President Trump has signaled his intent to pause deportations on immigrant workers in the hotel, agriculture and restaurant sectors: an important step toward lowering the temperature that led to riots in the streets of Los Angeles last week.
It’s welcome news for millions of hardworking individuals. But it ignores another important industry demographic, one we can’t exist without, where millions more will continue to live in perpetual fear: immigrant health care workers.
Today, over 20 percent of doctors who practice in America were born outside the U.S., a number that has grown by 30 percent since 2004.
Not surprisingly, a large number of physicians who trained overseas today serve rural and underserved U.S. populations — marginalized communities that already suffer from compromised access to quality medical care. While some are U.S. citizens who attended international medical schools, “most” are from other countries of origin.
Specifically, a report by the American Immigration Council found that over a third of doctors in America who practice in areas where poverty is high were trained outside of the U.S. In places where the majority of the population is nonwhite, it’s over 35 percent. In regions where annual per-capita income is lower than $15,000, it’s over 40 percent.
Proposed cuts to Medicaid will further decrease access to care and likely result in rural hospital closures.
U.S. reliance on immigrant physicians to serve underprivileged communities is “due, in part, to America’s growing and aging population,” says Selma Hedlund, a Boston University postdoctoral associate.
Hedlund argues many U.S.-born doctors have an “unwillingness to move to poorer and more rural areas” due to a “lack of interest in going into primary care, which can be less lucrative and prestigious than other areas of medicine.”
It’s why immigrants are “indispensable in hospitals and clinics across the nation,” she says.
Sadly, we’re giving these medical professionals reason to wonder if they made the right decision. Foreign-born physicians require federal visas to live and practice in America, a “privilege” the U.S. State Department has made clear it will use as a weapon, decreasing the nation’s ability to provide basic care across the country.
The ongoing immigration debate will likely raise even more questions in the minds of both foreign-born doctors who are here and those considering emigrating to America.
Such as: Will they feel safe to practice in America when immigration status is a flash point in urban and rural communities? When U.S. officials signal to the world that immigrant visas can be revoked at any moment, will foreign-born doctors want to bring their skills, and their families, to a place that says to the world: “We don’t want you here”?
The impact on the health care system goes beyond doctors. Immigrants make up a sizable portion of the healthcare support workforce, too.
Legal and undocumented individuals comprise nearly 30 percent of direct-care workers in America. Over 16 percent of nurses on staff are immigrants. Over 800,000 people served in this capacity in the U.S. as of 2023: 500,000 of them were naturalized citizens, and over 300,000 were noncitizen immigrants.
Immigrants also represent a significant percentage of the home-care workforce. One out of every three, to be exact. Over 20 percent of staff in nursing facilities and nearly a quarter of those who work in residential care environments came from other countries.
These individuals play a vital role in caring for the elderly, the disabled and supporting the needs of overcrowded hospitals and emergency rooms. And as our population increases, we will need more of them, not less.
Today, 75 million baby boomers in America will soon need long-term care services. Without immigrants, America will not be able to address the needs of this fast-growing community.
Our immigration system is broken. We must find sustainable and dignified paths for those who currently live here illegally, and those who wish to enter. Immigrants who provide critical health care services for a large segment of the U.S. population need to know they are welcome and appreciated.
Implementing responsible immigration reforms while ensuring the stability of the U.S. health system that relies on a strong immigrant workforce isn’t mutually exclusive. We can achieve both if the political will is there.
But it doesn’t stand a chance if our immigration crackdown is interpreted as a warning shot to skilled doctors and caregivers around the world that America is no longer a viable place to build a career.
We must value, not vilify, the role immigrants play in supporting our nation’s public health. And we must encourage more to come, not give them reasons to question what will happen to them if they do.
Lyndon Haviland, DrPH, MPH, is a distinguished scholar at the CUNY School of Public Health and Health Policy.