requiring either:
- Proof of payment of the $100,000 fee, or
- Evidence of an approved exception.
Hospitals should avoid submitting H-1B petitions without anticipating this additional step.
- Decide whether the fee is financially viable
For mission-critical hires, such as rural emergency physicians or subspecialists essential to service-line requirements, the fee may be the lesser cost compared to:
- Loss of program accreditation
- Locum tenens expenses
- Disruption to patient services
- Begin NIE packets early
Even before filing the petition, employers should gather:
- Labor market shortage evidence
- Recruitment history
- HRSA/HPSA/MUA data
- Patient-impact analyses
- Letters from department heads and service lines
- Consider alternative visa strategies
Depending on the physician’s specialty and skill set, employers may explore:
- O-1 (extraordinary ability)
- J-1 waiver pathways (Conrad 30, HHS)
- TN (for a narrow set of qualifying roles)
Immigration strategy should now be part of long-range workforce planning, not a last-minute scramble.
H-1B Takeaways for Employers
According to the one-page summary provided by DHS:
- All new Canadian H-1B physician petitions trigger the fee, unless DHS grants an exception.
- Hospitals should expect longer adjudication timelines.
Berardi Immigration Law is already seeing the real-world effects of this policy. H-1B petitions that were once routine now demand strategic planning, detailed evidentiary packages, and significantly longer timelines.
As Rosanna Berardi notes, “This is not a ‘wait and see’ moment for employers. If you plan to hire a Canadian physician in 2025 or 2026, get immigration counsel involved early and prepare for a more expensive, more complex process.”
Stay Ahead of Workforce Immigration Changes
The September 2025 Presidential Proclamation marks a sweeping change for Canadian physicians entering the U.S. in H-1B status. The new $100,000 fee, and the uncertainty surrounding National Interest Exceptions, requires employers to rethink staffing models, recruitment timelines, and budget planning.
Hospitals, private medical groups, and cross-border systems must now take a proactive, strategic approach to physician immigration. Early preparation will be essential to maintaining continuity of care and avoiding staffing disruptions.
Berardi Immigration Law will continue monitoring DHS updates and advising healthcare employers as criteria and adjudication trends emerge.
If your hospital or practice employs Canadian physicians, now is the time to strategize. Our team stands ready to help you navigate this evolving landscape with clarity and confidence. Click here to book your consultation today.
H-1B Status FAQs
Does the $100,000 fee apply to all Canadian physicians seeking H-1B status?
Yes. Any petition filed on or after September 21, 2025 requesting POE processing, consular notification, or PFI requires payment unless DHS grants an exception.
Can a physician avoid the fee by remaining in Canada to complete the two-year §212(e) requirement?
No. The fee is triggered by the H-1B classification, not where the physician resides.
Are National Interest Exceptions realistic?
They may be possible, but there is no standardized criteria and highly unpredictable timelines.
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