The New Weighted Selection Process: What’s Changing
On December 23, 2025, the Department of Homeland Security (DHS) announced the final rule for the Weighted Selection Process for Cap-Subject H-1B Petitions. DHS stated that the goal of the new Selection Process is to prevent abuse of the lottery system and protect American workers by prioritizing higher-paid earners. The new Weighted Selection Process will go into effect February 27, 2026, and will apply to the FY27 H-1B Cap Registration season. While there is a lot of apprehension surrounding the new Weighted Selection Process, physicians looking to work for U.S. employers should still consider the H-1B Selection Process as a viable immigration pathway for temporary work authorization in the United States.
How Wage-Based Selection Impacts Physicians
Unlike the current Selection Process, which does not give priority to certain occupations or industries, the new Weighted Selection Process will dramatically increase the chances of being selected for higher wage earners. The final rule states that “the chances of selection for a beneficiary weighted at a level IV wage will increase to over 61 percent and a beneficiary weighted at a level III wage will increase to over 45 percent.” 90 FR 60864.
Right now, DHS reports that “[u]nder the current system, the chance that any particular beneficiary is selected in the lottery is just under 30 percent, regardless of how highly skilled that beneficiary may be.” 90 FR 60864. This means that the chances of being selected will more than double for the highest wage earners.
This restructuring has the potential to uniquely benefit physicians. The new Weighted Selection Process is based on the wage level assigned to the sponsored position. For most physicians, they fall into a wage scale that includes trainee physicians such as residents and fellows. Consequently, many non-trainee physicians are paid at a level III or level IV wage, which means under the new Weighted Selection Process, physicians are much more likely to be selected.
Alternative Pathways to the Weighted Selection Process
While this new Selection Process stands to benefit many physicians, some physicians will unfortunately see their chances of selection shrink considerably. This is especially true for trainee physicians such as residents and fellows, who tend to only make level I wages.
Nevertheless, there are still several viable immigration pathways available to physicians who are unlikely to be selected in the new Weighted Selection Process, or who want to avoid the lottery entirely.
First, many U.S. residency and fellowship programs employ their trainee physicians through a J-1 visa sponsored by the Educational Commission for Foreign Medical Graduates (ECFMG). This means that the vast majority of trainee physicians do not have to file an H-1B petition at all during their training period.
There are some U.S. residency and fellowship programs that do employ their trainee physicians on H-1B visas. However, these individuals are still likely not subject to the new Weighted Selection Process because most teaching hospitals are exempt from the H-1B Cap.
In fact, obtaining an exemption from the H-1B Cap is a strong immigration option for most physicians, even those who may benefit from the new Weighted Selection Process. Most physicians can obtain exemption from the H-1B Cap through two pathways. First, for foreign medical graduates who completed their residency or fellowship training in the United States and are subject to the two-year return home requirement, obtaining a J-1 Waiver through an interested Federal agency or an interested State agency renders the physician exempt from the H-1B Cap. Moreover, as mentioned above, many hospitals themselves are exempt from the H-1B Cap if they are a nonprofit organization and have ongoing relationships with institutions of higher education.
Final Takeaways for Physicians and Employers
Physicians looking to work in the United States should not be afraid of the new Weighted Selection Process. Many physicians will benefit from the Weighted Selection Process, and for others, there are still many viable immigration pathways available to foreign medical graduates looking to work for U.S. employers.
We strongly encourage physicians or hospitals looking to employ foreign medical graduates to contact our Immigration Law team for assistance with obtaining an H-1B visa. Given the recent changes to the H-1B process, including the new $100K fee for consular H-1B petitions, it is important to obtain legal advice from a qualified immigration attorney who can analyze your specific situation. For assistance, please contact Olivia Shaw at [email protected] or Michael Muray at [email protected].