Foreign-trained physicians are an important part of the U.S. health care workforce, but immigration policies under President Donald Trump could make it harder for hospitals and clinics to recruit them — including for jobs in communities already short on doctors. About one-quarter of U.S. physicians earned their medical degrees abroad. They account for larger shares in some specialties, including 41% of internal medicine doctors, 46% of endocrinologists and 52% of geriatricians. The need is substantial: an estimated 102 million people live in areas without enough primary care providers, according to the federal Health Resources and Services Administration. The agency projects a nationwide shortage of 141,160 full-time physicians by 2038. Research cited by health policy experts finds that foreign-educated doctors are slightly more likely than U.S.-educated physicians to practice in primary-care shortage areas. Physicians working in the country on H-1B visas are also more likely to serve high-poverty communities. The administration has raised the potential cost and uncertainty of hiring through the H-1B program, which lets U.S. employers temporarily hire foreign workers for specialized jobs. A new fee set at $100,000 is far above the previous range of roughly $2,000 to $5,000. The administration has also imposed travel restrictions affecting residents of 39 countries and expanded online-presence screening for some visa applicants. The fee has faced legal challenges. Twenty Democratic-led states sued, and federal judges have ruled against the administration’s effort to impose it. The administration has since proposed a $103,265 charge for a subset of H-1B applicants, leaving employers to navigate a shifting legal landscape. A survey by the American Hospital Association found that 64% of hospitals using the H-1B program had paused, deferred or limited recruitment because of the prospect of the $100,000 fee. The association’s findings point to potential effects on staffing even as court fights continue. Dr. Tarun Ramesh, a physician at Massachusetts General Hospital and health policy researcher at Harvard Medical School, said the country relies on physicians trained abroad while making it harder for them to enter, train and remain in the United States. He said the policies could increase hospitals’ hiring costs and deter doctors from coming. Andrew Wizner, an attorney who represents medical institutions that hire foreign graduates, said uncertainty about rules and court decisions may discourage visa applicants who are weighing whether to move to the United States. Bradley Cunningham, a policy analyst at the Association of American Medical Colleges, said many hospitals lack the resources to manage the added legal and financial complications. States across the political spectrum have taken steps to attract foreign-trained physicians. About two dozen states had enacted laws by midyear to create additional routes to medical licensure for international graduates. Georgia Republican state Sen. Ben Watson, a physician who co-sponsored a licensing law, said the country does not graduate enough doctors to keep pace with population growth and that bringing more physicians to rural areas is a goal. A separate federal program, known as Conrad 30, allows a limited number of foreign medical graduates who trained in the United States on J-1 visas to remain if they practice in an underserved area, rather than return home for two years before seeking to come back. The administration has defended its H-1B fee by arguing that some employers use the program to replace U.S. workers rather than fill hard-to-staff positions. But health care advocates say added costs and unclear rules could also affect hospitals seeking physicians for communities with persistent shortages.