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UNDER TRUMP - FOREIGN DOCTORS IN THE US
Trump’s immigration crackdown hits MAGA-supporting areas of America the hardest
By The Immigrant Times
Junior doctors from India aiming to work in the US will mainly practise in hospitals and general practices in rural areas, mostly in the Midwest, which voted for President Trump in the 2024 elections.
May 2026: The United States relies on tens of thousands of doctors (physicians) trained abroad to staff its hospitals and clinics. They are mainly concentrated in rural communities and Midwestern states that form the core of Donald Trump's electoral support, the very areas least able to cope with the effects of his administration's immigration crackdown. A sweeping freeze on visa and green card processing, launched at the start of 2026, left many doctors in legal limbo, forcing some hospitals to remove them from duty. A partial reversal occurred within weeks, indicating the administration had belatedly recognised the damage.
An ill-thought-out immigration crackdown
In the early months of 2026, the Trump administration’s expanding immigration enforcement targeted a new group of migrants: the foreign-born doctors working in American hospitals, clinics, and residency programmes.
A presidential executive order issued on 16 December 2025, which took effect on 1 January 2026, expanded an earlier travel ban from June 2025 that had already restricted entry from 19 countries. The new proclamation extended these restrictions to 39 countries, with complete entry bans for nationals from Iran, Afghanistan, Haiti, Syria, and Yemen, among others. While the initial aim was to limit new arrivals, the administrative repercussions extended much further.
The Department of Homeland Security, then headed by Secretary Kristi Noem (succeeded on 31 March 2026 by Senator Markwayne Mullin), imposed a freeze on processing immigration benefits for nationals from all 39 affected countries. This meant that foreign doctors already legally working in the United States, holding J-1 exchange visitor visas or H-1B specialised worker visas, had their applications for renewal, work permits, and green cards suspended indefinitely. The doctors had not broken any laws; many had been in the US for years, completing residencies and establishing careers. However, they were nationals of countries now considered high-risk, and that was deemed enough.
The consequences were swift. Some hospitals placed doctors on administrative leave, unable to verify their right to work while applications remained frozen. Across the country, according to the Cato Institute, approximately two million immigration applications were affected by the broader policy, of which around 240,000 were for green cards.
The American Medical Association (AMA), along with more than 50 medical speciality societies, wrote to the Department of Homeland Security, urging clarity on the status of doctors, residents, and fellows. Hospital administrators warned that the loss of foreign-trained doctors would worsen existing staffing shortages, especially in emergency medicine, internal medicine, and psychiatry.
A quiet policy reversal
In early May 2026, facing increasing pressure from medical authorities, the government quietly lifted the freeze without issuing a formal statement. The US Citizenship and Immigration Services (USCIS) updated its website to show that applications involving medical doctors would still be processed, exempting them from the broader suspension.
The reversal, however, was only partial. Doctors already in the United States regained the ability to renew their visas and green card applications. However, foreign doctors and incoming medical residents currently outside the country remained barred from entry under the travel ban.
A further obstacle remained. In September 2025, the Trump administration introduced a $100,000 fee on new H-1B visa applications, the primary visa route for specialist workers, including doctors, with effect from 21 September 2025. The White House indicated that doctors might be exempted if officials determined the cases to be in the national interest, but no formal exemption had been confirmed. The AMA and its allied organisations continued to press Secretary Mullin for clarification.
The episode highlights the pattern that has come to define Trump administration immigration policy: broad restrictions implemented through executive order, often with unintended effects on groups of migrants not explicitly targeted, followed by ad hoc adjustments when the consequences become politically inconvenient. Foreign doctors, serving communities that voted most strongly for Trump, in rural and small-town America, most reliant on internationally trained medical staff, proved to be one category too costly to abandon.
Foreign doctors in the US
The United States has relied on doctors educated abroad for over 50 years. That reliance has grown in recent decades, and by 2026, it became embedded: remove foreign-trained doctors from the American health system and key parts of it would stop working, especially in areas with the greatest medical needs.
Over 230,000 licensed international medical graduates practise in the United States, coming from over 2,000 medical schools across 169 countries. They account for about a quarter of the entire physician workforce, one in four doctors. In 2025, nearly 9,800 international medical graduates secured first-year positions in accredited US graduate medical education programmes, representing more than a quarter of all matched applicants.
The proportion has increased steadily. In 1970, foreign-trained doctors accounted for a smaller part of the workforce; by 2025, that figure had risen by 18 per cent in relative terms. The trend reflects both a long-standing failure to train enough doctors domestically and an immigration policy, originating with the Hart-Celler Immigration and Nationality Act of 1965, that was explicitly designed to address the shortfall.
The largest proportion of foreign-trained doctors in the United States originates from India, followed by Pakistan and the Philippines, with Nigeria becoming an increasingly important source country in recent years. Citizens of Canada, Middle Eastern nations, and various Caribbean countries have also significantly contributed to the workforce. Recently, the majority of new arrivals have come from India and Pakistan, reflecting both the extent of medical training in these countries and well-established migration pathways.
The countries affected by the 2026 travel ban, Iran, Afghanistan, Haiti, Syria, and Yemen, among them, represent a smaller but nonetheless significant portion of the medical foreign doctor population. More recently, Syrian doctors, often trained in Germany and other European countries, have moved to the US.
The distribution of foreign-trained doctors within American medicine is unequal. They tend to cluster in specialities that American-trained doctors have historically been less willing to pursue: primary care, internal medicine, family medicine, and paediatrics. By 2025, international medical graduates will fill 45 per cent of all internal medicine residency positions and consistently account for more than 30 per cent of family medicine residents. In psychiatry, 22 per cent of the entire workforce is internationally trained.
These specialities share a common feature: they tend to be less financially rewarding and less prestigious than surgical or procedural fields, and they mainly serve low-income and elderly patients.
A survey of international medical graduates revealed that two-thirds practise in regions designated as Health Professional Shortage Areas by the federal government, communities lacking sufficient access to basic healthcare. In a sample of 15,000 doctors who started new roles within a single year, foreign-born doctors were nine times more likely to choose primary care specialities than their American-trained counterparts.
Geographically, Florida and California have the highest proportions of internationally trained doctors. New Jersey and New York have nearly 40 per cent of their physician workforces composed of foreign-trained graduates.
However, it is in rural Trump-voting America and midwestern states like North Dakota, where about half of internal medicine residents are international graduates, that reliance is most severe. In some hospitals and rural areas, foreign-trained doctors make up between a third and the majority of all medical staff.
This dependence on foreign-trained doctors is not a recent measure. It highlights a longstanding structural deficit in American medical education that has lasted for decades and is expected to worsen considerably.
According to the Association of American Medical Colleges (AAMC), the United States will face a shortage of between 13,500 and 86,000 physicians by 2036. The main cause is demographic. The American population aged 65 and over is expected to grow by 34 per cent from 2021 to 2036, with those aged 75 and over increasing by nearly 55 per cent. Since older patients use significantly more healthcare, the demand for doctors, especially geriatricians, cardiologists, internists, and family practitioners who treat the elderly, will rise sharply.
Meanwhile, a large part of the current doctor workforce is also ageing: those aged 65 or over already make up 20 per cent of the active clinical workforce, with another 22 per cent aged 55-64. More than four in ten active doctors will reach retirement age within the next decade.
A skill transfer from poor countries to the wealthy West
America’s, as Western Europe’s, dependence on foreign doctors carries a cost borne elsewhere. Most foreign-trained doctors who practise in the United States received their medical education at the expense of their home countries’ taxpayers. India, Pakistan, Nigeria and the Philippines train doctors who then emigrate to wealthier health systems, a transfer of human capital that the World Health Organisation (WHO) has described as ethically troubling.
The WHO urged member states to consider the consequences of unidirectional recruitment from developing to developed countries, noting that attempts to resolve the doctor shortage in the United States had, at times, intensified health crises in the countries those doctors left behind.
During the COVID-19 pandemic, the tension became acute: the United States was actively recruiting foreign doctors while India was attempting to prevent the emigration of its own trained medical staff.
Sources and methodology:
Statistics on international medical graduates in the United States are sourced from the Association of American Medical Colleges (AAMC), the National Resident Matching Program (NRMP), the American Medical Association (AMA), the American College of Surgeons (ACS), and the American Medical Women’s Association. Physician shortage forecasts are based on the AAMC’s 2024 update of its Physician Supply and Demand: Projections from 2021 to 2036, and the Health Resources and Services Administration’s (HRSA) 2024 National Center for Health Workforce Analysis. Policy developments are reported by CNN, Newsweek, the Washington Examiner, and by an immigration law firm in analyses published in May 2026.
* A note on terminology
In American medical usage, the term ‘physician’ is interchangeable with ‘doctor’ and is the standard professional designation. In this article, The Immigrant Times uses ‘doctor’ throughout. American sources and data sets typically refer to ‘International Medical Graduates’ (IMGs), a category that covers any doctor who obtained their primary medical qualification outside the United States or Canada, regardless of nationality.
Further reading from The Immigrant Times: Foreign doctors in Europe || Foreign doctors in Germany || Filipino care workers in Britain || Foreign doctors in Germany, France, Italy, Sweden, the Netherlands and the UK || Poland, an exporter of doctors ||
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