Allergy & immunology:
outpatient, predictable, and highly selective

At a glance

Every specialty profile on this site involves a trade. Allergy and immunology (A&I) offers something unusual: a genuinely predictable, outpatient quality of life — steady clinic hours, minimal call, long-term relationships across every age — without the acute-care intensity that buys most physicians their income. The catch is scarcity. This is a tiny field: it graduates on the order of a couple hundred fellows a year, fills nearly every seat, and asks you to compete for a small number of spots. It is also the one internal-medicine-adjacent subspecialty here whose certificate is not ABIM’s, and the one where international medical graduates fill the smallest share — both facts matter, and both are explained below.

What it involves

Allergy and immunology is the medicine of the immune system — both its overreactions and its failures — across the entire lifespan. The bread and butter is allergic disease: allergic rhinitis (hay fever), asthma, atopic dermatitis (eczema), chronic urticaria and angioedema (including hereditary angioedema), food allergy, drug and stinging-insect allergy, and anaphylaxis. Alongside that runs the “immunology” half of the name: eosinophilic disorders such as eosinophilic esophagitis, and inborn errors of immunity — the primary immunodeficiencies, some of whom need lifelong immunoglobulin replacement. Because immune disease crosses organ systems and ages, an allergist is unusual in medicine: the same physician may see a toddler and an octogenarian in one clinic day. The work is predominantly outpatient — scheduled clinic for new diagnostic consults, immunotherapy build-up and maintenance, biologic administration, and chronic-disease follow-up — with limited, mostly academic inpatient consulting for severe anaphylaxis, drug desensitization, or suspected immunodeficiency.

A day in the life

An allergist's day is almost entirely clinic. The morning is a mix of new consults — a child with recurrent wheeze, an adult with chronic hives that resist explanation, a penicillin-allergy label to evaluate and possibly “delabel,” a suspected food allergy to sort out with history and testing — interleaved with follow-ups: immunotherapy build-up visits, biologic administrations, asthma-control checks. Light office procedures punctuate the day: skin testing, spirometry, a supervised oral food or drug challenge that ties up a room for a few hours under close monitoring. Between patients you counsel families through shared decisions (oral immunotherapy versus a biologic; whether to start a biologic at all) and fight the prior-authorization queue that governs testing, immunotherapy, and expensive biologics. It is cerebral, deeply relational, and low-acuity — a day spent diagnosing, teaching, and managing over the long term rather than intervening acutely. The texture shifts at academic centers, where inpatient consults for drug desensitization or immunodeficiency add a hospital dimension.

The training pathway

The ACGME program requirements are specific: the program “must be 24 months in length” and must provide experience with both adult and pediatric patients; entry is from a completed internal-medicine or pediatrics residency, and foreign graduates must hold a valid ECFMG certificate before appointment⁵. A narrow research-pathway option lets a resident enter after two years of IM or pediatrics if accepted into the corresponding research pathway; most fellows complete their full residency first. Some add a third research year, and a handful of programs offer combined allergy/immunology and rheumatology training leading to dual certification — built for physician-scientist and complex-immunology careers, not a national norm.

Sub-tracks and niches

A&I is broad for a two-year fellowship, and most niches are built within the standard training and then deepened on the job through case mix and focused clinics rather than additional ACGME fellowships.

Competitiveness

A&I is a small field that fills almost completely every year, which is what makes it competitive despite modest raw applicant numbers. The honest way to read it is to keep four different metrics separate, because each shows something different:

• Position fill rate (98.9%): 175 of 177 certified positions filled. This measures how fully the field’s seats are taken — near-total — but says nothing about how hard any one applicant had to work.
• Applicants preferring the field (241): the pool competing. In a small field, a modest pool can still exceed the seats.
• Applicant match rate (72.6%): of those 241, 175 matched into A&I and 60 (24.9%) went unmatched entirely. This is the metric that captures individual difficulty — roughly one in four who tried came away with nothing.
• Applicant composition: 110 US MD (62.9%), 38 DO (21.7%), and IMGs 14.9% — which tells you who is competing and, as the IMG section explains, how much room is left over.

A near-total fill rate and a substantial unmatched rate are not a contradiction; they are two views of the same small, sought-after field². Two trends are worth naming. First, the field is growing its seats while its applicant pool softens: certified positions rose from 167 to 177 between the two cycles, and positions taken by US MD graduates fell even as total seats grew — 110 of 175 in 2026 versus 120 of 165 the year before⁶. That matches the peer-reviewed record: applicants per fellowship position fell from 1.7 in 2008 to a nadir of 1.0 in 2018, averaging about 1.23 since, and recruiting enough strong trainees has become a stated priority of the national societies⁷. Second, none of that has dented the fill rate: demand for the small number of seats still clears the market almost completely.

An application timeline. A&I rewards early commitment more than most fields, because most fellows decide during residency and the programs are tiny:

1. PGY-1: get an A&I elective or clinic exposure early and find a mentor; most fellows report deciding on the field during residency, not late.
2. PGY-2: build a scholarly project (a case report, abstract, or small study), deepen the mentor relationship, and line up an allergist’s letter alongside your program director’s; decide with commitment — A&I is not a strong late fallback.
3. PGY-3 (application year): apply broadly given how few seats exist; use program signals where offered; and build a deliberate geographic strategy, since tiny programs (often one or two fellows) weight fit and local ties heavily.

Because programs are small, fit and mentorship carry outsized weight. Build a coherent narrative around a real interest rather than treating A&I as a generic “lifestyle” fellowship — small programs can tell the difference.

Skills & personality

A&I is a cerebral, investigative specialty, and it rewards a specific temperament: the diagnostic detective who also likes people. Much of the work is untangling vague, multi-system, chronic complaints — is this true IgE-mediated food allergy or an intolerance? A drug allergy or a predictable side effect? Chronic urticaria or the first sign of a systemic disease? If you genuinely enjoyed immunology and enjoy chasing a puzzle whose answer is not on an algorithm, that is a real signal. So is comfort with longitudinal care: many patients are managed over years of immunotherapy build-up and maintenance or biologic therapy, and if you crave acute rescues and dramatic cures, this is not that.

The field is also unusually people-facing. Allergists see patients of every age and keep them for years — sometimes whole families — so warmth, patience, and the ability to listen matter as much as pattern recognition. Shared decision-making dominates, and patient and parent education is a core clinical act, not an afterthought. Detail and safety discipline count too: skin testing, food and drug challenges, and immunotherapy carry a real, if small, anaphylaxis risk, so protocol discipline is part of the job. And in private practice a business-minded streak helps, because A&I economics hinge on running immunotherapy, testing, and infusion services well.

Who tends to be unhappy? Physicians who want high procedural intensity, hospital-based adrenaline, the highest incomes in medicine, or a purely inpatient career. And — candidly — anyone worn down by insurance friction: allergists themselves most often name prior authorizations and administrative burden as the hardest part of the job. The lifestyle is real, but it is a reward for loving the content, not a substitute for it.

Lifestyle & balance

The predictable, outpatient schedule is the field’s calling card, and it is earned. A&I is predominantly office-based, weekday-oriented — commonly clinic hours in the eight-to-five range, Monday through Friday — and many private practices concentrate patient care into four clinical days and reserve the fifth for administration. Because the work is not physically strenuous and is highly schedulable, allergists have unusual flexibility to work part-time, shape a niche, or practice well into later career, and the field suits telemedicine follow-ups.

But “light call” varies by setting, and it is worth being precise. In routine outpatient allergy practice, after-hours coverage generally means answering a phone from home, and anaphylaxis is usually handled promptly in clinic or by emergency physicians. Practices that run in-office biologic and immunotherapy programs must be staffed and protocoled for infusion and injection reactions during clinic hours — a real, if manageable, acute responsibility. And academic and inpatient-consult roles carry more: drug-desensitization coverage, immunodeficiency consults, and on-service weeks that look less like the private-practice stereotype. Ask any prospective job exactly what call and inpatient coverage it includes rather than assuming the field-wide average.

Now the honest counterweight, because a good schedule is not the same as no burnout. Burnout has been measured in this workforce and it is not zero; the leading driver, tellingly, is not the schedule but administrative load — prior authorizations for testing, immunotherapy, and expensive biologics, plus the EMR inbox and insurance friction allergists cite as their top frustration⁸. The structure of A&I protects your evenings; the paperwork can still grind on your days.

Compensation & practice models

A&I pays in the middle of the internal-medicine range: comfortably above general internal medicine and the lowest-paid cognitive subspecialties, and well below the procedural and hospital-based fields. There is no allergy-specific federal wage code, so the public floor is the BLS physicians-and-surgeons figure⁹; above it, the traceable benchmarks cluster the field consistently.

Read those as ranges, not payroll — Doximity is self-reported and reports means, Marit is crowdsourced and directional, and Medscape is gated³¹⁰¹¹. The crucial thing to understand is where the money comes from: office-visit coding pays for the physician’s cognitive work, but the practice’s revenue leans on ancillary services — allergen immunotherapy, in-office skin testing and spirometry, and increasingly biologic and infusion administration. A structural quirk drives the business model: administering immunotherapy generates practice revenue but very little physician work RVU, which is why the practice model, not just personal productivity, shapes income.

Weigh the three models evenly. They are genuinely different jobs, and no one of them is the “right” answer:

• Employed academic: the lowest cash pay, traded for teaching, research, complex-immunodeficiency and referral care, and more inpatient exposure. Ancillary revenue is the institution’s, not yours.
• Employed community (hospital or multispecialty group): a stable salary, often with a wRVU component, and someone else running the ancillary business. Predictable, less upside, less administrative ownership.
• Private-practice ownership: the highest ceiling, because ownership captures the immunotherapy, testing, and infusion revenue the wRVU tally does not — but it comes with real business risk, overhead, and the operational and compliance work of running a testing-and-infusion enterprise.

The single biggest recent shift is biologics: omalizumab, dupilumab, and peers — for asthma, chronic urticaria, atopic dermatitis, nasal polyps, eosinophilic disease, and now food allergy — have turned in-office biologic administration into a meaningful revenue line, on top of the clinical value to patients. The headwinds are familiar: flat-to-declining reimbursement, Medicare payment pressure, the prior-authorization burden above, and emerging biosimilars.

Intellectual scope

For a physician who loves mechanism, A&I is quietly one of the richest fields in medicine, because the immune system is complex, incompletely understood, and moving fast. The daily reasoning spans organ systems — skin, lungs, gut, sinuses — and intersects with rheumatology, pulmonology, gastroenterology, dermatology, and infectious disease, so allergists draw on a wide base and encounter genuine puzzles. One clinic day might move from a child with recurrent infections needing an immunologic workup, to an adult with severe asthma on a cutting-edge biologic, to a patient whose chronic hives resist every obvious explanation.

And the therapeutics are being rewritten in real time, which is much of the appeal. Food allergy is the clearest example. In February 2024 the FDA approved omalizumab (Xolair) to reduce allergic reactions to one or more foods in patients aged one and older — the first medicine of its kind¹² — based on the NIH/NIAID-funded OUtMATCH trial, in which about 68% of participants on omalizumab could tolerate roughly 600 mg of peanut protein (two to three peanuts) without moderate-to-severe symptoms, versus about 6% on placebo¹³. At the same time the older approach is receding: Palforzia, the first FDA-approved peanut oral immunotherapy (2020), is being withdrawn — its manufacturer will end commercialization as of July 31, 2026, a voluntary decision it states is unrelated to safety, quality, or efficacy¹⁴. Layer on the broader biologics boom across asthma, eczema, and immune-mediated disease, and the immunodeficiency-diagnosis revolution driven by genetic testing, and you have a field where staying current is a core, energizing part of the job. Academic tracks carry strong translational and clinical-trial traditions, and the biologics pipeline makes industry and medical-affairs roles a natural fit.

Pathways & career arc

Most allergists practice in the community — single-specialty allergy groups, multispecialty groups, or hospital-employed clinics — where the income ceiling is highest through ownership and well-run ancillary services, and schedule autonomy is greatest. Academic practice trades income for teaching, research, complex-immunodeficiency and referral care, and more inpatient consult exposure. Beyond direct patient care, the field opens unusually good doors: the biologics boom makes pharma and biotech roles (medical affairs, clinical development, drug safety) a robust option, and telehealth, informatics, administration, and entrepreneurial OIT- or direct-care practices are all real paths.

The workforce picture is one of steady, if unglamorous, demand. Allergic disease is common and rising, while the allergist workforce is small, aging, and concentrated in metropolitan areas — leaving rural and suburban communities underserved. A workforce commentary cited an ACAAI projection that FTE allergist-immunologists would fall about 7% from roughly 3,660 in 2006 to about 3,400 by 2020, even as demand rose by roughly a third — dated projections, read directionally, but corroborated by the current AAAAI workforce discussion of rising disease burden and a training pipeline the societies consider too small⁴⁷. Job availability for new graduates should stay strong, especially outside the saturated metros — but the most desirable big-city locations remain competitive, and the field’s small size means fewer total openings than in the larger IM subspecialties.

The career arc, honestly. A&I is one of the most durable and sustainable careers in medicine: outpatient, low-acuity, not physically strenuous, and easy to scale to part-time or telemedicine as life changes — many allergists practice comfortably into their late career. Niches evolve over time (food allergy and OIT, severe asthma and biologics, immunodeficiency, drug allergy), and the biologics-rich science keeps an industry or medical-affairs second act unusually accessible. It is a field you can practice at full tilt at 40 and at a chosen tempo at 68, which is part of why it is so sought-after.

Choosing a fellowship & first job

A&I asks you to choose twice: first a fellowship, then a first job. The through-line is the same: decide what matters for your direction, evaluate the program or group against it, and negotiate the terms.

Choosing the fellowship. With programs this small, weigh mentorship and fit heavily, plus the balance of adult and pediatric exposure you want, immunodeficiency and research depth if that draws you, and geography. Because a single strong mentor can shape your whole training, where you can build a genuine relationship matters as much as the program’s name.

Choosing the first job. Decide first which of the three models (academic, employed community, ownership) fits your goals, then normalize competing offers to the same terms and get the details in writing:

• The clinical model: clinic volume and new-versus-follow-up mix, the adult/pediatric split, any inpatient-consult or desensitization coverage, and what “call” actually means here (see Lifestyle).
• The economics: base versus wRVU, and — critically — whether and how you participate in the ancillary revenue (immunotherapy, testing, biologics) that drives the field’s income; if it is an ownership track, the buy-in, valuation, and how testing/treatment decisions are governed.
• The contract: non-compete scope, without-cause termination, malpractice and tail, and who employs you.

IMG considerations

If you are an international medical graduate, read this section especially carefully, because A&I breaks the pattern that makes so many internal-medicine subspecialties attractive to IMGs. The infectious-disease and endocrinology pages describe fields where IMGs make up roughly 40–56% of the matched class and are, in effect, the backbone of the workforce. A&I is the opposite. In the 2026 appointment-year Match, US-citizen IMGs filled 5.7% of positions and non-US-citizen IMGs another 9.1% — a combined 14.9% (26 of 175 filled positions), among the lowest IMG shares of any internal-medicine subspecialty; US MD graduates took 62.9% and DO graduates 21.7%². (Two companion analyses take up the wider questions: whether international graduates take US graduates’ spots, and the H-1B for physicians in training; practical planning lives on the IMG guide.)

Understand why, because the reason is not a bias against IMGs — it is arithmetic. A&I is small, coveted for its lifestyle, and near-fully filled every year by a strong pool of US graduates competing for very few seats. When a desirable field has both high fill and few openings, there is simply less room left over than in the underfilled cognitive fields where demand falls short of supply. This does not make A&I closed to IMGs — IMGs do match every year — but it is a narrow door, and honesty serves you better than optimism here.

So what does it take? Everything the competitiveness section describes, done to a higher standard: excellent residency performance, genuine and documented A&I exposure, US clinical experience, scholarship you can point to, a strong program-director letter and ideally an allergist’s, and early, deliberate positioning — A&I is a field you commit to well before application season. On eligibility, a valid ECFMG certificate is required before appointment, and the ACGME rules include a Resident Eligibility Exception that lets a program accept an exceptionally qualified international graduate who does not meet the standard criteria — a narrow route, but a real one⁵.

On visas, verify each program individually, because programs are tiny and their sponsorship policies vary widely. J-1 sponsorship through ECFMG’s Exchange Visitor Sponsorship Program is the standard training route; a subset of programs sponsor H-1B, but many small academic divisions sponsor J-1 only¹⁵. And temper one expectation that works well in other fields: A&I’s shortage is real but metro-concentrated, so the Conrad 30 / J-1 waiver alignment that fits infectious disease so neatly is weaker here — many underserved-area waiver jobs are primary care or hospital medicine, not subspecialty allergy¹⁶.

The candid bottom line: if you love this field, pursue it with a focused, competitive application and start early — but build a realistic backup, because for IMGs A&I is attainable, not abundant.

Bottom line

Consider allergy and immunology if you love diagnostic reasoning across all ages and organ systems; you want a predominantly outpatient career with predictable hours and minimal overnight call; you value long-term relationships and chronic-disease management over acute rescues; you are excited by a therapeutic landscape being rewritten by biologics, oral immunotherapy, and immunodeficiency genetics; and you appreciate that ancillary services and practice model, not office-visit RVUs, drive the economics. It is one of the most livable careers in medicine for the people who genuinely want it.

It may not fit if you want the highest incomes in medicine, or high-acuity, procedure-heavy, or inpatient-dominant work; if you dislike chronic longitudinal care and repeated patient education; if you are uncomfortable with pediatric patients and families, which the fellowship requires; if insurance and prior-authorization friction is the thing you most want to escape; or if you need a field with many fellowship slots and easy geographic flexibility — A&I is small, metro-concentrated, near-fully-filled each year, and, for IMGs specifically, a narrower door than most of internal medicine.

A last mentor’s note. Allergists, as a group, tend to describe their field as intellectually rich, flexible, and fulfilling — and they mean it. The trade they made was deliberate: they gave up procedural income and a large field for intellectual variety, real relationships, and a life outside the hospital. If that trade appeals to you, do not be scared off by the small Match — be sharpened by it. Find an allergist at your program, ask to spend a day in clinic, and ask what they would change and what they would never give up. A week there will tell you more than any table on this page, including this one.

References

1. American Board of Allergy and Immunology. (n.d.). About ABAI. https://www.abai.org/ Established 1971 as a conjoint board of the American Board of Internal Medicine and the American Board of Pediatrics — not an ABIM subspecialty certificate. ↩₁ ↩₂
2. National Resident Matching Program. (2026). Results and data: Specialties Matching Service, 2026 appointment year (revised). https://www.nrmp.org/match-data/ Allergy and immunology: 177 certified positions across 101 programs, 175 filled (98.9%). Of 241 applicants ranking the field, 175 (72.6%) matched into it, 6 (2.5%) into another specialty, and 60 (24.9%) unmatched. Filled by 110 US MD (62.9%), 38 DO (21.7%), and IMGs 14.9% (5.7% US-citizen, 9.1% non-US-citizen). ↩₁ ↩₂ ↩₃
3. Doximity. (2025). Physician compensation report 2025 (2024 data). https://www.doximity.com/reports/physician-compensation-report/2025 Self-reported/modeled survey. Allergy and immunology average about $308,846 — above endocrinology ($290,606) and just below infectious disease ($320,730) in the same report. ↩₁ ↩₂
4. Malick, A., & Meadows, J. (2021). Allergy and immunology physician workforce: Where do we stand today? Annals of Allergy, Asthma & Immunology, 127(5), 522–523. https://pubmed.ncbi.nlm.nih.gov/34147654/ Cited an ACAAI white-paper projection that FTE allergist-immunologists would fall about 7% from roughly 3,660 (2006) to about 3,400 (2020) even as demand rose by roughly a third. Dated projections — read directionally. ↩₁ ↩₂
5. Accreditation Council for Graduate Medical Education. (2025). Program requirements for graduate medical education in allergy and immunology. https://www.acgme.org/globalassets/pfassets/programrequirements/2025-reformatted-requirements/020_allergyimmunology_2025_reformatted.pdf The program "must be 24 months in length" and must provide experience with both adult and pediatric patients; entry from a completed internal-medicine or pediatrics residency; ECFMG certification required before appointment; includes a Resident Eligibility Exception for exceptionally qualified international graduates. ↩₁ ↩₂ ↩₃
6. National Resident Matching Program. (2025). Results and data: Specialties Matching Service, 2025 appointment year. https://www.nrmp.org/match-data/ Prior cycle: 167 certified positions, 165 filled (98.8%), 120 by US MD graduates. ↩
7. Lanier, B., et al. (2024). Factors influencing career choice of allergy and immunology fellows-in-training. The Journal of Allergy and Clinical Immunology: In Practice (AAAAI Program Directors Assembly work group report). https://www.aaaai.org/Aaaai/media/Media-Library-PDFs/Allergist%20Resources/Statements%20and%20Practice%20Parameters/Factors-Influencing-Career-Choice-of-Allergy-and-Immunology-FITs-March-2024.pdf Applicants per fellowship position fell from 1.7 (2008) to a nadir of 1.0 (2018), averaging 1.23 since, with about 1.3 in 2023; recruiting enough strong trainees is a stated priority of the national societies. ↩₁ ↩₂
8. Marshall, G. D., et al. (2020). Risk of physician burnout in the North American allergist-immunologist workforce. Annals of Allergy, Asthma & Immunology, 125(3), 235–243 (ACAAI Physician Wellness Taskforce). https://pubmed.ncbi.nlm.nih.gov/32544532/ Burnout is measurable in the field; the leading driver cited is administrative and prior-authorization burden, not the schedule. ↩
9. U.S. Bureau of Labor Statistics. (2025). Occupational Outlook Handbook: Physicians and surgeons. https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm Federal floor only: no allergy-immunology-specific SOC code. Excludes many self-employed physicians. ↩
10. Marit Health. (2026). Allergist salary (community-sourced). https://www.marithealth.com/o/-/allergist/salary Crowdsourced, self-reported; directional only, not a representative survey. About $351,437 across 104 self-reported salaries, pulled July 9, 2026. ↩
11. Medscape. (2025). Allergist compensation report. Self-reported survey; subscription access required, not reproduced here. Places allergy and immunology in the lower-to-middle band of physician pay. ↩
12. U.S. Food and Drug Administration. (2024, February 16). FDA approves first medication to help reduce allergic reactions to multiple foods after accidental exposure. https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-help-reduce-allergic-reactions-multiple-foods-after-accidental ↩
13. National Institutes of Health / NIAID. (2024). Antibody reduces allergic reactions to multiple foods in NIH trial (OUtMATCH). https://www.nih.gov/news-events/news-releases/antibody-reduces-allergic-reactions-multiple-foods-nih-clinical-trial About 68% of participants on omalizumab tolerated roughly 600 mg of peanut protein without moderate-to-severe symptoms, versus about 6% on placebo. ↩
14. Stallergenes Greer. (2026). Palforzia discontinuation notice. https://www.palforzia.com/ The manufacturer announced it will end commercialization of Palforzia (peanut oral immunotherapy) as of July 31, 2026 — a voluntary decision it states is unrelated to safety, quality, or efficacy. ↩
15. Educational Commission for Foreign Medical Graduates. (n.d.). Exchange Visitor Sponsorship Program (J-1): General information. https://www.ecfmg.org/evsp/applying-general.html ↩
16. U.S. Citizenship and Immigration Services. (n.d.). Conrad 30 Waiver Program. https://www.uscis.gov/working-in-the-united-states/students-and-exchange-visitors/conrad-30-waiver-program A J-1 waiver requires placement in a designated shortage area; because allergy’s shortage is metro-concentrated, many underserved-area waiver jobs are primary care or hospital medicine rather than subspecialty allergy. ↩
17. Restriction on Entry of Certain Nonimmigrant Workers, Proclamation No. 10973. (2025, September 24). Federal Register. https://www.federalregister.gov/documents/2025/09/24/2025-18601/restriction-on-entry-of-certain-nonimmigrant-workers Signed September 19, 2025; effective September 21, 2025. Imposes a $100,000 payment requirement on certain new H-1B petitions for beneficiaries outside the United States, with national-interest exemptions and a twelve-month sunset absent extension. ↩
18. U.S. Citizenship and Immigration Services. (2025). H-1B: Frequently asked questions on the September 2025 proclamation. https://www.uscis.gov/newsroom/alerts/h-1b-faq USCIS guidance that the payment requirement applies to new petitions for beneficiaries outside the United States without a valid H-1B visa, and does not reach previously issued visas, earlier-filed petitions, renewals, or change-of-status, amendment, and extension petitions for people already in the country. ↩
19. State of California v. Mullin, No. 1:25-cv-13829-LTS (D. Mass. June 8, 2026) (Sorokin, J.), appeal docketed, No. 26-01699 (1st Cir. 2026). https://www.fragomen.com/insights/united-states-district-court-temporarily-stays-order-vacating-dollar100000-h-1b-fee.html The district court vacated the payment requirement on June 8, 2026 as an unlawful tax and Administrative Procedure Act violation, then temporarily stayed its own order on June 12, 2026 pending appeal; the government appealed to the First Circuit. The requirement therefore remains operational for affected petitions at this writing. A fast-moving matter — verify current status before relying. ↩

Figures here are survey-, model-, and projection-based and shift year to year; compensation figures are self-reported survey and crowdsourced estimates read only directionally, and some are subscription-gated; Match statistics, signaling rules, workforce numbers, the food-allergy therapeutic landscape, and the immigration landscape all move. Verify against the primary source before relying on any single figure for a career, contract, or immigration decision. This page is educational and is not career, financial, immigration, or legal advice.