Immigrant Physicians Help Sustain U.S. Health Care as Policy Changes Add Pressure to Already Strained Workforce

New report uses kidney specialists as a case study of how shifting policies could affect patients, hospitals and communities nationwide

WASHINGTON, DC — Internationally trained physicians serve an essential role in the U.S. health-care workforce, accounting for more than one-quarter of the nation’s 1 million active physicians and filling critical needs in many specialties already facing shortages. But a series of recent and proposed Trump administration policy changes could make it harder for international medical graduates (IMGs) to enter, train and remain in the United States—with effects for hospitals, clinics and patients already experiencing existing and projected doctor shortages.

A new Migration Policy Institute report examines these broader workforce dynamics through the lens of nephrology, the medical specialty focused on kidney care. Foreign-trained physicians made up 54 percent of practicing U.S. nephrologists in 2024—the largest share of any medical specialty, MPI’s data analysis finds. IMGs also comprised 61 percent of nephrology fellows, who represent the next generation of specialists.

The report, Physicians in an Era of Changing Immigration Policy: The Case of Nephrology, finds that the nation’s growing need for kidney care is colliding with a workforce pipeline already under strain. One in seven U.S. adults (37 million) have chronic kidney disease, with more than 866,000 living with kidney failure as of late 2025. At the same time, a significant nephrologist shortage is looming, with federal projections estimating the supply will meet only 85 percent of demand by 2038.

“International medical graduates are integral to the U.S. health-care system, with their contributions particularly significant in specialties and communities where physician shortages are already acute,” said MPI Senior Policy Analyst Jeanne Batalova, a co-author of the report. “So policies that make training, hiring or remaining in the United States less predictable could have consequences well beyond immigrant physicians themselves.”

The report, supported through a grant from the American Society of Nephrology, finds that the challenge is especially consequential in rural and underserved communities. As of 2023, 72 percent of U.S. counties had no nephrologist, with more than three-quarters of those counties in nonmetropolitan areas. Among nephrologists practicing in non-urban settings, 67 percent of IMGs worked in federally designated Medically Underserved Areas, compared with 55 percent of U.S. medical graduates.

The United States cannot quickly replace the specialists it may lose from the pipeline. Training a nephrologist generally requires at least 13 years after high school. Although expanding domestic training and increasing interest in nephrology among U.S. medical graduates remain important long-term goals, the report finds that these approaches cannot substitute for retaining and recruiting IMGs. 

Interest in nephrology among U.S. medical graduates has declined even as fellowship capacity has expanded. In the 2026 fellowship match, 33.5 percent of nephrology positions went unfilled, compared with 5.9 percent in 2010. The report concludes that the large role played by IMGs in nephrology should not be characterized as displacing U.S.-trained physicians from the field.

“Policy decisions about immigration are also decisions about health-care capacity,” said report co-author Michael Fix, an MPI senior fellow. “In specialties with longstanding workforce shortfalls, reducing the supply of physicians does not create opportunities that would otherwise be filled domestically.”

Added Batalova: “For patients in rural communities across the United States who lack access to a nephrologist or those facing longer waits for their life-sustaining dialysis, immigration policy becomes health-care policy.”

The report examines policy developments in three interconnected areas:

• Immigration pathways for physicians. Trump administration changes to J-1 and H-1B visa policies, visa-interview procedures and adjustment-of-status rules, along with state restrictions on H-1B hiring, have increased uncertainty for foreign-educated physicians and the institutions that train and employ them. Some measures remain under litigation, have been blocked by courts or have not yet taken effect, making their ultimate effects uncertain.
• Health-care and medical-education financing. New limits on federal student borrowing for professional education and reduced federal matching funds for certain emergency care could constrain the ability of hospitals and training institutions to educate, recruit and retain all physicians, including IMGs.
• Patient access to care. Medicaid changes, narrowed eligibility for health coverage among certain immigrant groups, expanded public-charge considerations and changes affecting immigration enforcement and data confidentiality may discourage some patients from seeking care or interrupt their coverage. These developments could also further strain safety-net institutions.

The changing policy environment comes as the United States faces growing competition for medical talent. Its share of foreign-trained physicians practicing across Organization for Economic Cooperation and Development (OECD) countries fell from 48 percent in 2010 to 36 percent in 2023, as Canada, Ireland and the United Kingdom, among others, offer more predictable pathways for skilled health professionals.

The report recommends that policymakers and health-sector leaders assess immigration, financing and public-benefit changes together rather than in isolation; preserve predictable pathways for IMGs to complete training and practice; and consider the effects of policy changes on rural hospitals, safety-net institutions and other communities with longstanding physician shortages. It also emphasizes the need for continued investment in domestic medical education and efforts to make shortage specialties such as nephrology more attractive to U.S. medical graduates.

Read the report here: www.migrationpolicy.org/publication/physicians-immigration-nephrology. 

For all of MPI’s work on health care, visit: www.migrationpolicy.org/keyword/health-care.