(UroToday.com) On the final day of the 2026 American Urological Association (AUA) Annual Meeting, Dr. Hachem Ziadeh from University Hospitals Cleveland Medical Center presented a simulation-based workforce analysis evaluating the projected impact of increased H-1B visa costs on the future U.S. urology workforce. The study examined how reductions in international medical graduate (IMG) recruitment may further exacerbate the already growing national shortage of practicing urologists.
The study was motivated by a recent U.S. Department of Homeland Security proposal to increase H-1B visa application fees to $100,000, a policy change that has generated substantial concern among the American Medical Association and multiple physician specialty societies. Dr. Ziadeh opened the presentation by acknowledging a related workforce analysis presented earlier in the session and emphasized that urology already faces significant structural workforce strain. In 2019, the United States had approximately 4 urologists per 100,000 population, while nearly 60% of counties lacked a practicing urologist. Against a backdrop of increasing patient demand and an aging physician workforce, Dr. Ziadeh’s team sought to model how even modest barriers to IMG recruitment may influence long-term workforce sustainability.
To address this question, Dr. Ziadeh’s team developed a workforce simulation model using previously published AUA and Journal of the American Medical Association (JAMA) workforce projections. The model incorporated current urologist supply estimates, historical trainee growth trends, projected population growth, and physician attrition rates through 2035. Beginning with a projected workforce of approximately 13,400 urologists in 2025, the simulation evaluated the effect of a hypothetical 10% reduction in IMG trainee recruitment beginning in 2025 secondary to increased H-1B visa costs (Table 1). Workforce adequacy was assessed relative to a target benchmark of 4 urologists per 100,000 population. During the presentation, Dr. Ziadeh emphasized that the simulation was designed using reasonable workforce assumptions and trend projections rather than precise deterministic forecasting models.
Table 1. Workforce simulation parameters and baseline model assumptions used for projection analysis.
Importantly, Dr. Ziadeh emphasized that the urology workforce was already projected to decline substantially even without additional immigration-related barriers. Under baseline continued-growth conditions, the national urologist-to-population ratio was projected to decline from approximately 4.0 to 3.3 urologists per 100,000 population by 2035, corresponding to an estimated supply of roughly 11,700 practicing urologists and a shortage of approximately 2,500 physicians. When incorporating the modeled visa-related reduction in IMG recruitment, projected supply further declined to approximately 11,400 urologists, increasing the shortage to nearly 2,800 physicians (Table 2). Of note, the modeled visa-related restriction alone accounted for approximately 300 additional missing urologists by 2035 beyond the baseline projected shortage.
Table 2. Simulation-based projection of baseline and visa-restricted urology workforce supply and shortage estimates from 2025–2035.
Dr. Ziadeh noted that workforce contraction appears to be driven largely by physician attrition and retirement outpacing trainee growth, reflecting the broader structural challenge of an aging specialty. Simultaneously, continued U.S. population growth was projected to steadily increase demand for urologic care, further amplifying the mismatch between workforce supply and healthcare needs. The simulation additionally demonstrated that workforce deficits begin immediately following the modeled reduction in IMG recruitment after 2025 and continue compounding annually through 2035.
Although the modeled increase of approximately 300 additional missing urologists may appear numerically modest, the presenters emphasized that workforce shortages in highly specialized fields often produce disproportionate downstream effects on patient access, referral wait times, and geographic care disparities. Dr. Ziadeh further cautioned that these projections likely underestimate real-world disparities, as workforce shortages are expected to disproportionately affect rural and medically underserved regions where baseline access is already limited.
Audience discussion expanded beyond the simulation itself and focused on the increasingly interconnected relationship between immigration policy and healthcare workforce sustainability. Several attendees noted that physician immigration policy increasingly functions as healthcare workforce policy, particularly in specialties such as urology, where training pipelines remain lengthy, and workforce replacement occurs slowly. Additional discussion focused on emerging state-level efforts to address physician shortages, including provisional licensing pathways for internationally trained physicians in states such as Texas, while simultaneous federal immigration restrictions may continue limiting physician recruitment. Several audience members additionally suggested that the projected shortages may underestimate the true future workforce deficit, given ongoing retirement trends and rising clinical demand.
Dr. Ziadeh and colleagues concluded that even modest barriers to IMG recruitment, including increased H-1B visa costs, may substantially amplify the already critical national shortage of urologists. His team proposed several potential mitigation strategies, including physician-specific visa exemptions, expansion of residency training positions, retention incentives, and greater integration of advanced practice providers to help preserve access to urologic care in underserved regions. As workforce shortages, population growth, and physician attrition continue to accelerate, the findings presented by Dr. Ziadeh highlight the growing need for coordinated workforce planning strategies that integrate physician training capacity, immigration policy, and long-term healthcare access considerations.
Presented by: Hachem Ziadeh, MD, University Hospitals Cleveland Medical Center, during the 2026 American Urological Association (AUA) Annual Meeting, May 15-18, 2026, Washington DC
Co-Authors: Thriaksh Rajan, George Gheordunescu, and Ramy Abou Ghayda
Moderated by: Keow Goh (Michigan Medicine), Charles Modlin (MetroHealth), Joseph Sonstein (University of Texas Medical Branch)
Written by: Seyed Amiryaghoub M. Lavasani, B.A., University of California, Irvine, @amirlavasani_ on Twitter during the 2026 American Urological Association (AUA) Annual Meeting, May 15-18, 2026, Washington DC