Caregiver Jonas Atta-Kyereme, left, an immigrant from Ghana, walks with David Reese in Alexandria, Virginia, in November. U.S. immigration crackdowns may hurt workforce capacity.
Photo by Maxine Wallace, courtesy The Washington Post/Getty Images
“Everyone who gets health care is going to be impacted. It's a very bad economic policy, it's a very bad health policy, it's a very bad human rights policy.”
— Stephanie Woolhandler
From nursing assistants and home health aides to primary care doctors and surgeons, people born beyond the borders of the U.S. form a critical backbone of the nation's health workforce. But with tighter immigration restrictions at the federal level, the stability of the workforce could be at risk.
The Trump administration's crackdown on immigration is expected to deepen health staffing shortages in hospitals, clinics and long-term care facilities nationwide, leaving patients with fewer caregivers at a time when demand for services is rising.
“Everyone who gets health care is going to be impacted,” Stephanie Woolhandler, MD, MPH, FACP, a researcher and professor of public health at Hunter College told The Nation's Health. “It's a very bad economic policy, it's a very bad health policy, it's a very bad human rights policy.”
Since returning to office in 2025, President Trump has moved swiftly to tighten restrictions on immigration. The administration paused immigrant visas — which allow for permanent residency, including family-sponsored and employer-sponsored visas — from 75 countries as of January this year. Among those are immigrants from Haiti, Jamaica and Nigeria, who together make up more than a third of foreign-born health workers from those countries, according to KFF.
The measures are expected to send ripple effects through the U.S. economy, with significant impacts on the health care workforce, where as many as 20% of workers are foreign-born. About 3.4 million immigrant health care workers were employed in the U.S. as of March 2024, according to a JAMA study co-authored by Woolhandler. About 2.3 million were naturalized residents who had completed the process to become U.S. citizens.
The direct-care health workforce — which includes personal care aides, home health aides and nursing assistants — is expected to be particularly harmed by Trump administration policies. Patients who receive long-term care, such as at home or in nursing facilities, will likely feel the most immediate impact, as foreign-born people make up a third of that workforce.
“It's already extremely difficult to find people with the skills — and the willingness — to do this work,” Woolhandler said. “Changes in immigration policy are going to make that situation much, much worse.”
Nursing assistant Felicia Togba, an immigrant from Liberia, cares for Maria Alvarez at Steere House, a nursing and rehabilitation facility in Providence, Rhode Island, in 2015.
Photo by Suzanne Kreiter, courtesy The Boston Globe/Getty Images
Even before the Trump administration's immigration crackdown, staffing levels in the direct care sector were strained. More than 45% of nursing homes reported limiting new admissions, and 38% had to turn away residents because of staffing shortages, according to a report from the American Health Care Association.
“The impact is felt by the people receiving care and their families because they're having to navigate this system that just really isn't prepared for an overwhelming demand,” Nicole Mattson, vice president of advocacy and workforce development at Care Providers of Minnesota, told The Nation's Health.
Fewer direct care workers who serve older adults and people with disabilities could create a bottleneck that strains the entire health care system, Woolhandler said. Without enough staff in nursing homes and home care agencies, hospitals and emergency departments will have limited options for discharging patients, further backing up care.
Anti-immigration policies are likely to impact other health care sectors too. Roughly a quarter of physicians and surgeons in the U.S. are immigrants, as well as 16% of registered nurses, a 2023 analysis from the Migration Policy Institute estimates.
At the same time, workforce shortages are mounting. The U.S. is projected to face a shortfall of more than 108,000 registered nurses and 140,000 physicians — including 70,000 primary care physicians — by 2038, according to December estimates from the Health Resources and Services Administration.
Despite those projections, fewer immigrants may be entering the U.S. to fill gaps. In September, the Trump administration imposed additional barriers for highly skilled workers coming from abroad, including a $100,000 application fee. The H-1B visa program allows U.S. employers to temporarily hire foreign professionals in specialty occupations, including as physicians and nurses.
The American Medical Association and more than 50 other medical groups warned the Department of Homeland Security against taking the action, noting that “there is a growing need for a larger physician workforce that the U.S. cannot fill on its own, in part because the U.S. does not have enough people in the younger generation to care for our aging country.”
A growing physician shortage would increase burnout among those already practicing as well as limit patient access to services, according to Michael Dill, MA, director of workforce studies at the Association of American Medical Colleges.
“Each physician we are short in this country likely represents tens of thousands of people not getting care,” Dill told The Nation's Health. “Anything that exacerbates the shortage — rather than trying to solve it — is almost incomprehensible.”
While health worker shortages will be felt nationwide, experts say communities that rely most heavily on immigrant clinicians are likely to face the greatest strain. Health care workers in the U.S. on H-1B visas disproportionately serve low-income and rural communities, where access to care is already limited, an October JAMA study found. The prevalence of H-1B-sponsored physicians is two times higher in rural areas compared with urban counties, and four times greater in counties with high poverty.
“The most socioeconomically vulnerable communities will be hit hardest,” lead author Michael Liu, MD, MPhil, a resident physician in the Mass General Brigham Department of Medicine, said in a news release. “Foreign health care workers fill critical gaps in health systems such as primary care and rural health, and millions of Americans depend on them to receive timely and high-quality health care.”
Raymund Guevara, a nursing assistant from the Philippines, works at a Jacksonville, Florida, hospital in 2023.
Photo courtesy Picture Alliance, Getty Images
The expected shortage of health care workers — made worse by fewer immigrant employees — will affect everyone who needs care, especially low-income and rural residents, older adults and people with disabilities.
Immigrant arrests and deportations by the Trump administration have also sent concerns rippling through the U.S. health care workforce. U.S. Immigration and Customs Enforcement arrests during the first nine months of Trump's new term quadrupled, according to the University of California's Deportation Data Project. Both voluntary deportations and those conducted by governmental removal jumped, with the former increasing by 21 times.
Deportations could reduce the direct-care workforce by about 395,000 jobs by 2028, including 275,000 positions held by immigrants, according to estimates released last year by University of Pennsylvania researchers.
Heightened immigration enforcement is also associated with declines in employment and hourly wages among U.S.-born workers, a 2023 study in the Journal of Labor Economics found. An estimated 120,000 direct care jobs held by U.S.-born workers could be lost as a result, adding to shortages.
But the impact of fewer immigrant workers goes beyond staffing numbers, according to Jim Platten, MS, a workforce development specialist and job navigator. Platten has spent more than 45 years in health care administration across Minnesota, a state with large Hmong and Somali and immigrant communities, among others. He said the state's health care system has long benefited from a diverse workforce.
Diversity benefits health care providers, creating a work environment that enhances learning, collaboration and clinical outcomes, research shows.
Platten has seen that firsthand in his own family. When his mother-in-law, an immigrant with limited English, needed care in recent years, having providers who looked like her and spoke her language made a difference.
“It makes us more robust, it makes us a better fabric,” Platten told The Nation's Health.
For more information on workforce shortages and immigration, visit www.kff.org/immigrant-health and see www.deportationdata.org.
- Copyright The Nation’s Health, American Public Health Association
