Nearly Half of U.S. Internists Are Foreign-Born, and They Carry a Disproportionate Share of Safety-Net Care

The numbers in a new study are hard to argue with, and for anyone who's spent time on a hospital floor they're not entirely surprising either. Foreign-born physicians aren't just present in American internal medicine, they're holding up a large share of it, particularly in the places that need doctors most.

<cite index="20-2,20-3">More than 22 million Medicare patients received care from doctors born outside the United States in 2024, according to an American Board of Internal Medicine study published in JAMA on August 12. Doctors born abroad make up nearly half, 47.2%, of the internal medicine workforce, including subspecialties such as medical oncology and cardiology.</cite>

<cite index="18-3">In 2026, non-U.S.-born international medical graduates accounted for 36.1% of the 249,679 internal medicine physicians who were board-certified between 1990 and 2025, with non-U.S.-born U.S. medical graduates adding another 11.1%.</cite>

The study wasn't just a headcount. It tracked where those physicians practice and who they see. <cite index="18-2">These physicians are more likely than native-born colleagues to care for patients who are poor, disabled, Black or Latino, or living in medically underserved communities, according to economist Giacomo Meille, PhD, of the American Board of Internal Medicine, and colleagues.</cite>

<cite index="18-6,18-7">"IMGs are most concentrated in specialties that have difficulty recruiting physicians and disproportionately treat patients who have greater difficulties accessing care," Meille said. According to the 2026 Main Residency Match, non-U.S. citizen international medical graduates filled 30.8% of internal medicine PGY-1 positions, far more than in emergency medicine at 2.9%, psychiatry at 8.8%, or surgery at 7.1%.</cite>

That pipeline data matters right now, because it's under pressure. <cite index="20-4">The study lands amid continued projections of physician shortages in most internal medicine disciplines and a shifting immigration policy landscape that has included travel bans, high H-1B visa fees, and social media vetting of visa applicants.</cite>

<cite index="18-8,18-9">About 5.9% of internal medicine physicians come from the 39 countries subject to travel bans, including Nigeria at 1.2% and Syria at 1.0%. Though that may seem like a small share, Meille noted that "it amounts to about 14,800 physicians who treat millions of patients."</cite>

The policy environment has already created disruption at the training level. <cite index="20-6,20-7">Though the travel bans that took effect for 39 countries in 2025 and 2026 ultimately exempted physicians, the effects of that uncertainty remain. Some hospitals placed noncitizen doctors from those countries on administrative leave, and the National Resident Matching Program reported in March that the match rate for non-U.S.-citizen international medical graduates in U.S. residency programs reached a five-year low.</cite>

The patient-access implications are direct. An internist who doesn't complete a residency here, or who leaves because of visa uncertainty, is a gap in care somewhere, and as the ABIM data make clear, that gap is most likely to open in a community that can least absorb it. <cite index="19-8">"In many underserved communities, physicians born outside the U.S. care for patients with complex medical conditions and limited access to care," said co-author Alicia Fernandez, MD, an internist and professor of medicine at the University of California, San Francisco.</cite>

The study's scope, 35 years of board certification records tied to actual Medicare patient data, gives it more weight than a workforce survey. It puts a number on a dependency that clinicians on the ground have known for a long time. What policymakers choose to do with that number is a separate question.

Sources cited:
- JAMA / American Board of Internal Medicine study, via Medscape (https://www.medscape.com/viewarticle/nearly-half-us-internal-medicine-docs-are-foreign-born-study-2026a1000rq7)
- Medical Xpress / ABIM press release (https://medicalxpress.com/news/2026-08-doctors-born-play-major-role.html)
- Mirage News / ABIM press release (https://www.miragenews.com/foreign-born-doctors-key-to-underserved-us-care-1726149/)