As the Trump Administration continues to support a crackdown on legal immigration, a new study reported that physicians born in other countries account for nearly half of a sample of almost all internal medicine physicians in the US.

These physicians are more likely than native-born colleagues to care for patients who are poor, disabled, Black or Latino, or living in medically underserved communities, economist Giacomo Meille, PhD, of the American Board of Internal Medicine, and colleagues reported on August 12 in JAMA.

In 2026, non-US-born international medical graduates (IMGs) made up 36.1% of 249,679 internal medicine physicians who were board-certified from 1990 to 2025, and non-US-born US Medical Graduates (USMGs) accounted for another 11.1%, the study found.

IMGs graduated from medical school outside the US and Canada, whereas USMGs graduated from medical schools inside the US.

“Some clinicians may not realize just how dependent internal medicine is on non-US-born IMGs,” Meille said. “IMGs are most concentrated in specialties that have difficulty recruiting physicians and disproportionately treat patients who have greater difficulties accessing care.”

White House Policies Disrupt Medical Pipelines

The Trump Administration’s strict immigration policies are touted as supporting public safety and protecting American workers but have disrupted workforce pipelines in medicine and other fields, experts said.

Last winter, the White House stopped processing visa applications for immigrants from 39 countries and ordered employers to pay $100,000 fees to hire certain immigrants via H-1B visas. An exemption was reportedly made for physicians applying for visas, and courts have stepped in to reverse the new policies.

But the rulings could be undone, making the future uncertain for immigrant physicians and students who have not yet become citizens.

Researchers launched the study to learn more about the role of immigrant physicians in internal medicine, which is especially dependent on non-US citizen IMGs, Meille said.

It’s already known that many immigrants work in the specialty, he said. “According to the 2026 Main Residency Match, non-US citizen IMGs filled 30.8% of internal medicine PGY-1 positions, significantly more than other specialties, such as emergency medicine (2.9%), family medicine (17.5%), pediatrics (21.9%), psychiatry (8.8%), and surgery (7.1%).”

Inside the Data: India in the Lead

The study reported that the countries providing the most international physicians are India (12.6%), Pakistan (4.1%), and the Philippines (1.4%). A total of 5.9% of internal medicine physicians are from the 39 travel ban countries, including Nigeria (1.2%) and Syria (1.0%).

Although 5.9% may seem like a small number, Meille said “it amounts to about 14,800 physicians who treat millions of patients.”

The percentages of internal medicine physicians who were non-US-born by certification year rose from 34.9% in 1990-1994 to 54.2% in 1995-1999. It fell after 2015 and reached 44.5% in 2020-2025.

Among subspecialties of internal medicine, the percentages of non-US-born physicians were highest in nephrology (62.2%), sleep medicine (60.8%), geriatrics (59.8%), and endocrinology (55.8%). “This is important because specialties such as nephrology and geriatrics already experience difficulties filling fellowship positions,” Meille said.

The levels of non-US-born physicians were lowest in infectious diseases (45.0%), gastroenterology (41.8%), and hospice and palliative medicine (37.8%).

Immigrants More Likely to Serve Poor Patients

A Medicare-only analysis of a sample of 178,782 internal medicine physicians found patients treated by foreign-born IMGs were more likely than native-born USMGs:

• Black (9.5% vs 7.0%)
• Latino (6.6% vs 3.9%)
• Originally eligible for Medicare based on disability (13.8% vs 11.1%)
• Dual-eligible for Medicare and Medicaid (20.9% vs 11.7%)
• In high-poverty zip codes (19.8% vs 15.9%)
• In areas designated as medically underserved (21.5% vs 19.9%)
• In primary care shortage areas (30.3% vs 29.2%)

The study noted limitations such as focus on physicians with initial American Board of Internal Medicine certification and traditional Medicare beneficiaries. Also, physicians certified prior to 1990 are excluded.

Wider Impacts Beyond Internal Medicine

Darshali Vyas, MD, a pulmonary/critical care fellow and health policy researcher with Richard A. and Susan F. Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center in Boston, said in an interview that the study’s focus on internal medicine is important not only because it’s the largest physician specialty, but also because it’s the gateway for a wide range of subspecialties.

She added that “when a resident physician can’t start on time, a fellow has a visa delay, or a physician can’t take a job, that pretty quickly translates into staffing gaps. This study makes clear that the consequences may not be evenly distributed because the physicians potentially most impacted are also caring for a disproportionate share of patients who already face barriers to care.”

Potential Disruptions in Care

Endocrinologist Graham McMahon, MD, MMSc, president and CEO of the Accreditation Council for Continuing Medical Education, Chicago, also highlighted the patient population served by immigrant physicians. (The organizationaccredits institutions that offer continuing medical education to physicians and other healthcare professionals.)

The study data “turns what can sound like an abstract workforce debate into an access-to-care issue,” he said in an interview. McMahon himself is an IMG from Ireland.

He added that immigrants “are not marginal participants in the healthcare system but constitute a substantial fraction of the physician workforce and disproportionately care for populations with fewer alternatives. Interruption of the lives, training, or contributions of this essential workforce would, therefore, disrupt care and continuity for many Americans.”

No study funding is reported. Study authors reported relationships such as employment with the American Board of Internal Medicine. Vyas and McMahon reported having no disclosures.