Federal immigration policy could deepen physician shortages where they’re already worst, study finds

A federal immigration ban covering 19 countries threatens to thin the physician and nurse ranks in the very places that can least spare them, according to a research letter published May 30 in JAMA Network Open.

Researchers at Harvard Medical School, Harvard Pilgrim Health Care Institute, Massachusetts General Hospital and Brigham and Women’s Hospital pulled a decade of migration data and traced where foreign-trained clinicians from the banned countries actually practice. The answer, they found, is disproportionately in counties the federal government has already flagged as short on care.

The policy, issued December 2, 2025, works differently from the policies the researchers had studied before, such as travel restrictions and higher H-1B visa fees. Those measures limited temporary entry or raised the price of an employment-based visa. This one reaches across every immigration pathway and visa status, the authors wrote, and it has no expiration date.

Where these clinicians work

Physician arrivals from the banned countries rose from 350 in 2010 to 459 in 2023, about 2.5% of all physicians who entered the country that year. Nurse arrivals went from 189 in 2010 to 368 in 2022, roughly 1% of the total. Iran, Venezuela and Cuba sent the most physicians over the study period; Cuba, Haiti and Iran sent the most nurses.

Year over year, those numbers add up. By 2023, clinicians from the banned countries accounted for 2.15% of all U.S. physicians and 1.41% of all U.S. nurses, the authors reported, a combined presence of nearly 24,000 physicians and about 56,000 nurses.

Notably, counties with at least one physician from a banned country were more than twice as likely to be designated a primary care health professional shortage area. They also had higher shares of Hispanic and Black residents and fewer high school graduates. The pattern repeated for nurses, and in the 222 counties with at least one nurse from a banned country, those nurses made up more than 14% of the local nursing workforce.

Ultimately, the authors concluded that the ban could reduce the physician and nurse workforce and worsen access to care in underserved communities, and given the administration's posture on immigration, clinicians from other countries are unlikely to make up the difference.

A shortage years in the making

The Association of American Medical Colleges (AAMC) projects a shortfall of up to 86,000 physicians by 2036, including as many as 40,000 primary care physicians. An aging population and an aging physician workforce drive most of it, and a federal cap on Medicare-funded residency slots, frozen at 1996 levels under the Balanced Budget Act of 1997, has held training capacity back ever since.

Jason Goldman, M.D., MACP, immediate past president of the American College of Physicians, stopped hedging on the projections a while ago. "It has always been a challenge in getting physicians into the areas we need them, especially when you look at all the challenges we face, the dwindling reimbursements, the administrative burden," he told Medical Economics. "We need more physicians. More specifically, we need more primary care physicians."

The math of the career path, he said, pushes new doctors elsewhere. Medical school debt now runs higher than the cost of a first house, followed by years of comparatively thin primary care reimbursement, so "there is an incentive now for people to go into high paying specialty fields and not primary care," Goldman said. Patients feel it: "That doesn't just hurt the physician workforce, it hurts their patients, because they don't have access to the care that they need."

An underused fix

The system has long depended on clinicians trained abroad. Tom Price, M.D., the orthopedic surgeon who served as the 23rd secretary of Health and Human Services, has argued that employment-based immigration is a workforce tool the country keeps leaving on the table.

"The shortage in health care workers has been going on for a long time, decades," Price said in an interview with Medical Economics. He pointed to the roughly 15 million people in the health care workforce, about a fifth of them born outside the U.S., and to the foreign students who train here and then leave. "They finish their training, they finish their education, and then we tell them to go home," he said, "instead of saying, ‘we'd love to have you stick around and use your expertise that you've learned here.’"

Price's pitch is a merit-based visa pathway weighted toward rural and underserved areas. "A merit-based visa program would be incredibly helpful, and it would just be adding on to the current system that we already have, but expand the numbers," he said. He noted that immigration is only half the bottleneck: because Medicare funds most graduate medical education, the number of residency slots is capped too.

"There's always something that's sucking the oxygen out of the room or pushing common sense things to the side," Price said, adding that he sees room for bipartisan agreement on the idea.

He also rejected the argument that the country has enough doctors and simply spreads them poorly. "Some people will argue that there isn't a shortage,” he said. "That it’s just a problem of distribution. But there's a physician shortage." The same gaps, he added, run through nursing, long-term care aides and therapists.