I learned today about a disturbing side effect of the new DOL H-1B wage rules. And it could have a dramatic effect on the American health care system I hadn't previously considered. 1

Because physician salaries are now so elevated under the new rule, DOL has shifted to a national default wage for all H-1B doctors and those seeking green cards - $208,000 per year. All specialties. All geographic areas. Doesn't matter if you're right out of med school or not. 2

This plays out in some crazy ways. Medical residents for example. In teaching hospitals across the country, residents are typically paid $50K to $70K per year. The new reg requires they be paid $208K. 3

A new pediatrician in, as an example, Minneapolis had a prevailing wage of $115K last week. Today - $208K. Most primary care positions pay below $208K in most places, particularly rural America and FQHCs - community health centers, rural health clinics and tribal clinics. 4

Some primary care specialties have 1/3 to 1/2 of the doctors in trying on visas. It's not inconsequential and we rely on those doctors to go to America's medically underserved communities. Psychiatry is 50% international & they're on the front lines dealing with addiction BTW. 5

Family medicine is another occupation that will be hit by the new rule in a serious way. 6

The kicker, however, was told to me by @ejtaub, in a conversation this afternoon. There is a very serious federal statute called the Stark Law which generally limits physicians to being paid the "fair market value." 7

Employers are going to have to violate Stark to comply with the DOL regs. An employer can't just say exceed the market rate by 40 or 50% to make Stephen Miller & the DOL happy. They will have to violate Stark in many cases. Is that something a judge is going to be cool with? 8