How H-1B Policy Affects the Laboratory Workforce—and Patient Care

In September 2025, President Donald Trump issued a presidential proclamation increasing the fee for new H-1B visas—for skilled foreign professionals to have temporary employment—to $100,000, an unprecedented increase. This increase made sponsoring international pathologists and laboratory professionals prohibitively expensive for many healthcare employers.  

Although a federal court recently blocked the proposed fee, the Trump Administration has appealed the ruling and consequently the court has stayed its decision pending the appeal. For many pathology and laboratory leaders, the new policy exposed just how fragile an already strained workforce has become, and it may also have discouraged more international professionals from pursuing employment opportunities in the U.S.  

The American Society for Clinical Pathology (ASCP), the ASCP Board of Certification (BOC), and members of the Medical and Public Health Laboratory Workforce Coalition (MPHLWC) joined a bipartisan congressional effort urging that healthcare professionals be exempted from the proposed fee. 

The fee debacle has laid bare that immigration policy has a direct impact on whether patients receive timely laboratory testing and the effective operation of healthcare systems.  

Why rural laboratories are especially vulnerable  

When the fee was first announced, it alarmed Rex F. Famitangco, MS, MASCP, MLS(ASCP)CM, QLCCM, LPH-C, IFBA PC, RBP(ABSA), Director of Laboratory Services at Morrill County Community Hospital, in Bridgeport, Nebraska, where approximately 40 percent of his workforce is employed under H-1B. Rural laboratories are particularly vulnerable because vacancies can be higher in rural and underserved areas, and remain open for months. Thus, internationally trained professionals, vital to maintaining laboratory services and filling critical workforce needs, can often find jobs in these locations. 

“These professional workers are not simply temporary workers,” Mr. Famitangco says, “they are trusted colleagues, community members, and essential members of our healthcare team. Without them, maintaining services such as blood banking, microbiology, chemistry, and twenty-four-seven laboratory operations would be extremely difficult.”  

Not only would replacing even five of Mr. Famitangco’s employees have cost his hospital a prohibitive half a million dollars, but it would also have had a negative impact on patient care. “It would delay testing. It could possibly reduce our services, [create] longer turnaround times and workforce instability," he says.  

One visa, one career, decades of service 

For Mr. Famitangco, the issue is deeply personal. He came to the United States 23 years ago on an H-1B visa. "I was a temporary solution, but I became a permanent solution." He stresses how important H-1B workers are to the laboratory. 

He feels his story “reflects on the original purpose of Congress envisioning what an H-1B program should look like” which is “a highly trained professional filling a critical workforce need, serving rural underserved communities, and ultimately becoming a long-term solution here in the United States, which I call my home."  

While under H-1B sponsorship, Mr. Famitangco earned an ASCP certification, his credentials, and advanced through leadership. “Now, today, I still continue to serve as the director of laboratory services in a critical access hospital in rural Nebraska,” he says. 

Why rural laboratories face unique workforce challenges 

Laboratory workforce shortages hit rural healthcare systems especially hard. "A lot of the folks that come here on immigrant work visas tend to work in rural and underserved areas [which] tend to have the most acute shortages,” explains Matthew Schulze, ASCP’s Senior Director for the Center for Public Policy. 

Unlike larger health systems, rural laboratories often operate with smaller staff, broader individual responsibilities, and far fewer recruitment options.  

Reduction in staff or delays in testing or diagnosis could significantly impact people’s care. Mr. Famitangco explains that the patients who come to their emergency rooms “are often experiencing the worst-case scenario."  

ASCP's advocacy extended beyond one court case 

The ASCP and the ASCP BOC did not wait to see what would happen regarding the proposed fee, Mr. Schulze says. "When Trump proposed the H-1B visa fee, we pretty quickly managed to get a letter over to the U.S. Department of Homeland Security... seeking an exemption for the laboratory and pathology workforce."  

ASCP also rallied the Medical and Public Health Laboratory Workforce Coalition "to engage the whole laboratory community on this issue," Mr. Schulze explains.  

Meanwhile, DHS finalized another rule that abandons the current H-1B visa lottery program for a less egalitarian income tiering approach. “[This] basically means that the more money you make, the more likely you are to get a visa,” Mr. Schulze explains.  

Though challenges persist, Mr. Famitangco appreciates the way that ASCP “continues to be a strong advocate to the workforce... the patient is our center. That's why we're here." 

The H-1B proposal highlighted a bigger workforce problem 

Because of the pending appeal, the fee policy remains in effect, with fees still being collected until the appeals process is exhausted, Mr. Schulze says. However, regardless of the fee’s fate, significant workforce challenges remain. 

Mr. Schulze points out, "We've got this issue where we don't spend money to train the domestic workforce, and we aren't really encouraging international talent. So, the result is worsening personnel shortages." 

Making it harder for international talent to come work here will not help, he says, and losing existing professionals will only make things worse, because “the amount of time that it takes to replace a position can take more than a year for most departments." And vacant positions in a healthcare system “mean the workload on the remaining staff can get more intense." 

Given the workforce shortages in the laboratory, Mr. Schulze says, “We need to address that before it gets worse, and immigration is one of those ways that we can deal with it.” 

Not only can bringing in foreign talent keep laboratories and healthcare systems running better, “it can help mitigate other challenges,” he says. “A vacant position could mean the lab has to turn away business. We're doing what we can to make sure that this is a tool that employers can use at their choice. It's not being forced on them,” he says.  

Building the workforce for the long term 

Mr. Famitangco didn’t wait to let the workforce shortage in his rural Nebraska area become an even greater problem. He established a phlebotomy program in 2009 and a medical laboratory technician associate’s degree program in 2017 at Western Nebraska Community College. He sees those efforts as both giving back to the community and providing opportunities.  

"For us to have a sustainable workforce, my thinking was let’s build it in our own backyard,” he explains.  

He’s seen that effort continue to bear fruit. “Some of the graduates are now my employees too,” he says. 

His hope is that “people see more than a visa category because every H-1B professional is a person who left their country to contribute, who chose to serve.” He considers himself just one example “of a single investment in a healthcare professional that can positively impact thousands of patients, students, colleagues and communities over time.”