What Immigration Policy Changes Mean for America's Health Care Workforce

One in three medical residency positions in the United States cannot be filled by American graduates alone. Twenty-seven percent of physicians practicing today are foreign-born. Twenty percent of hospital workers are immigrants.

In Florida, a large share of home health care workers are immigrants as well. These numbers aren't abstractions — they are the backbone of a health care system that is now under strain from a wave of federal immigration policy changes.

I recently joined Julie Rovner of KFF Health News on the "What the Health?" podcast (Episode 442, aired April 17, 2026) to talk about how the Trump administration's immigration policies are affecting the medical workforce. The conversation covered a lot of ground, and I wanted to share some of the key points here for clients and colleagues who are trying to make sense of what's happening.

Legal immigration, not just illegal immigration, is being reshaped

Much of the public conversation about immigration enforcement focuses on illegal immigration. But a great deal of the disruption we're seeing in health care staffing comes from changes to the legal immigration system: suspended J-1 visa processing, an added penalty on H-1B petitions, and visa bans affecting workers from 75 countries in some categories and 39 in others. Thousands of health care workers are currently stuck outside the United States as a result.

The effects go well beyond doctors

When we talk about immigrant health care workers, the conversation usually centers on physicians. But the workforce is much broader than that. Immigrants fill critical IT and technical roles that keep hospital systems running, staff research labs, and — especially here in Florida — provide the bulk of home health care for our aging population. Much of that home care workforce is made up of Haitian workers on Temporary Protected Status or asylum seekers with work authorization. When that workforce shrinks, there is no technological substitute waiting in the wings.

Rural and underserved communities feel it first

J-1 and H-1B physicians disproportionately staff veterans' hospitals and rural medical facilities — the same communities the administration says it wants to serve. As those pipelines dry up, patients in these areas are traveling farther for specialty care, and some are forgoing care altogether because of the added cost and inconvenience. It's also affecting the residency pipeline: international medical graduates make up a meaningful share of positions that keep hospitals staffed, and it takes seven to fifteen years to train a physician domestically. There is no quick way to backfill that gap.

Where this leaves employers and workers

For the hospitals, clinics, and other employers we represent, the last year has meant a lot of uncertainty. Many of these policies are being challenged in court, but the practical damage — cancelled hires, stalled visa processing, workers looking elsewhere — is happening in real time, well before any litigation resolves. Employers who have long relied on foreign-trained talent are increasingly forced to scale back services rather than risk further disruption.

What would actually help

Congress has the ability to close the gaps that make it possible for these disruptions to happen so quickly and with so little structure — for example, by creating a durable pathway for long-term TPS holders and by limiting the executive branch's ability to impose broad, categorical visa bans. Support from hospitals, professional organizations, and the courts (including amicus participation in the pending litigation) will also matter in the meantime.

My concern is that the impact of these changes won't be widely felt until it's too late to reverse course easily.

Rebuilding a health care workforce pipeline, once it's disrupted, takes years, not months.

Listen to the full interview: "What the Health?" from KFF Health News, Episode 442