A federal judge in Massachusetts on Monday, Sept. 14, postponed a Department of Homeland Security rule just hours before it was set to take effect, preserving the system that lets international students and exchange visitors, including physicians in training, stay in the U.S. for the length of their programs. The rule would have replaced that system, known as duration of status, with fixed admission periods of no more than four years for F, J, and I visa holders, requiring many to apply to the government for more time, Fierce Healthcare reported. Health care and medical education groups had warned that nearly one in 10 physicians in U.S. residency and fellowship programs train on a J visa.
The stakes extend to patients. A Health Affairs study cited by Fierce found that reliance on J-1 trainees was highest in North Dakota, where they made up 29% of physicians in training, followed by Connecticut and West Virginia at 17% each. The researchers found heavy reliance in the Upper Midwest, Northern Plains, and Appalachia, regions that already faced severe physician shortages.
For now, the current system remains in place for doctors already in training and the hospitals where they work. The ruling is temporary, however, and the legal fight is not over.
Ruling Keeps the Current System in Place for Now
U.S. District Judge F. Dennis Saylor IV postponed the rule's effective date while the case moves forward. According to the Presidents' Alliance on Higher Education and Immigration, which brought the lawsuit with NAFSA: Association of International Educators and other education and labor groups, the order provides nationwide relief and bars DHS and Immigration and Customs Enforcement from taking further steps to carry out the rule.
In his memorandum, Saylor found that the challengers were likely to succeed on the merits and would face immediate, irreparable harm without relief. He wrote that the rule did not explain how extension requests would be judged or how the government would handle a surge of applications, and that it offered no way to challenge a denial. He also faulted DHS for allowing what he called "an exceptionally short, and barely legal, 32-day period" for public comments. The memorandum cited public comments noting that these trainees often serve in rural and medically underserved areas.
This is a postponement, not a final ruling striking down the policy. Immigration law firm Fragomen said the government is likely to appeal quickly, and the court has scheduled a status conference for Oct. 2. Attorneys general from 19 states and the District of Columbia, including California, New York, Illinois, Massachusetts, and Minnesota, filed a brief supporting the challenge, according to NAFSA.
DHS Says Fixed Terms Close an Oversight Gap
DHS published the final rule on July 17. The agency argued that open-ended stays do not give immigration officers enough set opportunities to confirm that students and exchange visitors are following the terms of their visas, which it said has weakened enforcement and created incentives for fraud and abuse. DHS also cited national security concerns and said it received close to 22,000 public comments on its 2025 proposal.
Under the rule, visa holders who need more time would apply for an extension with U.S. Citizenship and Immigration Services, a process that can include biometrics and background checks. DHS Secretary Markwayne Mullin said in July that the United States was "reclaiming its ability to properly screen, vet, and monitor individuals within our borders," according to Fierce. DHS has described the current system as a loophole that lets some foreign students stay indefinitely by continuing to enroll in courses.
Training Programs and Patient Access in the Balance
Medical groups argue that the rule is a poor fit for physician training. Under the current approach, Intealth, the organization that sponsors J-1 physicians, sponsors them for the length of their program, up to seven years, with annual renewals. Coalition letters warned that federal processing times have historically run as long as 19 months. Many training paths last longer than four years; general surgery residency, for example, takes five years.
Intealth sponsored nearly 17,500 J-1 physicians in residency and fellowship programs in 2025, working at nearly 780 teaching hospitals, a 76% increase over the past decade, Fierce reported. In its comment letter, the American Hospital Association said J-1 physicians reduce wait times, support continuity of care, and strengthen local health systems. The Association of American Medical Colleges has said the rule does not account for graduate, postdoctoral, and residency programs that often take longer than four years to complete.
Many J-1 doctors also go on to serve communities with too few physicians. After training, they must return to their home country for at least two years or obtain a waiver, which requires a signed employment contract to work in a federally designated shortage area. Groups opposing the rule said a substantial number of J-1 physicians eventually practice in those areas.
The evidence has limits. The Health Affairs figures show where J-1 trainees work, but because the rule never took effect, there are no data on how it would change patient wait times or access. Warnings about disruption are projections from medical groups, and DHS said in the final rule that it does not believe the extension requirement places an undue burden on visa holders.
Patients do not need to take any action, and care at teaching hospitals continues as usual. Trainees and their families should check with their program's graduate medical education office or Intealth before making travel or filing decisions, since an appeal or new court orders could change the timeline. Hospitals in shortage regions will be watching the Oct. 2 conference and any appeal closely.
Key Questions Answered
What did the judge do? Judge F. Dennis Saylor IV postponed a DHS rule that was set to take effect on Sept. 15. DHS and ICE cannot implement it while the lawsuit continues.
What would the rule have changed? It would have replaced duration of status with fixed admission periods of no more than four years for F, J, and I visa holders. People needing more time would have had to apply to USCIS for an extension.
Why were hospitals worried? Nearly one in 10 U.S. residents and fellows train on a J visa, and many programs last longer than four years. Medical groups warned of processing delays, added costs, and training interruptions.
Why does DHS want the change? DHS says fixed terms give immigration officers regular chances to screen and vet visa holders. The agency cited fraud and national security concerns.
Which states rely most on J-1 trainees? A Health Affairs study found reliance was highest in North Dakota, followed by Connecticut and West Virginia. Heavy reliance also appeared in the Upper Midwest, Northern Plains, and Appalachia.
Is the case over? No. The court has set a status conference for Oct. 2, and the government is expected to appeal.
Should patients change their care plans? No. Care at teaching hospitals continues as usual while the case proceeds.
