Hospital and physician groups warn the new extension process could interrupt medical training and patient care at teaching hospitals.
By Eve Bender , Healthcare Reporter | July 22, 2026 | 9:24 AM
The Department of Homeland Security has finalized a rule eliminating the “duration of status” policy for foreign students, exchange visitors and foreign media representatives, including physicians training in the United States on J-1 visas.
The current policy generally allows J-1 physicians to remain in the country for the duration of their residency or fellowship as long as they maintain their immigration status and continue participating in an authorized program.
Under the final rule, J-1 physicians will instead be admitted for the length of their training program, up to a maximum of four years. Those who need additional time will have to apply to U.S. Citizenship and Immigration Services for an extension of stay.
The rule is scheduled to take effect Sept. 15, although it is classified as a major rule subject to congressional review. DHS said it would publish another notice if that process changes the effective date or terminates the rule.
WHY THIS MATTERS
Nearly 17,000 J-1 physicians participate in residency and fellowship programs at more than 770 teaching hospitals, according to the American Hospital Association.
Many medical residencies and fellowships take longer than four years. Internal medicine followed by subspecialty training in cardiology or geriatrics, for example, generally exceeds four years, while surgical residencies typically last at least five years.
Physicians who file timely extension applications will be permitted to continue their training and employment for up to 240 days while the application is pending.
DHS also revised its initial proposal so physicians and other visa holders working under annual contracts can receive an admission period based on the anticipated length of their full program, rather than having to apply for extensions every year.
However, DHS declined requests to exempt J-1 physicians. The agency said the new process would give immigration officers more opportunities to verify that visa holders remain eligible and have complied with immigration laws.
The Association of American Medical Colleges (AAMC) warned that the rule could exacerbate workforce shortages and impede biomedical research.
“Creating impediments to the seamless training of our future physician and biomedical research workforce will have direct impacts on patients’ access to quality care,” the AAMC said in an announcement.
About 16,000 residents and fellows — approximately one in 10 nationwide — use J visas to train at U.S. academic health systems each year, according to the association.
When the rule was proposed, the AHA urged DHS to retain the existing policy for J-1 physicians. The group said the change “could lead to significant disruptions to physician training programs, affect access to patient care” and raise hospitals’ administrative costs.
The American Medical Association similarly urged DHS to exclude J-1 physicians and their dependents, warning the change could disrupt specialty and subspecialty training and negatively affect patient care.
DHS estimated the final rule would generate annualized costs of between $443.1 million and $448.6 million over 10 years, including between $119.9 million and $125.1 million annually for U.S. parties.
THE LARGER TREND
Healthcare organizations have increasingly relied on international physicians as the industry confronts persistent staffing shortages.
The AMA previously urged the federal government to accelerate visa processing for physicians entering U.S. residency programs or planning to practice in underserved communities.
Physician recruitment has remained difficult, particularly in rural and underserved areas.
Entering 2025, health systems needed an average of about 125 days to fill a primary care physician opening and as many as 135 days for a specialist, with licensing and credentialing potentially adding another four to six months to the wait.