Immigration reform meets primary care: How the Dignity Act of 2025 could help ease the workforce shortage

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Since the COVID-19 pandemic, America’s long-standing workforce gap in the health care sector has accelerated into an all-out crisis in 2025.

A perfect storm of sorts has sent the sector, especially primary care, into a downward spiral of constant staffing shortages that have made patient care a challenge at best. A rapidly aging population, increased burnout within the staff ranks and a declining interest in primary care among medical students are all working together to cut off the pipeline of available physicians, nurses and support staff.

While this situation has been picking up steam, an outdated immigration system that is deeply entangled in a political stalemate is making a bad situation far worse. For primary care practices, it means a limited pool of available health care workers, stymied by limited legal pathways for foreign workers who could otherwise help stabilize the health care workforce.

John Dorer
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This has no doubt been a tough situation for physicians who are just trying to keep their practices afloat with patient care always at the forefront. There is hope, however, with the Dignity Act of 2025, recently introduced in Congress by Republican Rep. María Elvira Salazar of Florida and Democratic Rep. Veronica Escobar of Texas. It’s a bipartisan immigration reform bill that would provide needed relief, opening new doors for immigrant workers and bringing much-needed relief to the physicians tasked with hiring them.

The bill includes solutions to a broad range of ongoing immigration issues. Covering everything from border security to legal status for undocumented immigrants, the provisions in the bill could have a net positive effect on hiring, especially in primary care settings.

A primary care shortage decades in the making

The numbers tell a grim story for the health care sector overall. The Association of American Medical Colleges (AAMC) is predicting the shortage of physicians will reach a staggering 86,000 by 2036. Of those, the vast majority of 55,000 are in primary care alone.

There are some 74 million Americans already living and trying to access primary care in areas of the U.S. hit hardest by the shortage. For these Health Professional Shortage Areas (HPSAs), even the most basic preventive care services are exceedingly difficult to access due to the shortage of health care professionals.

Here are some of the most salient factors, including tightly intertwined trends, that are contributing to the health care shortage:

• An aging workforce: Nearly 40% of active physicians are over 55.
• Burnout: Accelerated by COVID-19, many physicians are retiring early or reducing hours.
• Economics: Primary care often pays less, discouraging new graduates.
• Immigration bottlenecks: International medical graduates (IMGs), nurses and caregivers face long waits for green cards and limited visa options.

All of this has resulted in a health care system that is increasingly dependent on immigrant workers. At the same time, it’s made it equally difficult for immigrant workers to enter primary care, stay and advance professionally.

What is the Dignity Act of 2025?

The new Dignity Act of 2025 is a comprehensive immigration reform proposal that attempts to bridge decades-long partisan bickering on immigration policy with four main components:

• Border security: Investments in technology, infrastructure and enforcement to secure the southern border.
• The Dignity Program: A legal status program for undocumented immigrants who have been in the U.S. for at least five years, requiring them to pay restitution, pass background checks and maintain employment.
• Modernized employment-based immigration: Reforms to expand and streamline legal immigration pathways for workers across key sectors, including health care.
• Mandatory E-Verify: Nationwide requirement for employers to use E-Verify to confirm work eligibility.

Immigration reform has had a rough road in recent decades, repeatedly failing to pass through Congress. The Dignity Act stands out as a bipartisan effort that focuses on both border enforcement and remedies for the workforce shortages impacting health care and numerous other industries. In fact, this may be one of the few times immigration reform has a chance to gain real traction in a highly divided Congress.

How the Dignity Act could impact health care hiring

While it wasn’t specifically written to address the workforce shortage in health care, the Dignity Act includes multiple provisions that could ease the shortage dogging primary care practices.

1. Expanded legal pathways for health workers

Among the key aspects of the bill is modernizing the employment-based visa system. This could increase the number of green cards available annually and improve processing times. If passed, it would benefit the following:

• International medical graduates (IMGs) waiting years for permanent residency
• Nurses and home health aides who qualify under the EB-3 “other workers” category
• Foreign-trained health professionals seeking legal entry to fill open roles in rural areas

An accelerated timeline built on more predictable immigration processes would allow clinics and health systems to plan more long-term staffing while reducing their dependence on high-cost locum tenens arrangements.

2. Legal status for undocumented health workers

There are currently hundreds of thousands of undocumented immigrants working in health care. Many of them serve in roles as home health aides, caregivers or support staff. The Dignity Program would provide a clear path to legal status for those who meet strict requirements. These include restitution payments, background checks and consistent employment history.

Not only does this improve the lives of immigrant workers, it helps everyone else in the clinic. It reduces turnover, prevents other workers from being forced to take too much work, boosts morale and, most importantly, increases patient continuity, all key components to quality primary care.

3. Workforce support in underserved communities

The Dignity Act encourages job placement and worker mobility in industries with chronic shortages, which could complement existing J-1 visa waiver programs and other rural recruitment efforts. While the bill doesn’t directly modify physician visa rules, it could create a more supportive ecosystem for health care hiring in high-need regions.

Primary care: The front line of impact

Compared with other health care sectors, primary care is disproportionately affected by the worker shortage. Unlike specialists, for example, primary care physicians often work in small practices. They often serve vulnerable populations and rely heavily on nonphysician staff. These practices stand to gain the most from Dignity Act reforms, which would stabilize both the professional and support workforce. Such reforms include the following:

• Support retention of IMGs and allied health professionals
• Boost diversity and language access, improving care for multicultural patient populations
• Help independent practices compete with large systems for talent

It’s not a stretch at all to view the health of our immigration system as being directly tied to the health of our primary care infrastructure in the United States.

What health care leaders should know

The Dignity Act certainly isn’t perfect, and it’s not going to fix everything in one fell swoop. It’s a challenging political path for an issue that has failed to gain support time and time again.

Critics argue that its E-Verify requirements could add to compliance burdens, especially for those small practices like primary care offices. Others are concerned that its enforcement-heavy provisions could discourage bipartisan support.

Despite such concerns, the Dignity Act presents America with a rare opportunity to link immigration policy with the workforce realities of today. Health care organizations, particularly those in primary care, should do the following:

• Monitor the bill’s progress closely
• Advocate for workforce-friendly amendments
• Prepare for compliance with E-Verify and other employment-related rules
• Recognize that immigration reform is also health care reform

Conclusion: A turning point for health workforce policy?

The primary care crisis facing the U.S. won’t be solved overnight. It also won’t be solved without immigration reform. The Dignity Act of 2025 offers a two-pronged approach to a framework that acknowledges both our need for secure borders and our urgent workforce gaps.

For clinics, hospitals and health systems trying to deliver accessible care, this legislation could very well turn out to be the pivotal piece of this puzzle. Immigration policy is health policy. It’s time we treated the two as being inseparable!

John Dorer is a global mobility executive with a focus on employer-sponsored green card solutions and the CEO of EB-3 Staffing Solutions for Employers. Headquartered in New York City, eb3.work is the leading company in the U.S. that provides effective solutions in addressing the country’s chronic and growing unskilled and entry-level labor shortage by connecting employers with foreign nationals seeking to work legally in the United States. eb3.work leverages its proprietary business processes and technology to assist qualifying U.S. companies and foreign national workers in navigating the complex U.S. immigration system.