Amid healthcare workforce crisis, US immigration policies fall short

Editor’s note: This is the first in a series of articles focused on workforce issues challenging US nursing, including immigration hurdles for foreign nurses who are poised to help fill workforce gaps and the many factors narrowing the nursing pipeline domestically. Visit the series homepage, Immigration and the US Healthcare workforce, to find all the series content. 

We offer this special article series in conjunction with our inaugural CompassionIT Virtual Summit, scheduled for May 20, 2025.  Our CompassionIT initiative explores the evolving relationship between technology and compassion in healthcare, including how AI, UX design, accessibility, and clinical innovation can ease burnout and build a more humane, inclusive, and sustainable healthcare system. The summit program includes Insights from Nursing Informaticists for CIOs on how informatics and innovation can unite to develop technologies that care for the caregivers. Also, be sure to check out all of our CompassionIT-related content.

The United States is a nation of immigrants. Throughout our history, people from all over the world have contributed their talents, labor, and love to building a better future for themselves, their families, and their communities.  

Nowhere is this more apparent than in the healthcare industry. Close to 20% of the US’s healthcare workers are immigrants – that’s nearly 2.8 million physicians, nurses, home health aides, dentists, pharmacists, and allied professionals who were not born on US soil.  

And yet, those numbers aren’t anywhere near enough to meet the exponentially growing demands of the American healthcare system. The most recent estimates warn of staggering shortages of clinical workers in our future: 200,000 registered nurses, 300,000 LPNs, 187,000 physicians (including 87,000 primary care providers), and 130,000 psychologists and psychiatrists by 2037. 

The United States must find solutions to this looming crisis, and common-sense dictates that the answers won’t come entirely from within our own borders.  

Foreign-trained professionals will be essential for helping close the gaps, particularly in nursing. However, opportunities for immigrant healthcare workers have been limited for a long time via complex visa programs, and the Trump Administration’s sharp turn toward xenophobia, complete with mass deportations already underway, will only increase the difficulty and confusion. 

Under new policies, more than 350,000 noncitizen healthcare workers may be at risk for deportation, needlessly exacerbating an already dire situation. 

In light of these challenges, how can the US develop workable, equitable policies to allow foreign-born nurses and other healthcare workers to assist with our growing needs while maintaining high standards of care now and in the future? 

A deepening mismatch between supply and demand

Nursing is one of the most popular professions in the country, with more than 5.2 million registered nurses (RNs) currently in practice. It’s a job category with extremely low unemployment and a stable career trajectory due to the high demand, so it’s no wonder that it attracts talented young people looking to get the most out of their working years. 

But the good job prospects hide some major problems.  

Unemployment is so low because there aren’t enough nurses to go around to begin with. And even though plenty of people want to become nurses to help the gaps, they can’t always find the training they need to enter the field.   

In 2023, more than 65,000 qualified nursing school applicants were turned away from baccalaureate or graduate nursing school programs due to lack of faculty, classroom space, and clinical placements, creating a huge bottleneck for students seeking a US-based education.  

Without the capacity to educate nurses that can enter clinical practice now — and fill the thousands of vacant faculty roles later in their careers to train the next generation — the domestic nursing pipeline will continue to dwindle.  

The challenge of leveraging the international workforce to meet demands  

Foreign-born registered nurses, nursing assistants, nurse practitioners, and other nursing professionals make up a large proportion of the nursing workforce thanks to immigration policies beginning in the post-war era, which launched the ongoing influx of professionals from the Philippines, India, Mexico, Jamaica, Nigeria, Haiti, and elsewhere. 

1970 was a key turning point for immigration as the H-1 occupational visa program was amended to allow visa holders to fill permanent positions instead of just temporary jobs. In 1990, the H1-B category was created specifically for highly educated workers. 

Current policy dictates that nurses are only eligible for the H-1B visa category if their role requires “specialized knowledge,” typically including a bachelor’s degree or higher. This excludes the majority of RNs, since typical RN positions only require an associate’s degree. The H-1B visa is also only applicable for a total of six years, unless the holder has started a separate green card application, which limits its utility for long-term staffing needs. 

However, a larger proportion of nurses may be eligible for EB-3 visas, which only require two years of education in an accredited institution along with two years of licensed practice in their home country and an unrestricted license to practice in their chosen US state. Visa holders can work in a US-based medical facility for up to ten years and bring their families with them.  

But neither of these programs are ideal solutions. There are strict caps on the number of visas available per year, including 65,000 HB-1 visas for foreign-educated professionals and just 40,000 EB-3 visas. The scarce H1-B spots are spread across all job categories and are often taken up by technology workers sponsored by the Big Tech community, while ten thousand of the EB-3 places are reserved for unskilled workers, leaving too few visas available to clinical workers to make a real dent in the workforce shortfalls.  

Apollo Hospitals has been training nurses in India, and many seek to work internationally for better salaries — as much as 10x what they’d make in India.  

“It’s a difficult journey, … and sometimes immigration agents cheat them,” said Dr. Sangita Reddy, Joint Managing Director at Apollo, in the 2024 CHIME Fall Forum featured keynote. “So, we decided to proactively help them go abroad.”   

Apollo now has a global workforce program. “Last year, we placed about 570 nurses in the UK (in NHS), over 2,000 in Middle East and additional nurses in other countries,” Reddy reported. “Now we are helping nurses learn how to pass the US exam.”  

She explained that nurses who have passed the US exam and are now board-qualified to work in the US face about a two-year wait to get their visas.  

Innovative solutions for addressing clinical workforce deficits

Clearly, the United States needs to think of new and creative solutions for augmenting the inadequate supply of US-born nurses and other clinical care providers with a steady supply of foreign-born professionals. 

While expanding existing visa categories could be part of the answer, there may be a need to take it a step further: establishing a healthcare-specific visa program designed to recruit and retain exceptional clinical professionals in the highest-need areas of practice. 

Policymakers could take inspiration from the existing National Interest Waiver (NIW) for Physicians, which allows physicians in the EB-2 visa category (similar to the EB-3, but with higher educational requirements) to accelerate their green card applications if they commit to working full-time in a designated underserved area for a minimum of five years.   

Expanding similar options to other clinical care categories, especially nursing, could help increase the number of foreign-born healthcare workers able to enter the US while ensuring that they are distributed to places with the greatest need and reducing fears of potential abuse of the program.  

As it becomes increasingly clear that today’s immigration policies are poised to make workforce shortages worse, not better, it’s time to take a bold look at how the United States can balance its desperate need for more clinicians with its perennial hesitancy to embrace immigrants who can get the job done. 

While finding our way out of the crisis will require long-term, systemic changes both at home and abroad, opening up more opportunities to bring experienced and accomplished foreign-educated nurses and other clinicians into the country will be crucial for ensuring that patients can receive the care they require when and where it is most needed. 

Other articles in this series

How foreign nursing schools prepare for the U.S. market

Should the US create a healthcare-specific visa program?

How the nursing shortage exposes cracks in the US’s healthcare and educational systems

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry. Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system. She can be reached at [email protected].