As families across the United States celebrate the holidays, many will quietly appreciate the healthcare professionals who keep their loved ones healthy. Yet few may realise just how many of those critical nurses and doctors were born outside the country, or how immigration debates in Washington could directly affect their future access to care.
The Vital Role of Immigrants in American Healthcare
An economist studying immigration's impact on economies reveals a consistent finding: immigrants form a crucial part of the healthcare workforce, particularly in roles already facing severe staffing shortages. Current policy shifts, however, including increased visa fees, stricter eligibility rules, and enforcement actions, threaten to undermine this workforce precisely when it is needed most.
The United States is heading towards a projected shortfall of up to 86,000 physicians by the year 2036. Simultaneously, hospitals, clinics, and elder-care services are expected to add roughly 2.1 million jobs between 2022 and 2032, many in front-line caregiving. For decades, immigrant health workers have filled gaps where US-born workers are scarce, serving as doctors in rural clinics, nurses in busy hospitals, and aides in care homes.
Nationally, immigrants constitute about 18% of the total healthcare workforce, with a higher concentration in critical positions. Strikingly, approximately one in four physicians, one in five registered nurses, and one in three home health aides are foreign-born.
A State-by-State Reliance on Foreign-Born Staff
State-level data underscores how deeply embedded immigrants are within the system. In California, immigrants account for one in three physicians, 36% of registered nurses, and 42% of health aides. On the opposite coast, immigrants make up 35% of hospital staff in New York state, rising to a majority 57% of the healthcare workforce in New York City.
This reliance is not confined to coastal states with large immigrant populations. In Minnesota, immigrants represent nearly one in three nursing assistants in care settings, despite comprising just 12% of the overall workforce. In Iowa, where immigrants are only 6.3% of the population, they provide a disproportionate share of rural physicians.
These patterns show that from urban hospitals to remote clinics, immigrants keep facilities running. Policies that reduce their numbers—through higher barriers or increased deportations—have direct consequences, including closed hospital beds and longer wait times.
The Looming Crisis: Demand Soars as Supply is Threatened
America's healthcare system is under unprecedented strain from an aging population and rising chronic conditions. The pipeline for new professionals is slow; training a doctor can take a decade. Immigrants have long bridged this gap, not only in clinical roles but also in medical research and innovation.
International students in STEM and health fields at US universities are a key part of this talent pipeline. However, surveys indicate a sharp decline in new international student enrolment for the 2025-26 academic year, driven by visa uncertainties and global competition. Smaller cohorts now mean fewer future doctors and researchers exactly when demand will peak.
While no major study has yet modelled the full impact of stricter immigration rules on healthcare staffing, experts warn that tighter visa rules and higher fees will likely intensify shortages. These policies create hiring difficulties and uncertainty, complicating efforts to staff hospitals and care homes when the system is already stretched.
The Human Cost: Delayed Care and Rising Risks
Patients do not experience staffing gaps as statistics; they feel them physically. A specialist appointment delayed by months can mean worsening pain or deteriorating conditions. Older adults without home care aides face higher risks of falls and medication errors. An understaffed nursing home turning away patients leaves families in crisis—scenarios already occurring in parts of the country with acute shortages.
The true cost of restrictive immigration policies will be measured in human suffering: months of untreated illness, preventable hospitalisations, and declining quality of life. Rural communities and urban care homes, which rely heavily on immigrant staff, will be hit hardest.
Most Americans will not analyse visa bulletins over their holiday dinners. But they will notice when it becomes harder to secure care for a child, partner, or aging parent. Aligning immigration policy with healthcare workforce realities will not solve every systemic issue, but tightening rules amid rising demand and known shortages guarantees further disruption. Policymakers must consider this link to ensure that when Americans reach out for care, someone is there to answer.
Bedassa Tadesse, a Professor of Economics at the University of Minnesota Duluth, authored the original analysis.
