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Immigrants comprise about one-fourth of U.S. doctors, and rural communities rely even more on physicians from overseas. But new immigration policies are making it harder and less appealing for foreign-born talent to come to the U.S. NPR's Yuki Noguchi reports that's likely to worsen staffing shortages in U.S. health care.
YUKI NOGUCHI, BYLINE: Michael Liu grew up in Toronto, Canada, then moved to the U.S. for college and medical school.
MICHAEL LIU: You know, in chase of the American dream and understanding all of the opportunities, that was such a draw for me.
NOGUCHI: Now 28, Liu has deep personal and professional roots in Boston, where he's an internal medicine resident at Mass General Brigham. But he was rattled by the Trump administration's cuts to research and health funding this spring.
LIU: That was a really striking moment for me. It made me question, you know, where professionally it made the most sense for me. I still have strong connections to Toronto and mentors.
NOGUCHI: In September, Liu was seeing patients alongside doctors from Mexico and Costa Rica, who had H-1B visas designated for highly trained professionals. The administration abruptly hiked fees for those visas nearly 30-fold to a hundred thousand dollars. Liu watched his colleagues grapple with the news.
LIU: It was terrible to see. One of them definitely started to tear up, and the other one immediately stepped out to call their family. So there's just a lot of uncertainty and a lot of grief.
NOGUCHI: There are 325,000 foreign-born doctors in the U.S., not including nurses or other critical health care workers. In some fields like primary care or oncology, immigrants represent half or more of the American doctor workforce. The Department of Health and Human Services did not respond to requests seeking comment on its policies. Last month, Liu co-authored research in the journal JAMA, estimating 11,000 doctors - or roughly 1% of the country's physicians overall - have H-1B visas. But in some communities, it's as high as 40%.
LIU: High-poverty counties had a four times higher prevalence of H-1B physicians. We also saw that same pattern in rural counties or rural communities.
NOGUCHI: Liu himself has a green card, having married an American citizen earlier this year. But he says...
LIU: It feels like my contributions - just because I was not born in this country - are less valued. I really hadn't thought so deeply about going back home before, but definitely it's been much more top of mind.
NOGUCHI: For over six decades, people like Liu have contributed to the U.S.' reputation as the undisputed world leader in health research and practice. In pay and prestige, the country's been unparalleled. That began in 1965 during a period of expanding federal investments in scientific research and public health. That year, the U.S. began recruiting foreign doctors in large numbers after the creation of Medicaid and Medicare, says Eram Alam, a professor of science history at Harvard.
ERAM ALAM: Overnight, you have, you know, 25 million, approximately, people who can now access health care services.
NOGUCHI: The U.S. granted visas to 75,000 physicians in the decade that followed. By 1975, Alam says about 45% of all U.S. doctors were immigrants.
ALAM: There were more immigrant physicians that were entering the labor force per year than there were U.S. trained physicians that were joining.
NOGUCHI: Now the U.S. is undoing a lot of that by dismantling its global leadership role in medicine, says Dr. Julie Gralow, chief medical officer for the American Society of Clinical Oncology.
JULIE GRALOW: Up until this year, it was a dream, a wish that you could get a job and you could come to the U.S. and, you know, you could get the research funding. And now nobody wants to come.
NOGUCHI: Gralow says countries like China, Denmark, Germany and Australia are taking advantage, even recruiting American doctors and medical researchers abroad. American patients will feel the impact from that, she says, for generations.
Yuki Noguchi, NPR News.
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