Steep visa cost poses new barrier to foreign doctors in CNMI

A $100,000 H-1B visa fee is emerging as a major barrier to recruiting badly needed healthcare professionals in the CNMI, undermining recent efforts to streamline the licensing and vetting of foreign physicians, according to Health Care Professions Licensing Board chair Ted Parker.

“These islands are very vulnerable when it comes to healthcare. The $100,000 fee, I don't know all of the inside information as to why that was put into place, but it does curtail certain, I mean, it's for all professions,” he said.

Parker explained that while recent CNMI regulations—effective since late 2025—have simplified the process for foreign physicians to apply and practice, the steep visa cost has made recruitment “next to impossible.”

Hospitals and clinics must first identify a physician, extend a job offer, and then the physician can apply for licensure. The $100,000 H-1B fee adds a prohibitive financial burden, discouraging many qualified candidates from coming, even if they are invited by local healthcare facilities.

He expressed hope that the CNMI could receive an exception from $100,000 H-1B visa fee.

“Just because of our geophysical location in relation to the rest of the world and in relation to the U.S. It's difficult to get U.S.-trained physicians here,” said Parker.

Currently, only one foreign ophthalmologist is practicing under the new system, at Marianas Eye Institute, though several others have been invited.

Parker noted that in the past, CNMI hospitals were able to recruit physicians from countries like Bangladesh, Nepal, and Canada. He said the fee now effectively blocks most foreign recruitment, a serious concern for a territory that already struggles to attract U.S.-trained doctors due to its geographic isolation.

While it’s easier now to have foreign physicians work in the CNMI due to the new regulations, he said the $100,000 H-1B fee presents a big obstacle.

“The ability for foreign physicians to apply here more easily now under the new regulations just that just in effect, I believe, back in either September or October. Previously, foreign physicians could apply to practice here, but the process was very arduous. There were a lot more conditions. There were a lot more rules that they had to follow before they could start practicing here. They had to have a supervising physician. They had to work only under certain strict circumstances. And they weren't allowed the freedom that the new regulations allow now,” said Parker.

The issue was a key topic during last week’s visit by officials from the Federation of State Medical Boards, who reviewed the CNMI’s licensing processes and offered guidance on vetting foreign-trained doctors.

FSMB representatives praised the board’s procedures and discussed international credentialing support through organizations such as the International Association of Medical Regulatory Authorities, which helps member countries and jurisdictions share physician competency information.

Separately, Parker said the board is working on proposed regulations that would allow experienced physician assistants to practice independently under a two-tiered system, while newer PAs would still require physician supervision. The regulatory process, including public comment periods, is expected to take three to six months before any changes are implemented.

Effective Sept. 21, 2025, a $100,000 supplemental fee was implemented for certain new H-1B visa petitions. The fee, introduced via a presidential proclamation, is designed to deter the use of foreign labor for entry-level roles and encourage the hiring of American workers