The United States 🇺🇸 health system is heading into the next decade with too few workers, and the gap is large enough that even small shifts in immigration policy could be felt in clinics, hospitals, and long-term care facilities. The staffing shortfall is already tied to delayed care, longer waits, and heavier workloads, especially in rural communities. The risk is not only about future demand; it’s also about today’s churn as experienced staff leave and fewer new workers replace them.
Workforce projections that frame the policy stakes
Multiple national forecasts point in the same direction: demand is rising faster than the supply of trained clinicians.
- Registered nurses (RNs): The system is projected to be 78,610 full-time RNs short in 2025, easing to 63,720 by 2030. The 2025 NSI report also found hospital RN turnover at 16.4% and overall hospital turnover at 18.3% in 2024, signaling that retention remains a daily problem for employers.
- Physicians: The Health Resources and Services Administration (HRSA), in a November 2024 assessment, projects a shortage of up to 187,130 physicians by 2037 across specialties. The Association of American Medical Colleges (AAMC) revised its estimate to 86,000 by 2036, down from an earlier forecast of 124,000 by 2034, but still a major gap. AAMC also projects primary care shortages of 17,800–48,000.
- Primary care access: HRSA’s assessment warns that by 2037, 47 states will lack enough primary care physicians, with rural areas hit hardest.
- Wider health staffing: The source material cites projections of up to 3.2 million total healthcare workers short by 2026, including 73,000 nursing assistants by 2028. It also points to 80 million Americans living in primary care shortage areas, 60 million in dental shortage areas, and 123 million in mental health shortage areas.
- Hospital stress signals: Over 1,400 U.S. hospitals reported critical staffing shortages as of 2022 in roles such as bedside nurses and respiratory therapists. The source also notes that 40% of hospitals had more than 10% RN vacancies in 2025, which can fuel a cycle of overtime, burnout, and more exits.
Quick-reference table: Selected projections and signals
| Area | Key projection / signal |
|---|---|
| RN shortage (2025) | 78,610 full-time RNs short |
| RN shortage (2030) | 63,720 short |
| Hospital RN turnover (2024) | 16.4% |
| Physician shortage (HRSA by 2037) | Up to 187,130 |
| Physician shortage (AAMC by 2036) | 86,000 |
| Primary care shortage (states by 2037) | 47 states affected |
| Total healthcare worker gap (by 2026) | Up to 3.2 million |
| Nursing assistants (by 2028) | 73,000 short |
| Hospitals reporting critical shortages (2022) | 1,400+ |
The drivers behind these numbers are straightforward: an aging population, retirements, burnout, and rising demand. Demographics matter: the population age 65 and older is projected to double to 83.9 million by 2050, and the worker-to-senior ratio is expected to move from 4:1 to 2.9:1 in five years. That means more people will need care while a smaller share will be available to deliver it.
Why shortages are sticking: exits, burnout, and uneven geography
The nursing pipeline is under pressure at both ends: more patients and fewer experienced staff staying on the job.
- Nurse exits: NCSBN data show 100,000 nurses left during the pandemic, with 610,000 more planning to exit by 2027.
- Upcoming retirements: About one-third of nurses are nearing retirement in the next 10–15 years.
Physician shortages are uneven geographically. The source material lists projected worst shortages by 2028 for physicians in:
- Texas: -2,830
- California: -2,580
- New York: -2,706
It also notes a broader worker gap in New York of -61,473.
Even when metro areas can hire, smaller towns may not compete on pay, schedules, or family needs, so shortages appear first where access is already thin.
The American Hospital Association (AHA), in its 2025 Workforce Scan, notes that burnout peaked during the pandemic and has improved slightly but remains significant. Clinician migration away from states with restrictive policies (for example, abortion bans) also adds a push factor, making staffing less stable in some regions.
Key takeaway: exits, burnout, retirements, and geographic mismatches combine to make staffing shortfalls persistent even without new shocks.
Where immigration fits into the staffing pipeline
The source material does not point to a specific 2025 rule that directly worsened shortages, nor does it link new immigration policy changes conclusively to rising shortages. Still, immigration remains a central pressure point because major workforce forecasts assume a steady inflow of international workers.
HRSA and AAMC both highlight reliance on international recruitment when U.S. training slots cannot grow fast enough. In practical terms, immigration affects supply in two main ways:
- Timing: International recruitment can sometimes fill roles faster than expanding U.S. medical school seats, nursing faculty positions, and residency slots.
- Location: International hires may be more willing to take hard-to-fill jobs in rural and underserved areas, depending on employer needs and the worker’s options.
The source material also notes that immigrant workers historically filled about 20–25% of RN and physician roles based on pre-2025 data. If policy becomes more restrictive, or processing becomes slower, a health care workforce shortage already baked into the numbers could deepen.
According to analysis by VisaVerge.com, the biggest practical issue for hospitals is not whether a visa category exists on paper, but whether employers can predict timelines well enough to staff units safely and keep experienced workers from burning out.
Visa pathways most tied to nurses and physicians
The source material gives examples of common routes:
- H-1B visas — commonly used for physicians (temporary, employer-sponsored).
- EB-3 immigrant visas — often used by nurses and other skilled workers seeking permanent residency.
For many nurse hires, the employer-side immigration step involves the immigrant petition process. The core filing for many employment-based green card cases is Form I-140 (Immigrant Petition for Alien Workers). Employers and clinicians watch these filings closely because delays can affect start dates, unit schedules, and retention.
The official government page is here: USCIS Form I-140, Immigrant Petition for Alien Workers.
For physicians, employers often rely on temporary work options like H-1B when a permanent case will take longer. This reflects how systems try to cover immediate patient needs while longer-term workforce fixes move slowly.
What restrictive policy could mean on the ground
Because the U.S. training system takes years to produce new clinicians, a smaller inflow of foreign-trained nurses and physicians can have fast and tangible effects:
- More overtime and higher turnover: Hospitals lean harder on overtime to cover bedside needs, which can increase turnover beyond the 16.4% hospital RN turnover rate reported in the 2025 NSI report.
- Rural primary care fragility: HRSA projects 47 states will lack enough primary care physicians by 2037, making rural access even more vulnerable.
- Specialty bottlenecks: Physician shortages can push more work onto nurses and other clinicians, increasing stress and shifting workloads.
- Wider patient access problems: Tens of millions already live in shortage areas for primary care, dental care, and mental health; reduced inflow would worsen access.
It is important to be clear about limits of the evidence: the source does not identify a single 2025 rule that caused shortages to rise. The analysis is about risk: if policy choices reduce inflow or slow processing, the existing forecasts leave little slack.
Warning: In a system already missing 78,610 full-time RNs (2025) and potentially up to 187,130 physicians (by 2037), even modest immigration friction can translate into longer waits for patients and heavier shifts for remaining clinicians.
Practical steps employers and workers are taking now
Even without a single “new rule” to point to, health systems are already acting as if staffing will remain tight:
- Mix recruitment pipelines: Combine local training hires and international recruitment so no single pipeline failure collapses staffing.
- Invest in retention: Prioritize retention to slow churn; replacing experienced bedside staff is harder than hiring on paper.
- Target underserved regions: Focus recruitment and retention where forecasts are worst, especially rural primary care.
- Track retirement risk: Monitor retirement timelines closely; about one-third of nurses may retire within 10–15 years.
For foreign-trained clinicians, predictability is often the primary concern. A job offer is only the first step; actual ability to start work depends on how smoothly the immigration process moves. In a labor market already missing 78,610 full-time RNs in 2025 and potentially up to 187,130 physicians by 2037, even modest immigration delays or restrictions can lengthen waits for patients and increase pressure on the clinicians who remain.
The United States faces substantial health workforce shortages—78,610 full-time RNs in 2025 and up to 187,130 physicians by 2037—driven by aging populations, retirements, burnout, and geographic imbalances. Forecasts estimate up to 3.2 million total missing healthcare workers by 2026. Immigration historically supplies 20–25% of clinicians; slower or restrictive policies could worsen gaps. Health systems are diversifying recruitment, investing in retention, and targeting underserved areas to mitigate immediate impacts.
