The immigrant physicians holding up U.S. healthcare

The intersection of healthcare and immigration policy is found in the halls of hospitals and clinics across America, where increasing numbers of International Medical Graduates (IMGs) are filling in for doctors who won’t return, and state governments are doing their best to usher IMGs into practice where they’re sorely needed.

Help (Badly) Wanted: Foreign Doctors Apply Within

In 2023, Tennessee became the first U.S. state to drop residency requirements for some IMGs,¹ giving them a new pathway to permanent licensure. Following Tennessee’s (somewhat surprising) lead, at least 15 states have introduced legislation to create streamlined pathways to medical practice for IMGs, with both Republican and Democrats contributing.²

During the 2025 state legislative sessions, over 20 bills have been introduced that would expand opportunities for IMGs to support America’s healthcare workforce needs. These range from allowing qualified DACA recipients to apply for licensure in New York to removing redundant training requirements in Montana.³

Some state legislation is more focused in scope. For example, in Illinois, IMGs must not only be legally able to work in the U.S., but are also mandated to work in medically underserved areas.

Perhaps most shockingly, in 2024 Governor Ron DeSantis of Florida signed the “Live Healthy” initiative to allow IMGs to bypass residency requirements if they have equivalent training experience. But then, the largest population of IMGs is in geriatric medicine, where they make up more than half of the physician population. And, well, it’s Florida.

Already at their shift

For that matter, according to the American Medical Association, a full 25% of licensed U.S. physicians are IMGs,⁴ with the largest number coming from India, followed by the Caribbean, Pakistan, the Philippines, and Mexico.

This is where the cognitive dissonance comes in– or at least, it should.

The new administration’s condemnation of everything related to equity and diversity, coupled with its rabid pursuit of an America free from immigrants, is simply incompatible with this reality. The reality is that massive numbers of the country’s doctors come from foreign countries, and are supported by legislation and advocacy work focusing on combatting racial and ethnic disparities.⁵ ⁶

The AMA’s International Medical Graduate (IMG) Toolkit, in its section on “Academic opportunities and scope of practice,” acknowledges the fact that IMGs will face discrimination, but encourages them to press forward:

IMG physicians face several barriers in their goals and aspirations towards a career in academic medicine. . . Systematic exclusion is also a reason leading to discrepancies in leadership positions and promotions among IMG physicians. Despite challenges, IMG physicians are encouraged to choose an academic career as diversity is a strong determinant of innovation in medicine.”⁷

Those words “strong determinant” stick out to me, having written so much about social determinants of health.⁸⁹¹⁰

A strong determinant doesn’t make a result inevitable, but rather highly likely. “You have something to contribute,” this guidance says, “So don’t give up in the face of discrimination. Keep trying, because we need you.”

I wonder if America is aware of how much we need IMGs, and how opponents of “DEI” and immigration reconcile their views with this reality.

Wait, actually I don’t. The reality itself is what matters– it’s where IMG physicians can, and do, make an enormous difference.

Let’s hope they never stop.

Giant If