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Hundreds of foreign doctors about to complete training in the U.S. will have to leave the country if the federal government doesn’t rapidly process their visa waiver applications, which have been languishing since the fall and winter, immigration attorneys say.

The waiver program, run by the Department of Health and Human Services, allows physicians who aren’t U.S. citizens to stay in the country while transitioning from the visa they used during their training to temporary worker status. In exchange, the doctors agree to work in underserved areas for at least three years.

“It will be the patients that suffer the most because in about three months, there’s going to be hundreds of places that are not going to have a physician that should have,” said a psychiatrist caught in the delay.

The doctor — whom KFF Health News agreed not to identify because they fear government reprisal — was among hundreds who applied this year for what’s known as a J-1 visa waiver through the HHS Exchange Visitor Program.

If their waiver is granted, the psychiatrist — who attended medical school in their home country in Europe before coming to the U.S. for their residency and fellowship — would work with vulnerable and disadvantaged patients in New York.

In recent years, the HHS program processed waiver applications in one to three weeks, according to two immigration attorneys.

“It will be the patients that suffer the most.”

But it currently has a backlog of hundreds of applications that still need to be reviewed by the State Department and approved by U.S. Citizenship and Immigration Services, according to four attorneys interviewed by KFF Health News.

They said the foreign physicians will likely have to return to their home countries if their applications don’t advance to USCIS by July 30.

For them to reenter the U.S., their employers would have to pay a new $100,000 fee associated with the H-1B work visa. It’s a cost that many hospitals and clinics in rural and underserved areas say they can’t afford. “That’s the cliff that this train is headed for,” said Charles Wintersteen, a Chicago-based attorney who specializes in health workforce-related immigration.

HHS spokesperson Emily Hilliard didn’t answer questions about the number of pending applications or explain what caused the delays. But she said the Exchange Visitor Program has reviewed all clinical J-1 waiver applications for fiscal year 2025, as well as some from fiscal 2026.

The department is “implementing key process improvements to prevent future delays” and “working diligently” to evaluate remaining applications ahead of the July 30 deadline, she said.

The psychiatrist in limbo said employers hiring J-1 waiver physicians have to show they were unable to fill positions with American workers. If the doctors they planned to hire can’t arrive on time — or at all — patients will have to wait even longer for those vacancies to be filled, they said.

Wintersteen said postgraduate medical education positions are largely funded through Medicare and that “the taxpayers who pay for that training will not get the benefit of it.”

Physicians and immigration attorneys said HHS hasn’t explained the delays or let them know what to expect from their applications.

“Why would HHS want to take a program that is working — a program that places hundreds of U.S.-trained international physicians in highly underserved parts of the country every year — and slow-walk it into non-existence,” Jennifer Minear, a Virginia-based health workforce immigration lawyer, said in an email. “How does that serve the public health? It is baffling.”

Waylaid waivers

The U.S. healthcare system depends on foreign-born professionals to fill its ranks of doctors, nurses, technicians, and other health providers, particularly in chronically understaffed facilities in rural and low-income urban communities.

Nearly a quarter of physicians in the U.S. went to medical school outside the U.S. or Canada, according to 2025 licensing data.

Once noncitizens complete postgraduate education in the U.S., which typically ends on June 30, they must return to their home country and wait two years before applying for an H-1B work visa. Or, they can seek a J-1 waiver, which lets them remain in the U.S. on H-1B status in exchange for working for three years in a provider shortage area.

The attorneys said they’re seeing delays only in the Exchange Visitor Program, not in other federal or state J-1 waiver programs.

Nearly a quarter of physicians in the U.S. went to medical school outside the U.S. or Canada.

Minear and Wintersteen said the HHS clinical care program received 750 waiver applications last year, which is reserved for doctors working in pediatrics, psychiatry, family and internal medicine, or obstetrics and gynecology.

The program typically needs to forward recommendations to the State Department by mid-March for the process to be completed in time, according to a letter from John Whyte, CEO of the American Medical Association.

Minear said HHS stopped processing applications in late September or early October before it started forwarding them again a few months ago.

“But the pace is dramatically slower” than usual, she said.

Minear said the State Department usually takes two or three months to review HHS recommendations and must send them to USCIS before July 30 for most of the doctors to stay in the country.

If they don’t make that deadline, Wintersteen said, doctors will have to leave the country unless they obtain another kind of visa, get a J-1 waiver through another program or extend their current visa by taking board exams or doing additional training.

The psychiatrist, who is supposed to start work on July 1, said they applied for a waiver in order to stay in the U.S with their partner, and because it would let them help the most vulnerable mental health patients. They said their future clients would likely include human trafficking survivors, homeless people and prison or jail inmates. “That’s the population I want to work with,” they said.

Waiver delay meets H-1B dilemma

President Donald Trump issued a September proclamation that railed against the tech industry’s use of H-1B work visas. The order created the $100,000 fee that applies to workers in all fields — not only tech — coming from outside the U.S. The payment doesn’t apply to those already in the country.

As of Feb. 15, U.S. employers had paid the fee for 85 workers, according to a court filing from USCIS. It’s unclear if any of those payments were for physicians or other medical providers.

The psychiatrist said officials at the hospital that plans to hire them said they can’t afford to pay to bring them back to the U.S. if they must go home.

“A lot of hospitals who hire J-1 waiver physicians are in underserved areas, and so they treat Medicare and Medicaid patients,” they said. “By definition, for the most part, they’re not rich hospitals.”

“A lot of hospitals who hire J-1 waiver physicians are in underserved areas.”

Barry Walker, an attorney in Tupelo, Mississippi, focused on health workforce-related immigration, said employers have already spent money on recruiters and attorneys like him to help with the waiver process.

Adding the H-1B fee is “just a deal killer, especially for the small, rural hospitals,” he said.

Attorneys said most employers will sponsor physicians in need of an H-1B visa only if they’re in lucrative specialties, such as cardiology or orthopedics, in which they can recover the cost of the fee.

They said healthcare facilities are much less likely to pay the fee to hire foreign nurses, lab technicians and other healthcare professionals who are more likely than physicians to complete their training outside the U.S.

Employers can request fee exemptions, but attorneys said they haven’t heard of a hospital or clinic being granted one.

Fighting on two fronts

Physicians, hospital leaders, lawmakers and immigration experts are trying to draw attention to the J-1 waiver delays at HHS while hoping to overturn or limit the new H-1B fee.

The Trump administration hasn’t acted on letters from hospitals, medical societies and rural health organizations that requested an exception to the $100,000 fee for physicians or all healthcare workers.

In March, a bipartisan group of lawmakers introduced a bill that would create a healthcare exemption. It has not yet had a hearing.

At least three lawsuits — from the U.S. Chamber of Commerce, a group of 20 states and a coalition of plaintiffs that includes a company that recruits foreign nurses and a union that represents medical graduates — are seeking to end the fee entirely.

“This entire process has been so incredibly painful and just soul-crushing.”

As for the J-1 waiver delays, the American Medical Association CEO asked the Exchange Visitor Program to use “emergency batch processing” for physicians with contracts to start work this summer.

Efrén Manjarrez, president of the Society of Hospital Medicine, which represents doctors who work in inpatient units, also called for emergency measures.

“Every day this backlog persists is a day that hospitalized patients in these communities face greater risk,” he wrote in a letter to the program.

Meanwhile, Canadian hospitals have been recruiting foreign physicians completing their training in the U.S, the psychiatrist said. They said one of their friends accepted an offer, withdrawing their HHS waiver application to head north.

The psychiatrist said if they must leave the U.S., they’ll be separated from their partner and out of a job for months as they work to get licensed in their home country.

Even if their employer were able to afford the H-1B fee, they’re not sure they’d want to return.

“This entire process has been so incredibly painful and just soul-crushing,” they said. “I would rather go to a country that would appreciate my motivation to work with patients.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source for health policy research, polling and journalism.

The post Delays in Visa Program Threaten Placement of Doctors in Underserved Areas appeared first on Truthdig.

If you haven’t heard the argument that civilization is about to collapse because women aren’t having enough babies, you haven’t been consuming much media.

“The Birth-Rate Crisis Isn’t as Bad as You’ve Heard—It’s Worse,” announced the Atlantic last June. Business Insider ran a piece in August headlined “America’s great people shortage,” which opened, “America is about to tumble off the edge of a massive demographic cliff.” And NPR‘s Brian Mann warned on PBS in April that, as a result of the birth rate decline, “many people say” that the U.S. soon “will be unrecognizable.”

The issue is repeatedly in the news in part because it’s a priority of the “pronatalist” right, which has prominent backers in the Trump administration. Vice President JD Vance has called the U.S. birth rate decline a “civilizational crisis.” He said people with children should have “more power” at the polls and “more of an ability to speak your voice in our democratic republic” than those without.

It’s repeatedly in the news in part because it’s a priority of the “pronatalist” right.

Elon Musk, who regularly posts on the subject and has fathered at least 14 children, has claimed that “population collapse due to low birth rates is a much bigger risk to civilization than global warming.” “There will be no West if this continues,” he said. And President Donald Trump has called for a new “baby boom.”

The story generally goes like this: Fewer babies being born in the U.S. leads to fewer working-age adults relative to retired adults, which means, as the Atlantic piece put it, ”higher taxes, higher debt or later retirement — or all three.”

But there’s a lot more to the story, and ignoring it masks the white nationalism, regressive gender ideals and economic inequality driving the narrative.

Hidden xenophobia

The numbers might look striking on the surface: As news reports have pointed out, the number of births and the fertility rate (births per 1,000 women) in the U.S. have dropped to record lows. Both decreased by 1% from 2024 to 2025; the fertility rate has fallen by about 20% over the past 20 years.

In terms of births per woman, that’s about 1.6 — well below the “replacement” rate of 2.1, which would be required to maintain a population count without migration.

But that last detail is key. If you believe we need a certain number of working-age adults to support an aging population of retirees, there are — or at least were, until Trump’s brutal immigration regime — millions of people willing and eager to come to this country and help make up that deficit. Even with the declining birth rate, the U.S. population grew by more in 2023-24 than it did in 2003-04.

Even so, immigration was conspicuously missing from too much of the birth rate coverage. For instance, in a long piece on Trump contemplating a “baby bonus” — a $5,000 payment to new parents in the form of a government check or tax credit — CBS reported:

A declining birth rate can spell long-term economic problems, including a shrinking labor force that’s financially strapped to pay for medical services and retirement benefits for an aging population.

It managed to go in depth on why the birth rate might be declining, what a baby bonus might look like, how much it would cost and whether it could work. But it never mentioned immigration policy.

On CNN, anchor Michael Smerconish explored the falling birth rate with economist Melissa Kearney, who told him:

We’re now looking at, you know, being a society that’s aging, with fewer young people going to school, entering the workforce. This poses demographic headwinds for our economic growth and dynamism going forward.

They discussed the “threat posed in terms of the sustainability of Social Security” and ways to address the problem, but neither ever raised the impact of immigration.

When news outlets ignore that obvious facet of the issue, they hide the xenophobic assumptions underlying the claims of “crisis.”

‘To save civilization, reject feminism’

And then there’s the misogyny. Right-wing media are quick to blame women for this impending “crisis.”

A New York Post column by Rikki Schlott, for instance, drummed up the “fear of a baby bust,” blaming it in particular on Gen Z (which is having fewer kids than previous generations at the same age) lacking “positive, empowering messaging that teaches you can prioritize marriage, family and children while also valuing independence, career and financial stability”:

“I don’t need a spouse” (or, for that matter, children) feminism has told left-leaning young women that pretty much everything else is more important than family.

That’s a very sad development.

Syndicated columnist Victor Joecks took things further in a piece headlined “To Save Civilization, Reject Feminism and Honor Mother.” He opened by declaring, “The triumph of modern feminism has put society on the path to demographic collapse.”

Joecks further opined:

Society applauds women for becoming executives, not moms with kids. Reports on the mythical [sic] gender pay gap describe motherhood with the word “penalty.” … Modern feminism has left many women lonely and depressed. It has put the globe into a demographic downward spiral that’s going to be hard to reverse.

‘National motherhood medal’

Women-blaming in right-wing media is no surprise, particularly given the surge of pronatalism on the right. But centrist media coverage of that movement also sometimes boosts it.

The New York Times ran an article last year on the pronatalist groups pushing the Trump administration on increasing birth rates, noting that “advocates expressed confidence that fertility issues will become a prominent piece of the agenda.” Among their ideas: a “National Motherhood Medal” awarded to women with six or more children, and tax credits to married — but not unmarried — couples with children that increase with successive children.

The paper insisted on normalizing it, calling the coalition “broad and diverse.”

It’s instructive to recall, as Vogue does, that fertility was likewise central to the Nazis, who also offered medals to (Aryan) women who bore many children.

While the misogyny embedded in the pronatalist movement generally comes through loud and clear in the Times article, the paper insisted on normalizing it, calling the coalition “broad and diverse,” including both “Christian conservatives” who see a “cultural crisis” in need of more marriage and gender inequality, as well as those who “are interested in exploring a variety of methods, including new reproductive technologies, to reach their goal of more babies.”

‘Collapse of our civilization’

The New York Times repeated the economic collapse narrative in its description of the pronatalist movement’s

warning of a future in which a smaller work force cannot support an aging population and the social safety net. If the birth rate is not turned around, they fear, the country’s economy could collapse and, ultimately, human civilization could be at risk.

By making no effort to analyze that narrative, the Times lent it legitimacy.

Similarly, in a USA Today piece on whether Trump’s effort to be known as the “fertilization president” was sparking a baby boom (“that question is complicated,” the paper concluded), reporter Madeline Mitchell quoted a pronatalist podcaster saying that the declining birth rate “is going to lead to the collapse of our civilization.”

That piece was part of a package that interviewed many women of varying ages to understand why they were or were not having children; those pieces included perspectives about the financial and existential struggles facing women who want to have children and feel they can’t afford to, or don’t feel the world is stable enough to bring children into.

It’s an important perspective, and interviewing women on this subject is something all outlets should be doing. But without addressing the question of whether a falling birth rate will, in fact, bring about imminent civilizational collapse, as the widely disseminated right-wing narrative claims, the framing pits women’s feelings and choices against the survival of civilization — hardly a fair contest.

Since birth rate is not a significant problem for the U.S. in the foreseeable future unless you prevent immigration, the idea repeated in these pieces that “civilization” will collapse from a falling birth rate actually means “white civilization.” Pronatalists, you see, tend to share a lot in common with Christian white nationalists.

‘The problem is teens’

Another New York Times article in February headlined “The Birthrate Is Plunging. Why Some Say That’s a Good Thing,” pointed out that the drop in the U.S. is mostly among teens and women in their early 20s, and reminded readers that

30 years ago, the growing number of teenage and single mothers was seen as a societal crisis, with poor economic and health outcomes for mother and baby. The most vociferous critics called these women “welfare queens” and said they were draining public coffers.

It is indeed whiplash-inducing to hear today’s right-wing mouthpieces, like Fox News senior medical analyst Marc Seigel saying:

The problem is teens and young adults. From ages 15 to 19, the fertility rate is down 7%, and it’s down 70% over the last two decades, meaning we’re telling people that are young not to have babies, to wait until they’re in a more stable life situation.

In any case, despite its better gender framing, the Times still pushed the “not enough workers” economic narrative — and downplayed the administration’s xenophobia with euphemism:

If the birthrate drops too far for too long, it could eventually present problems, as the country needs workers to support an aging population. The population can grow through immigration too, but that issue has become politically sensitive, with numbers falling sharply under the Trump administration.

Vanishing productivity

The economic doomsday argument being spread applies both in the U.S. and globally. Declining fertility isn’t just happening in the U.S. — it’s a worldwide phenomenon. In fact, the U.S.’ “demographic cliff” is much less dramatic than many countries’. China, for instance, has one of the lowest fertility rates in the world, and that nation’s population is already beginning to shrink.

While some might think this slowdown (and even potential reversal, many decades from now) in global human population growth could be a positive development, there are plenty of media outlets looking to fearmonger about it. “The demographic cliff will end us, unless we act quickly,” declared Forbes‘ Alexander Puutio.

In the Atlantic article, Marc Novicoff presaged that within a few decades “rich countries will all have become like Japan, stagnant and aging.” After arguing that United Nations population growth projections are overly optimistic, he addressed those who remain skeptical of doomsday warnings:

If you’re not sure why this is all so alarming, consider Japan, the canonical example of the threat that low fertility poses to a country’s economic prospects. At its peak in 1994, the Japanese economy made up 18 percent of world GDP, but eventually, the country’s demographics caught up with it. Now Japan’s median age is 50 years old, and the country’s GDP makes up just 4 percent of the global economy. Measured per hours worked, Japan’s economic growth has always been strong, but at some point, you just don’t have enough workers.

Who cares what percentage of world GDP a country produces? If you’re a resident of Japan, what you care about is your quality of life. As Novicoff acknowledges, Japan’s productivity hasn’t weakened. And if you look at the human development index, which measures gross national income per capita, years of schooling and life expectancy, Japan continues to improve over time. So it’s entirely unclear on what basis he makes his claim that Japan doesn’t “have enough workers.”

But it is clear what readers are being primed for — governments and companies cutting retirement benefits. As the Atlantic piece concludes:

If the birth rate continues to drop around the world at its current pace, economic growth and workers’ retirement prospects will go the way of those projections: adjusting every few years to a smaller, sadder, poorer future.

Productivity swamps demographics

That neoliberal push for austerity is the third ideological agenda that lurks behind many of these population crisis stories. Even those news outlets that acknowledged the role of immigration in a country’s economy often took it as further evidence that the economic outlook is bleak. NPR, for instance, told its audience last month that

many demographers and economists see the apparent shift toward smaller families and fewer children as a significant concern for the nation and its labor force, especially as immigration into the U.S. has also plunged under the Trump administration.

What such economic warnings hide is that, just as population size isn’t solely dependent on the native fertility rate, economic growth isn’t solely dependent on the working-age population.

It’s true that increasing life expectancies mean that the ratio of the U.S. working-age population to the retired population is slowly decreasing, even with a growing population. That can put pressure on things like Social Security, which operates like a social insurance program in which taxes from current workers go into a fund for current retirees. A shrinking, aging population does require some policy adjustments. But it doesn’t mean the sky is falling. Progressive economist Dean Baker explains:

Even pulling out the impact of immigrants, the reality is that we have been seeing a fall in the ratio of workers to retirees pretty much forever. Life expectancies have been rising as people have better living standards and better healthcare. (Recent years have been an exception, where life expectancies have stagnated.) In 1950 there were 7.2 people between the ages of 20 and 65 for every person over the age of 65. This ratio now stands at just 3.6 to 1.

Over this 70-year period, we have seen huge increases in living standards for both workers and retirees. The key has been the growth in productivity, which allows workers to produce much more in each hour of work. (We also have a much higher rate of employment among workers between the ages of 20 and 65, as tens of millions of women have entered the labor force.) The impact of productivity growth swamps the impact of demographics.

Not enough babies? Too many billionaires

The U.S. has experienced an average of over 2% annual productivity growth in the nonfarm business sector since World War II, and there’s no reason to expect that to end. The gradually shifting worker-to-retiree ratio does start to become a bigger problem if productivity gains are siphoned off to only accrue to the rich. Which, as it turns out, they increasingly do.

Look at Social Security, which is frequently pointed to as being in peril because of the aging population and decreasing birth rate. An Aug. 2025 op-ed in USA Today advocating for “killing” Social Security claimed that “due to a collapse of the American birth rate, the program is expected to be unable to pay the full promised benefits to retirees within the decade.”

A CNBC article in May 2025 told readers that “fewer births mean fewer future workers to support programs like Social Security and Medicare, which rely on a healthy worker-to-retiree ratio.” (That idea was supported with a quote from the director of the “Get Married Initiative at the Institute for Family Studies” — a right-wing think tank that recently launched a “Pronatalism Initiative.”)

“Fewer births mean fewer future workers.”

But none other than the chief actuary at the Social Security Administration, Karen Glenn, testified to Congress in March that birth rate has nothing to do with impending shortfalls in the program. Instead, one of the biggest factors imperiling Social Security is the problem of greater-than-expected income inequality.

Since 1980, when income inequality began to increase sharply, the amount of wage income that exceeds the cap for Social Security tax has doubled. The vast majority of us — those who make up to $184,500 a year — pay Social Security tax on all of our income; those who make more pay nothing above that cap. Simply removing the cap would eliminate three-quarters of the Social Security fund’s long-term projected shortfall.

Economic value judgments

And, of course, there are all the other ways the rich avoid paying their fair share in our economy, whether it’s through low capital gains tax rates, or simply through the fancy accounting that lets the super-rich — including those who own the news outlets reporting on such things — pay next to nothing in federal taxes. Jeff Bezos, for instance, owner of the Washington Post, paid an effective income tax rate of under 1% on the over $4 billion he amassed from 2014-18, ProPublica has reported.

So when the New York Times tells you in its reporting on U.S. population change that “the country needs a population of young workers and taxpayers large enough to finance infrastructure like schools, hospitals and healthcare for older residents,” understand that they’re making a value judgment about taxation. The more objective statement would be that the country needs an economic output large enough to finance these things, which is certainly true.

There are important policy conversations to be had about supporting people in having the size family they want to have. Many Americans have fewer children than they want because of financial limitations — like lack of affordable child care or housing — or concerns about the state of the world or the environment. News outlets can and should be addressing these issues.

But reporting that covers birth rate decline without the critical contexts of immigration policy, gender norms and economic inequality mask the regressive ideologies behind the purported solutions.

The post What’s Behind the ‘Baby Bust’ Panic? appeared first on Truthdig.

After a two-year investigation, Austrian and Albanian authorities recently swooped in on several alleged scam call centers in Tirana, seizing more than $1 million and arresting 10 people. 

Europol said authorities had “disrupted” a criminal network that had “caused significant financial damage,” totalling $59 million.

But experts say the best efforts of law enforcement may only make a dent in the booming global scam industry. That’s because the people behind such scam centers can easily shift their operations elsewhere. 

“The real organizers behind the call centers are not at the physical location,” said Jorij Abraham, managing director of the Global Anti-Scam Alliance. 

“They have ‘sergeants’ managing the call centers for them,” he told OCCRP. “If one center is busted, the next one is easily set up.”

Europol said the call center workers in the Albanian capital specialized in languages directed at target markets. They allegedly used their language skills to build trust and then “deceive their victims, presenting false investment opportunities and convincing them to transfer significant amounts of money.”

Some victims were targeted twice, Europol said. People who had already lost money were contacted again and offered help recovering their funds, then told to open cryptocurrency accounts and make an initial deposit of 500 euros.

Abraham said victims are often targeted more than once, either by the same scammers or by others who buy their data.

That type of cooperation between scam networks creates another challenge for law enforcement. 

“These are not isolated fraud schemes,” said Fatjona Mejdini, who directs a Balkans-focused program at the Global Initiative Against Transnational Organized Crime.

“Call-centre scam networks across Europe and beyond are increasingly interconnected, relying on one another for platforms, victim contact lists, techniques, employees, and most importantly, channels and methods for transferring and laundering money,” she said.

Mejdini said the Western Balkans and parts of Eastern Europe have become fertile ground for such schemes. The region has a young, well-educated population facing limited employment opportunities, while scam centers often operate in plain sight as seemingly legitimate businesses.

Europol said the call centers in Tirana were set up like professional businesses, with as many as 450 people in departments such as IT and human resources. Each “operator” received a salary of about $938 a month, as well as commission.

The case echoes OCCRP’s previous investigations into the call center fraud industry. The 2020 Fraud Factory investigation exposed an industrial-scale investment scam including operations with links to Albania and Georgia. In 2025, Scam Empire found that two call center groups took in about $275 million from would-be investors.

The UN has formally concluded its cross-border humanitarian operations from Türkiye into Syria, marking the end of an 11-year mission that served as one of the most complex supply chains in the organization’s history. 

Concern is mounting over the health of imprisoned Iranian Nobel Peace Prize laureate Narges Mohammadi, who was reportedly being held alongside high-risk offenders.

Media freedom is not a given and its absence frequently leaves communities and vulnerable individuals in danger. To mark World Press Freedom Day, we’ll be hearing from UN agencies, along with war correspondents and reporters who face major obstacles trying to do their job. The aim is to get a better understanding about what press freedom means in practice and why it is worth defending.