H-1B visa

USCIS describes the H-1B as a classification for workers in a specialty occupation: a job that requires the theoretical and practical application of highly specialised knowledge and a bachelor's degree or higher in a specific field. The employer files a petition on Form I-129 after the Department of Labor certifies a Labor Condition Application, in which the employer attests that it will pay at least the prevailing wage, provide working conditions that will not adversely affect similarly employed workers, and give notice of the filing.

USCIS says the worker can qualify through a US bachelor's or higher degree in the specialty, a foreign equivalent degree, an unrestricted state licence to practise the occupation, or equivalent education and progressively responsible experience.

USCIS says H-1B status is granted for up to 3 years at a time, extendable to a usual maximum of 6 years, with longer extensions possible for some people with pending green card cases.

In healthcare, the H-1B is used mainly by physicians, for residency, fellowship and attending posts, as an alternative to the J-1 visa. US regulations require a foreign medical graduate coming to provide patient care on an H-1B to have passed the licensing examinations, which in practice means USMLE Steps 1, 2 and 3, and to show English competency, usually through ECFMG certification. A state licence may also be required for the job.

Most registered nurse posts do not usually require a bachelor's degree, so nurses more often use the EB-3 green card route. Physicians who finish J-1 training and receive a Conrad 30 waiver work on an H-1B during their waiver service.

USCIS says there are 65,000 new H-1B visas each fiscal year, plus 20,000 for people with a US master's degree or higher. Employers enter cap-subject candidates in an annual registration; for the 2027 fiscal year DHS introduced a weighted selection that gives more entries to higher wage levels. Jobs at institutions of higher education and their affiliated nonprofits, nonprofit research organisations and government research organisations are cap-exempt, which is why many university hospitals can sponsor at any time of year.

A presidential proclamation of 19 September 2025 made a $100,000 payment a condition of eligibility for certain new H-1B petitions filed from 21 September 2025, mainly for workers outside the US. USCIS says it does not apply to amendments, changes of status or extensions for people inside the US that are granted. In June 2026 a federal court vacated the agency's implementing guidance, and in September 2026 a further proclamation extended the restriction. Because this is changing, check the current USCIS H-1B page before relying on any figure. Standard filing fees are set by the USCIS fee schedule and paid by the employer.

• USMLE Step 3 not passed before an H-1B residency start date.
• Cap timing for employers that are not cap-exempt.
• Switching from J-1 without a waiver of the two-year home residence requirement.

See our USMLE guide and USA page.