The US healthcare system has quietly come to depend on foreign-born physicians to fill gaps in the workforce, especially in rural reas
The U.S. consistently creates more residency positions than it graduates, international medical graduates — especially noncitizens — fill an increasing number of those roles, disproportionately taking the primary care jobs, rural postings and Medicaid-heavy patient panels that domestic graduates often pass over. That reliance has now collided with a wave of federal immigration restrictions, and a new study published Aug. 12 in JAMA puts a number on exactly what’s at stake.
Here are 10 takeaways from the report:
1. Non-US-born physicians accounted for 47.2% of the US internal medicine workforce in 2026. Giacomo Meille, PhD, of the American Board of Internal Medicine in Philadelphia, and colleagues examined all 249,679 physicians certified in internal medicine by ABIM between 1990 and 2025. Of the current workforce, 36.1% are IMGs born and trained abroad, and another 11.1% were born outside the US but completed their medical training domestically.
2. Non-US-born IMGs make up at least 27% of every internal medicine subspecialty the researchers studied, and more than half of physicians certified in nephrology, geriatrics and sleep medicine.
3. India and Pakistan supplied the most non-US-born physicians by a wide margin — physicians born in India alone account for 10.8% of the entire internal medicine workforce, the single largest source country outside the US. The pattern isn’t unique to internal medicine: immigrants make up 27% of physicians and surgeons across all specialties, according to federal workforce estimates, but the new data show how much more concentrated that reliance becomes within internal medicine’s subspecialties.
4. Dr. Meille’s team also linked the data to 2024 Medicare claims and found non-US-born physicians treated 22.5 million traditional Medicare beneficiaries that year. Compared with patients treated by US-born, US-trained physicians, patients treated by non-US-born IMGs were more likely to be Black (9.5% vs. 7%), Latino (6.6% vs. 3.9%), dually eligible for Medicare and Medicaid (20.9% vs. 11.7%) and living in high-poverty ZIP codes (19.8% vs. 15.9%). The gap was widest in physicians’ first three years after training — the window covered by the Conrad 30 waiver program, which allows physicians on J-1 visas to remain in the US if they practice in underserved areas.
5. The authors frame those numbers against a fast-moving set of immigration policy changes. Recent travel bans covering 39 countries, expanded social media vetting for visa applicants, and a new $100,000 fee for H-1B petitions filed from outside the US have all disrupted the physician pipeline, they wrote.
6. Even after physicians were exempted from the travel ban, some hospitals placed noncitizen physicians from the affected countries on administrative leave. The 2026 Main Residency Match rate for non-US-citizen IMGs fell to its lowest point in five years.
7. The $100,000 fee alone is already reshaping hospital recruitment. In an American Hospital Association survey of more than 1,000 health systems and hospitals, 64% of respondents using or planning to use H-1B visas said they would pause, defer or limit recruitment because of the fee, and more than 70% said they expect it to directly affect patient care.
8. More than 10,000 physicians on H-1B visas were left unable to work as a result of the changes, even though H-1B-sponsored physicians made up just 1% of all practicing US physicians in fiscal year 2024 — a workforce that still ran a shortage of 64,000 physicians that same year.
9. Twenty states have sued to block the fee, including in State of California v Noem, and the American Medical Association and AHA have both pushed Congress for a healthcare-specific exemption. A bill introduced in March remains in the House Judiciary Committee.
10. Dr. Meille and his co-authors — all current or former ABIM employees or board members — conclude that the immigration changes “may substantially affect internal medicine subspecialties that depend extensively on non–US-born IMGs,” and that “these policies may also further increase disparities in health care access among underserved populations.”
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