New research finds that admitting more foreign-born physicians helps Americans live longer and does not crowd out U.S. doctors. The study is relevant to the debate over H-1B visas and concludes that blocking the admission of high-skilled professionals lacks sound economic reasoning. The results are similar to other research that finds foreign-born scientists and engineers aid the economy and do not harm the prospects of U.S. professionals.
H-1B Lottery Results
Because lawmakers believed high-skilled foreign nationals could harm the employment of U.S.-born workers, Congress limited the annual admission of new H-1B visa holders for companies to 85,000. That includes a 65,000 annual cap and a 20,000 exemption to the yearly limit for individuals with an advanced degree from a U.S. university.
U.S. Citizenship and Immigration Services changed the H-1B registration selection process for FY 2025 to eliminate possible gaming by some employers. The new system is beneficiary-centric, meaning USCIS selects unique beneficiaries to eliminate the issue of employers filing multiple registrations for the same individuals (except for those with legitimate job offers). That change seems to have succeeded and will likely make additional selection rounds unnecessary. (USCIS added selection rounds for FY 2024 to approve a sufficient number of qualified beneficiaries.)
“The new system will change the process but is unlikely to solve a fundamental shortcoming in U.S. immigration law—the H-1B annual limit is too low for America’s size and an economy that relies on technical talent to grow and innovate,” according to a March 4, 2024, Forbes article. That proved to be the case.
According to an agency statement, USCIS selected only approximately 25% of eligible beneficiaries in FY 2025. It was about the same proportion as in FY 2024 after accounting for the additional rounds due to multiple registrations. USCIS stated it selected 120,603 registrations out of 470,342 eligible registrations in FY 2025. (USCIS selects more than 85,000 H-1B registrations to accommodate denials and withdrawals.) USCIS selected 114,017 beneficiaries out of approximately 442,000 unique beneficiaries for FY 2025, meaning the agency did not select nearly 328,000 high-skilled foreign nationals in the FY 2025 H-1B registration process due to the low annual limit.
Research On Increasing The Number Of Foreign-Born Physicians
The inadequate annual limit for H-1B visas affects high-tech employers, hospitals, and rural health clinics. Many states need help attracting physicians to practice in rural areas, and limited access to medical care affects residents’ health outcomes.
In 1994, Congress passed the Conrad Visa Waiver Program to allow states to waive the requirement for a foreign physician in J-1 status to return home in two years if they worked in a medically underserved area for at least three years. The federal government must designate the location as a Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), or Medically Underserved Population.
The 1994 law limited the number of waivers for foreign physicians on J-1 visas to 20 per state. In 2002, Congress expanded the program to 30 for each state. That expansion made it easier for economists to research the program’s impact on patients and other physicians.
“Our analysis uses available data on physicians, utilization of J-1 visa waivers and associated state policies to assess the impact of the Conrad 30 program on the supply of physicians,” according to a study by Breno Braga (Urban Institute) Gaurav Khanna (University of California, San Diego) and Sarah Turner (University of Virginia).
“We find that relaxing the baseline cap on J-1 visa waivers generated a sustained increase in IMG [international medical graduates] physicians, without reducing the supply of U.S.-trained physicians, with these effects particularly large in states with the fewest restrictions on the nature of employment for waiver recipients.
“In precise terms, we find that states that took advantage of the cap expansion of the program have 0.04 more IMGs per thousand habitants than states that did not take advantage of the cap expansion in 2001. Using simple calculations based on Basu et al. (2019), we estimate that this increase in supply of doctors was associated with a 20.6-day increase in life expectancy in states taking advantage of the cap increase in 2001.”
No Evidence Of A Negative Impact On U.S.-Born Physicians
Braga, Khanna and Turner examined the impact of the Conrad 30 program expanding the number of foreign physicians per state on U.S.-born doctors and found no negative effect. “Our results are also consistent with evidence that an increasing supply of high-skilled immigrants might have null to positive effects on labor market outcomes of natives when their labor supply is constrained (Kerr and Lincoln 2010 and Peri, Shih, and Sparber 2015).”
As the economists noted, the findings on the Conrad 30 program’s expansion align with other research results. A May 2020 NFAP study by University of North Florida economics professor Madeline Zavodny found, “[T]he evidence points to the presence of H-1B visa holders being associated with lower unemployment rates and faster earnings growth among college graduates, including recent college graduates.”
Economists Giovanni Peri, Kevin Shih and Chad Sparber examined the impact of H-1B visa holders on U.S. professionals. They concluded, “A rise in foreign STEM growth by 1 percentage point of total employment increases wage growth of college-educated natives by 7–8 percentage points. The same change had a smaller but usually significant effect on non-college-educated native wage growth equal to 3–4 percentage points.”
William R. Kerr (Harvard Business School) and William F. Lincoln (University of Michigan) analyzed Current Population Survey employment records from 1995 to 2008. They found a rise in H-1B visas increased innovation (patents) and had no negative impact on U.S. professionals. “A 10% growth in the national H-1B population corresponded with a 2%-4% higher growth in immigrant SE employment for each standard deviation increase in state dependency,” according to Kerr and Lincoln. “We do not find any substantive effect on native [U.S.-born] scientists and engineers across a range of labor market outcomes like employment levels, mean wages, and unemployment rates.”
The research on the Conrad 30 program and other recent studies indicate that allowing more foreign-born physicians, scientists and engineers to work in the United States would help the U.S. economy and not harm the employment of U.S.-born professionals.
