I've spent most of my working life on one side or another of the same problem: there are not enough doctors where patients need them. I started as an Army medic, then worked the bedside as an ER and ICU nurse, and for the last sixteen years I've made my living connecting hospitals and physician groups with the doctors and advanced practice providers who keep them staffed. I've watched this shortage from every angle available to a person who isn't sitting in a hospital boardroom or a congressional hearing room.

My daughter is in medical school right now. She'll graduate into a country that, by every credible projection, still won't have enough physicians to go around. That's not a talking point for me — it's a fact I think about every time she calls to tell me about her rotations.

So I want to talk plainly about something that doesn't get discussed enough outside of workforce policy circles: the role international medical graduates play in keeping American healthcare running, and what's happening right now with the immigration policies that determine whether that pipeline stays open.

The Shortage Isn't a Projection Anymore — It's Arriving on Schedule

The Health Resources and Services Administration projects a national physician shortage of 124,180 by 2027, growing to 167,030 by 2032, and reaching 187,130 by 2037. The Association of American Medical Colleges, using a different and more conservative model, still projects a shortfall of up to 86,000 physicians by 2036. Either way you slice it, the country is short.

Primary care takes the hardest hit in nearly every model. Rural and medically underserved communities take the hardest hit within primary care. These are exactly the settings where I've spent sixteen years trying to help hospitals and clinics fill seats — and exactly the settings where international medical graduates have historically stepped in when American-trained physicians could not be recruited fast enough.

IMGs Are Not a Side Note. They're a Quarter of the Workforce.

International medical graduates make up roughly one in four practicing physicians in the United States today. Most are foreign-born and completed their residency training here, inside the same accredited U.S. graduate medical education system that trains every other physician in this country. They didn't skip a step. They matched, they trained, they got licensed, and then a large share of them went to work in the places American medical graduates are statistically least likely to go.

Older data cited by physician advocacy groups found that roughly 64% of foreign-trained physicians were practicing in medically underserved areas or federally designated Health Professional Shortage Areas, with close to 46% working in rural communities specifically. In my own recruiting work, I've seen this pattern up close more times than I can count — a rural hospital that spent a year failing to recruit a family medicine physician finally fills the seat with an IMG on a J-1 waiver who is genuinely excited to build a life in a small town most domestic candidates never considered.

What's Actually Happening with Visa Policy Right Now

This is where it gets complicated, and I want to be straight with you instead of oversimplifying it.

The pressure is real

In September 2025, a presidential proclamation imposed a $100,000 filing fee on employers sponsoring new H-1B visas — a fee that applies to physicians the same as any other H-1B category unless a specific exemption is granted. The proclamation does allow the Department of Homeland Security to waive the fee for individual workers or entire industries it deems to be in the national interest, and the medical community moved immediately to ask for that carve-out.

The American Medical Association and more than fifty national specialty societies sent DHS a formal request within days of the announcement, asking that physicians, residents, and fellows be categorically exempted. By March 2026, a bipartisan group of House members introduced the H-1Bs for Physicians and the Healthcare Workforce Act, which would exempt physicians and other healthcare workers from the fee entirely and block future fee increases targeting the profession. As of this writing, that bill has not yet passed — it's still moving through Congress.

Separately, broader travel restrictions on specific countries have created real delays and, in some cases, outright blocked incoming residents and physicians from starting training on schedule. Visa and green card processing backlogs for the J-1 and H-1B categories that most IMGs depend on have left qualified physicians stuck in limbo, sometimes for months.

The numbers already show the strain

The 2026 Main Residency Match, the largest in NRMP history, told an uneven story. U.S. citizen international medical graduates had their best match year on record — a 70% PGY-1 match rate, up from 61.4% just four years earlier. Non-U.S. citizen IMGs went the other direction: a 56.4% match rate, the lowest in five years, even as the number of applicants in that category grew by more than half over the same four-year period. Break it down further and the gap sharpens — foreign-born IMGs who required visa sponsorship matched at just 54.4%, a five-year low, while foreign-born IMGs who did not need sponsorship matched at 67.9%, a five-year high.

That's not a coincidence, and the NRMP itself said as much — noting that current federal immigration policy has increased the weight visa sponsorship status now carries in how residency programs build their rank lists.

And yet — the policy has quietly bent under the weight of the shortage

Here's the part that tells you everything about how real this need is: even an administration pursuing genuinely tight immigration enforcement has had to carve out room for physicians. The national-interest waiver language was built into the original H-1B fee proclamation. Reporting has described a rollback of a broader immigration freeze that had been restricting visa, work permit, and green card processing for physicians from dozens of previously restricted countries. Lawmakers from both parties, including members representing rural districts, have been publicly pressing DHS for a categorical healthcare exemption, citing the specific damage the fee is doing to small and rural hospitals trying to recruit.

You don't roll back immigration restrictions for a workforce you don't need. The rollbacks and the exemption push are themselves evidence of how essential this pipeline is to keeping American hospitals staffed.

What This Means Going Forward

My daughter is going to graduate into a physician shortage that domestic medical school expansion alone cannot close fast enough — residency slots, not medical school seats, are the real bottleneck, and GME funding has not kept pace with either. The AAMC has said plainly that without continued investment in graduate medical education, the shortage will trend back toward the more severe end of its projections. That's true whether or not a single additional international medical graduate ever sets foot in this country.

But it's also true that the fastest, most immediately available way to close gaps in rural and underserved American communities over the next five to ten years runs through the roughly 12,000 non-U.S. citizen IMGs entering the Match each year, plus the thousands more already trained, licensed, and waiting on a visa decision. Whatever your view of immigration policy broadly, the healthcare workforce math doesn't leave much room for debate: this country needs these physicians, and the shortage will only get harder to manage if the visa pathway keeps narrowing.

I built MDdocjobs because I got tired of watching good hospitals lose good candidates to slow, expensive, opaque agency processes — and that includes IMG candidates who are often navigating a visa timeline on top of everything else. Every posting and every database profile on the platform supports HPSA, loan repayment, and visa sponsorship language, because that's the reality of who's actually available to fill these seats right now.

The shortage is not a future problem. It's a today problem, and it's going to be a bigger problem before my daughter finishes her training. IMGs are not the whole solution — but they're an essential part of it, and pretending otherwise doesn't get a single rural hospital its next physician any faster.