Abstract A121: H-1B Visas and the U.S. Stroke Workforce: Trends in International Medical Graduates Across Training and Practice

Background: International medical graduates (IMGs) are an integral part of neurology and stroke care in the United States, yet the specific footprint of H-1B eligible physicians in stroke training and practice remains under described. Understanding trends in fellowship composition and H-1B sponsorship can inform workforce planning and regional access to stroke care. This issue has become even more important with current visa policy proposals to impose an annual $100,000 fee for H-1B petitions. We aimed to quantify IMG representation in vascular neurology fellowships, describe temporal trends in physician H-1B petitions, and examine regional distribution of neurologists requiring H-1B sponsorship. Methods: Cross-sectional and longitudinal analyses were performed using (1) NRMP vascular neurology fellowship match results (2021-2025), (2) USCIS H-1B petition data for physicians and medical occupations, and (3) historical certified Labor Condition Applications for neurologists. Time trends from 2020–2025 were assessed, and regional distribution was examined across Northeast, Midwest, South, and West regions. Results: In the 2025 match cycle, 110 programs offered 236 positions; 195 positions were filled across 79 programs (figure 1). Fellows included MD graduates 49% (n=96), DO 12% (n=24), U.S.-IMGs 13% (n=25), and non-U.S. IMGs 26% (n=50), indicating ~39% IMG representation overall. Nationally, H-1B petitions for physicians increased over time, with a brief dip in 2022; neurologists followed a similar upward trend (figure 2). Most neurologist H-1B petitions were concentrated in the South and Midwest “stroke belt”, reflecting alignment with regions of high stroke burden and underserved areas (figure 3). Conclusions: IMGs constitute a substantial portion of vascular neurology fellows (~39%), highlighting their integral role in training pipelines. Increasing H-1B petitions for physicians and neurologists underscore the reliance on international talent in sustaining the workforce. The higher proportion of H-1B sponsored neurologists in stroke belt regions suggests an appropriate distribution of IMGs to areas of critical need, supporting both accesses to care and workforce resilience. Recruitment strategies and national policies should explicitly consider the role of vascular neurologists to ensure adequate staffing in high need regions.