This analysis synthesizes 7 sources published the week ending Aug 19, 2026. Editorial analysis by the PhysEmp Editorial Team.
Nearly half of America’s internal medicine workforce was born outside the United States—47.2%, according to a JAMA study published August 12. That single stat forces immigration policy into any serious conversation about physician supply. Hospitals planning staffing for the next decade now have to account for visa rules, travel restrictions, and fee structures that can change on a political whim. It matters for the Healthcare Workforce & Labor Market. Supply constraints increasingly start outside the traditional medical education pipeline.
The Dependency Runs Deeper Than Headlines Suggest
The ABIM study matched 249,679 board-certified internists to Medicare claims and found non-U.S.-born international medical graduates (IMGs) alone make up 36.1% of the internal medicine workforce. Another 11.1% were born abroad but trained at U.S. medical schools. Together, these physicians cared for 22.5 million Medicare beneficiaries in 2024.
The concentration is heaviest in subspecialties already losing ground. Non-U.S.-born IMGs account for 62.2% of nephrologists, 60.8% of sleep medicine physicians, and 59.8% of geriatricians. HRSA projects geriatrics at only 84% supply adequacy by 2038 and nephrology at 85%. The doctors most likely to close those gaps are the ones most exposed to shifts in immigration policy.
When 60% of your geriatrics workforce requires immigration status that can change with a single executive order, workforce planning effectively becomes immigration planning.
Who These Physicians Actually Serve
The JAMA data disputes the idea that foreign-born physicians merely plug holes anywhere. Their panels tilt toward patients U.S.-born physicians serve less often. Patients treated by non-U.S.-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 to live in high-poverty ZIP codes (19.8% vs. 15.9%).
They were also more likely to practice in federally designated medically underserved areas (21.5% vs. 19.9%) and primary care shortage areas (30.3% vs. 29.2%). The gap widened in the first three years after training—the same period covered by the Conrad 30 waiver program that keeps J-1 physicians in underserved communities.
The result: immigration restrictions hit hardest where access was weakest. A visa delay in nephrology doesn’t just leave a shift uncovered; it leaves a dialysis unit short in a rural area serving dual-eligible patients.
The Pipeline Is Already Narrowing
The 2026 Main Residency Match suggests policy uncertainty is influencing entry. Non-U.S. citizen IMGs matched to PGY-1 positions at 56.4%—the lowest in five years—even as their applicant pool rose by 479 to 11,944. Applicants needing visa sponsorship matched at 54.4%, also a five-year low. By contrast, U.S. MD seniors matched at 93.5%.
The $100,000 H-1B fee announced in a September 2025 presidential proclamation—still unenforceable after a June 2026 federal court ruling—already affected planning. More than 70% of hospitals surveyed by the American Hospital Association said the fee would change patient care. Among hospitals using or planning to use H-1Bs, 64% expected to pause, defer, or limit recruitment because of the cost.
Hospitals Placed Physicians on Administrative Leave
The 39-country travel ban caused immediate operational fallout. USCIS later exempted physicians from the adjudicative hold, but hospitals had already put some affected noncitizen physicians on administrative leave. The uncertainty fed itself: employers and prospective physicians factored policy risk into hiring and career decisions.
Immigration policy now acts as a de facto workforce allocation mechanism. The physicians most likely to serve underserved populations are also the most likely to face administrative barriers entering or remaining in practice.
The Eldercare Dimension
The internal medicine numbers sit on top of a larger demographic squeeze. In 2030, more Americans will die than are born—the year the youngest baby boomer turns 65. The CBO baseline assumes net immigration will rise toward 1.2 million annually by the mid-2030s; current net immigration is near 410,000.
Home health and personal care agencies must fill about 765,800 openings every year. Immigrants already do roughly a quarter of that work. The Bureau of Labor Statistics expects healthcare and eldercare to account for roughly two of every five new jobs the economy adds.
For physicians weighing careers, the specialties with the biggest projected demand—geriatrics, nephrology, primary care in underserved areas—are the ones most dependent on an immigration-sensitive pipeline. For hospital leaders, higher pay won’t fix delays caused by visa processing or by fee structures that change hiring patterns.
What Workforce Planning Now Requires
Immigration attorneys advising healthcare practices say the shift looks less like raids and more like administrative tightening: stricter I-9 completion, closer adherence to approved visa petition terms, and earlier renewal planning. Practices that treat immigration as a paperwork afterthought will find themselves short-staffed.
The ABIM launched a competency-based special consideration pathway in July, letting IMGs who completed internal medicine residencies abroad—and who were accepted into ACGME-accredited U.S. subspecialty fellowships—sit for certification exams. More than 150 physicians are in the pilot, and at least 4,000 could be eligible across subspecialties. It’s one of the few mechanisms currently widening the pipeline.
Nearly half of internal medicine depends on physicians whose presence in the U.S. rests on policies that can flip faster than medical school enrollment can respond. Hospitals and health systems that split immigration from workforce strategy are running a risk they may not see until a critical shift forces it into view.
Sources
Nearly Half of Internal Medicine’s Workforce Was Born Abroad New JAMA Study Finds – Medical Economics
America’s Healthcare Staffing Crisis — Also a U.S. Immigration Strategy – National Law Review
Immigration cuts could deepen U.S. eldercare shortage – Wisconsin Law Journal
Nearly Half of U.S. Internal Medicine Docs Are Foreign-Born Study Finds – Medscape
Non-US-Born Physicians Form Major Share of US Internal Medicine Workforce – Bioengineer.org
Physicians born abroad make up nearly half of internal medicine workforce in US – Healio
The truth about Trump’s vaccine order; Half of U.S. internal medicine workforce was born abroad; Medicare moves to fast-track devices — Morning Medical Update Weekly Recap – Medical Economics
