When Mark Ryan, MD, left a large academic health system this summer to open an independent family medicine practice in Richmond, Virginia, he was motivated in part by a desire to continue caring for vulnerable patients. He wanted to practice without what he viewed as growing constraints on medical practice stemming from federal policy changes.

Ryan, now a family physician at Sanctuary Family Medicine, said he wanted to create a practice that would be more accessible to Spanish-speaking families and others who might struggle to obtain care.

Almost immediately, Ryan and his colleagues noticed a troubling pattern. Missed appointments and cancellations tended to increase whenever immigration enforcement activity was visible in the community.

“There has been a general sense that people have backed away from care,” Ryan said. “Folks have started to come to the clinic less often.”

Ryan’s observations reflect findings from a new national survey suggesting primary care clinicians are increasingly caring for patients whose fears about immigration enforcement are delaying medical visits, worsening anxiety, and straining the physician-patient relationship.

Nearly three quarters of clinicians surveyed reported that immigration enforcement activity had negatively affected their patients or their practice.

The survey, administered during the first quarter of 2026, followed two policy changes that raised concerns in clinicians caring for immigrant communities: the January 2025 rescission of federal protections designating healthcare facilities as sensitive locations for immigration enforcement, and a December 2025 court decision allowing Medicaid enrollee data to be shared with US Immigration and Customs Enforcement (ICE).

The findings, released in July by The Larry A. Green Center for the Advancement of Primary Health Care in Richmond, Virginia, reflect responses from 632 primary care clinicians practicing in 44 states.

Rebecca Etz, PhD, codirector of The Larry A. Green Center, said the findings point to an erosion of trust that extends beyond immigration status.

She said concerns about government access to personal information have left many patients feeling they are being surveilled. More than half of clinician respondents expressed concern about US citizens who speak a language other than English (57%) or who feel targeted because of their race (57%).

Heightened Patient Mental Health Concerns

Among clinicians reporting effects from immigration enforcement, 64% said immigration enforcement activity was affecting their patients’ mental health, and one third described it as a significant concern.

One family physician reported that immigration enforcement had caused “serious interruptions to medical care and to daily life,” leading to economic hardship, missed work, and lower school attendance. An internist said patients were experiencing worsening anxiety and depression amid ongoing uncertainty about changes affecting healthcare access.

Etz said she was not surprised by the findings because primary care depends on trust.

“Primary care is the first point of contact that many people have with the health system,” she said. “It is a place where you are supposed to be able to go, and the people who help you are worthy of your trust.”

Uncertainty surrounding immigration enforcement has made it more difficult for clinicians to reassure patients that the exam room remains a safe space, Etz said.

Ryan said the greatest barrier is often getting patients through the clinic door. “People don’t want to leave the house because they’re afraid of getting picked up,” he said.

Once patients arrive, he said, trust is often easier to build.

“If they’ve worked with a clinician or a medical space that is a welcoming space, they will trust us,” Ryan said.

Overall reluctance to present for care has become apparent in emergency departments, according to Theresa Cheng, MD, a civil rights attorney and assistant Clinical Professor of Emergency Medicine at the University of California, San Francisco.

“We’re seeing people present to emergency departments sicker and with more complex or complicated diseases that could have been addressed weeks or months earlier,” she said. “We see it every single shift, the ramifications of what happens when people delay care because of fear.”

Those observations align with findings from a recent study led by Rama Salhi, MD, associate director for emergency medicine at Massachusetts General Hospital’s Center for Immigrant Health in Boston. Emergency department visits by undocumented patients at five large Massachusetts-based hospitals declined after the January 2025 reversal of federal protections that had previously limited immigration enforcement in healthcare settings, the study found.

Salhi said delaying primary care can have consequences for long-term health.

“This can include delayed or missed vaccinations that then lead to otherwise preventable infections, unmanaged high blood pressure, which increases risks of severe illness like heart attacks or strokes, or missing cancer screenings leading to more severe presentations,” she said.

Clinicians’ experiences echo concerns raised earlier this year by the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American College of Physicians. In a joint statement, the organizations said healthcare facilities “must remain safe spaces where patients can seek care without fear and clinicians can provide confidential care without interference.”

In a separate policy statement, the American Academy of Family Physicians recommended “timely access both to healthcare for migrant, asylee, and refugee persons in detention facilities and measures to reduce the toxic stress associated with the threat of detention and deportation.”

Federally Qualified Health Centers (FQHCs) Report the Greatest Impact

FQHCs, which care for many medically underserved communities, may be experiencing the greatest burden, the survey suggests.

Among clinicians practicing at FQHCs, 83% reported concerns about patient mental health compared with 64% of clinicians in other practice settings. Across every domain measured, concern among FQHC clinicians exceeded that of non-FQHC clinicians by 20 to 30 percentage points.

Burnout Also Rises

Etz said the survey reflects a pattern The Larry A. Green Center has observed that as pressures on patients increase, so do clinicians’ reports of moral injury.

“One of the largest drivers of their burnout and injury is their feeling that their ability to take care of patients is being hampered by decisions that are not health, population health, or healthcare decisions,” she said. “They are decisions of policy.”

Clinicians reporting six or more enforcement-related concerns had substantially higher burnout scores than those reporting none (3.72 vs 2.86 on a 5-point scale).

One family physician described in the survey said patients increasingly questioned whether their medical information could remain confidential.

“I can’t tell my patients that their medical data is secure from ICE, and my patients are questioning my judgment in ways that they have not done in the past,” the clinician said.

The survey captured clinicians’ observations rather than patients’ perspectives, and its cross-sectional design identified associations but cannot establish that immigration enforcement directly caused the reported changes.

Still, Etz said the findings underscore that protecting patients and supporting clinicians are inseparable.

What Clinicians Can Do

Although many of the policy issues are outside physicians’ control, Etz said practices can still take steps to preserve trust.

“Even the act of bearing witness can be a healing and trust-generating activity,” she said. “To be willing to hear the frustrations of their patients, to open that conversation and not pretend like it isn’t going on, can be a curative act.”

Salhi said clinicians can reassure patients by explaining that healthcare providers remain bound by privacy and confidentiality laws.

“Many health systems have also established policies to clearly delineate private care areas and engage local security or legal counsel to help navigate potentially challenging situations,” said Salhi.

In Massachusetts, for example, the attorney general has issued guidance recommending that healthcare providers review any warrants before information is released, she said.

Etz encouraged practices to communicate proactively with patients about how they are responding to policy changes, share any plans they have developed should immigration officials appear at a clinic, and remind patients about alternatives such as telephone visits or patient portals if they are reluctant to come to the office.

Ryan said building trust includes limiting unnecessary collection of sensitive information.

“If I don’t need to know someone’s immigration status, I don’t ask that,” Ryan said. “Don’t make it part of your demographics when you enroll patients.”

Cheng, who coauthored a resource published by the National Immigration Law Center for clinicians to navigate immigration enforcement, also recommended displaying multilingual information explaining Health Insurance Portability and Accountability Act privacy protections, training staff on how to respond if immigration officials appear at a healthcare facility, and developing family preparedness plans and medical-legal partnerships for patients at risk for detention.

“We can’t guarantee safety,” Cheng said. “But there are things we can do to make things safer or make things more reassuring.”

Cheng, Ryan, and Etz did not disclose any relevant conflicts of interest.

Lara Salahi is a health journalist based in Boston.