Healthcare System Under Strain
American healthcare providers are facing unprecedented challenges as demographic shifts and immigration policies create what sources indicate is a perfect storm for medical practices nationwide. According to reports, physicians like Dr. Brian Moreas in Boca Raton, Florida, find their schedules increasingly consumed by specialist referrals that are becoming harder to fulfill, particularly in geriatric care and other less-lucrative specialties.
Specialist Shortages Worsen
The report states that Dr. Moreas spends significant time attempting to connect patients with geriatric specialists, psychiatrists, endocrinologists, and rheumatologists – all of which are increasingly scarce. “There’s a huge gap in geriatric care,” Dr. Moreas told Fortune. “I don’t talk to any medical students who say, ‘Oh, I want to go into geriatrics when I get out.’ Everybody says, ‘I want to go to dermatology or orthopedics.'”
Analysts suggest this specialist shortage coincides with demographic data showing the number of Americans aged 65 and older is projected to increase from 58 million in 2022 to 82 million by 2050 – a 42% jump according to Population Review Bureau statistics.
Immigration Policy Impact
The situation is reportedly exacerbated by recent immigration policies that have reduced the flow of foreign-born healthcare workers. Since the 2024 election, when immigration emerged as a major voter concern, the Trump administration has implemented several restrictions including adding a $100,000 price tag to highly-skilled H-1B visas and enhanced vetting of green card applicants.
These policies are having measurable effects, according to reports. Pew Research found America’s foreign-born population declined by more than one million people between January and June 2025 – a reduction not seen since the 1960s. Preliminary data from the National Travel and Tourism Office reportedly shows student visas declined 19% in August compared to the previous year.
Economic Consequences
The changing immigration landscape is creating unforeseen economic outcomes, analysts suggest. A working paper from the American Enterprise Institute found the Trump administration’s immigration policy will likely result in negative net migration in 2025, potentially shrinking U.S. GDP by 0.3% to 0.4%. Meanwhile, experts believe America’s unemployment rate has remained stable partly because job losses are being offset by a shrinking labor force as individuals leave the U.S.
Healthcare Workforce Composition Shifts
Studies show immigrant healthcare staff have become increasingly crucial to the system. Research from the Baker Institute found that between 2007 and 2021, while the share of foreign-born population grew from 12.62% to 13.65%, the portion of foreign-born healthcare workers increased from 14.22% to 16.52%.
Similarly, as total workers in U.S. nursing care facilities declined from 1.8 million to 1.5 million pre-pandemic to COVID, the proportion of foreign-born workers in the sector rose to 18.21% in 2021 from 16.43% a decade prior. This trend highlights the crucial role immigrants play in nursing and direct patient care positions.
Administration Response
The White House has countered that domestic talent can fill healthcare workforce gaps. Spokeswoman Abigail Jackson told Fortune that over one in ten young adults in America are neither employed, in higher education, nor pursuing vocational training. “There is no shortage of American minds and hands to grow our labor force,” Jackson stated, pointing to the administration’s commitment to enforcing immigration laws while creating jobs for American workers.
Physician Perspectives
Medical practitioners express concern about the compounding challenges. New York urologist Dr. David Shusterman, who emigrated from the Soviet Union in the 1980s, described a basic math problem: “Our medical schools are filled with foreign-born people… There’s a lot of positions that need filling right now.”
Dr. Shusterman noted that current immigration policy means “a lot of good people, because the uncertainty, choose not to stay, or are more worried about staying.” He advocated for clearer benchmarks for skilled labor the U.S. wants to attract, suggesting that even employers should be able to advertise qualified positions with government approval pathways.
Regional Disparities
The impact varies significantly by region, according to reports. While Connecticut reproductive endocrinologist Dr. Shaun Williams of Illume Fertility hasn’t yet seen policy impacts in his wealthy, well-connected area, rural communities face more immediate crises.
The Center for Healthcare Quality and Payment Reform reports only 42% of rural hospitals offer labor delivery services, with more than 100 labor and delivery units closing in the past five years. Staffing costs and availability are cited as primary reasons, with traditional long hours and on-call schedules posing additional recruitment hurdles in areas already struggling to attract talent.
Long-term Implications
As healthcare systems nationwide grapple with these intersecting challenges, physicians like Dr. Moreas warn that the U.S. may be losing competitive advantage for foreign-born talent. “Other countries are actually economically starting to do better and it may be more lucrative,” he noted, suggesting that changing goalposts in immigration policy create uncertainty that could drive skilled workers to other destinations.
Despite these concerns, some providers remain optimistic about the industry’s resilience. Dr. Williams suggested that “none of these changes are permanent” and that the system would “work itself out,” though he acknowledged his perspective might be shaped by operating in a wealthier region with better resources.
As the administration continues implementing its immigration agenda and healthcare providers navigate these complex industry developments, the coming years will test whether domestic recruitment can sufficiently address healthcare workforce shortages while managing the needs of an aging population. With immigration enforcement statistics showing ongoing detentions and removals, the tension between policy objectives and healthcare realities appears likely to continue shaping the medical landscape.
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