The American Epilepsy Society (AES) is closely monitoring two significant immigration policy changes that may impact the recruitment and retention of international medical graduates in epilepsy care. Because international physicians, trainees, and researchers play a critical role in providing epilepsy care and driving scientific progress, AES is committed to ensuring our members are aware of these developments and understand their potential implications on the epilepsy community.
On September 19, 2025, a Presidential Proclamation was issued, implementing a $100,000 fee for new H-1B visa applications to be paid by the employer. Additionally, the Department of Homeland Security has proposed a rule to eliminate "duration of status" for J-1 and F-1 visa holders, replacing the current flexible admission system with fixed periods capped at four years. For neurology and epilepsy, where residency and fellowship programs commonly span five to seven years, this change would require mid-training visa extension applications, introducing repeated U.S. Citizenship and Immigration Services adjudications that could disrupt training and patient care. These policy changes are transpiring when the United States faces a projected shortage of up to 86,000 physicians by 2036; international medical graduates currently comprise approximately one in four practicing physicians nationwide, with 64% practicing in medically underserved areas or health professional shortage areas. Any added barrier threatens continuity of epilepsy care, access to specialists and the stability of training programs.
AES strongly supports the American Medical Association’s (AMA) advocacy efforts on behalf of international medical graduates and the institutions that employ them. The AMA, joined by 53 other leading medical societies, has formally urged the Department of Homeland Security to exempt physicians, including medical residents, fellows, researchers, and those in non-clinical settings, from the $100,000 H-1B visa fee, recognizing that these physicians are essential to maintaining a strong healthcare workforce and serving the national interest. In response to the proposed “duration of status” visa changes, the AMA and a broad coalition of medical organizations have submitted a letter to the Department of Homeland Security expressing concerns that mandatory mid-training extensions of stay would create unnecessary uncertainty and administrative burdens for physicians on J-1 visas, risk interrupting physician training and patient care if extensions are delayed or denied, weaken the international medical graduate pipeline at a time of worsening physician shortages, and particularly impact teaching hospitals and essential providers that rely on these physicians to maintain coverage and serve communities with limited access to health care services.
The proposed change to “duration of status” would also significantly impact international PhD students who are on F-1 visas and are engaged in advanced biomedical research. Doctoral training commonly extends beyond five years, meaning these researchers would face the same mid-program visa renewal applications and associated risks of delay or denial. This is particularly concerning for fields like neuroscience and epilepsy, where PhD trainees play a critical role in driving laboratory discovery, developing new treatments, and advancing our fundamental understanding of disease. Interruptions to their training not only affect their individual careers but also slow progress toward scientific innovations that improve patient outcomes.
AES supports the AMA and our medical and scientific community partners in advocating for policies that strengthen – rather than hinder – the physician and scientist workforce. We will continue to track these proposals and support advocacy that protects the clinicians, trainees, and researchers essential to advancing epilepsy care and research.