Immigration Policies Threaten U.S. Healthcare Staffing, Particularly in Rural and Impoverished Areas
Washington D.C. – A notable portion of the U.S.physician workforce – roughly a quarter – are immigrants, and new policies are creating headwinds for foreign-born doctors seeking to practice in the United States. this shift is raising concerns about worsening healthcare staffing shortages, particularly in rural communities and areas with high poverty rates, where reliance on these physicians is even greater.
Recent changes, including a nearly 30-fold increase in fees for H-1B visas (designated for highly skilled professionals), are making the U.S. less appealing to international medical talent. Dr.Michael Liu, an internal medicine resident at Mass General Brigham, exemplifies this growing unease. Having moved to the U.S. from Canada to pursue the “American dream,” Liu now questions his future here following cuts to research and health funding.
“That was a really striking moment for me,” Liu stated, “It made me question…where professionally it made the most sense for me.” He witnessed firsthand the distress of colleagues facing the increased visa fees, with some openly expressing grief and uncertainty about their future.
Data reveals the extent of the reliance on foreign-born doctors. Approximately 325,000 doctors in the U.S. were born abroad (excluding nurses and other healthcare workers). In fields like primary care and oncology,immigrants comprise over half the workforce. A recent study co-authored by Liu, published in JAMA, estimates that around 11,000 U.S. physicians – or 1% nationally – are on H-1B visas. However, this number jumps to as high as 40% in some communities, particularly those designated as high-poverty or rural.
“High-poverty counties had a four times higher prevalence of H-1B physicians,” Liu explained.
The current situation represents a reversal of decades-long policy. Following the creation of Medicaid and Medicare in 1965, the U.S. actively recruited foreign doctors to meet the healthcare needs of a newly insured population. Between 1965 and 1975, the U.S.granted visas to 75,000 physicians, with immigrants outpacing U.S.-trained doctors entering the workforce.
Harvard professor eram Alam notes that this influx was crucial to expanding access to care. “overnight, you have…approximately 25 million people who can now access health care services.”
The Department of Health and Human Services has not yet responded to requests for comment on these policy shifts. As the U.S. potentially unwinds this long-standing practice, concerns are mounting about the future of healthcare access, particularly for vulnerable populations. For doctors like Liu,the changing landscape raises fundamental questions about belonging and the value placed on their contributions. “It feels like my contributions – just because I was not born in this country – are less valued,” he said.
