Changes to the federal H-1B visa program could make it more difficult and costly for clinical laboratories and pathology groups to recruit internationally trained professionals, potentially worsening longstanding workforce shortages.
In September 2025, President Donald Trump issued a presidential proclamation imposing a $100,000 fee on new H-1B visa petitions. Although a federal court subsequently blocked the fee, the administration appealed, and the policy remains in effect while the case proceeds, according to an article by Jordan Rosenfeld for the American Society for Clinical Pathology (ASCP).
ASCP, the ASCP Board of Certification, and members of the Medical and Public Health Laboratory Workforce Coalition have urged the federal government to exempt healthcare professionals from the fee.
The dispute highlights how clinical laboratories often rely on international professionals to fill positions that can otherwise remain vacant for months.
Visas are just one aspect of staffing difficulties that laboratories must juggle. The Dark Report noted in its latest issue how an Alaska lab reduced its reliance on traveling medical lab scientists to help control staffing costs.
Rural laboratories face heightened risks
At Morrill County Community Hospital in Bridgeport, Neb., approximately 40% of the laboratory workforce is employed through the H-1B program, according to Laboratory Services Director Rex F. Famitangco, MS, MASCP, MLS(ASCP)CM, who is quoted in the article.
Replacing five international employees under the proposed fee structure could cost the critical access hospital $500,000. Losing those workers could also force the laboratory to reduce services, extend turnaround times, or struggle to maintain 24-hour operations in blood banking, microbiology, and chemistry.
Famitangco entered the United States through the H-1B program 23 years ago and later became a laboratory director. He also established phlebotomy and medical laboratory technician programs at Western Nebraska Community College to develop a local workforce.
“For us to have a sustainable workforce, my thinking was let’s build it in our own backyard,” he told ASCP.
Rural laboratories are particularly vulnerable because they typically have smaller staffs, broader responsibilities for individual employees, and fewer qualified applicants. Vacancies can take more than a year to fill, increasing workloads for remaining employees and potentially forcing laboratories to turn away testing business.
ASCP Senior Director Matthew Schulze warned that the country is neither investing sufficiently in its domestic laboratory workforce nor encouraging international professionals to fill critical positions.
The policy debate carries operational implications for clinical laboratory leaders beyond the immediate cost of visa sponsorship. Restricting access to internationally trained personnel could affect testing capacity, turnaround times, employee retention, and patient access especially at rural and underserved hospitals already struggling to recruit laboratory professionals.
