Philadelphia, Aug. 12, 2026 — More than 22 million people enrolled in traditional Medicare received care from physicians born outside the United States in 2024, according to a new analysis published in JAMA. The study offers one of the most detailed examinations to date of how internationally connected physicians sustain the U.S. internal medicine workforce, particularly in communities where medical care is difficult to obtain. Researchers found that physicians born abroad accounted for 47.2% of doctors trained and certified in internal medicine, including both doctors who completed medical school overseas and those who were born in another country but received their medical education in the United States. The findings arrive as the nation confronts an aging population, persistent shortages in several medical specialties and growing uncertainty surrounding immigration policy.
The study analyzed records for 249,679 physicians initially certified in internal medicine by the American Board of Internal Medicine between 1990 and 2025. Investigators linked 178,782 of those physicians to Medicare claims, allowing them to examine the patients treated by different groups of doctors. Approximately 36% of the physicians were international medical graduates, or IMGs, who were born outside the United States and attended medical school abroad. Another 11% were born abroad but trained in U.S. medical schools. Together, these groups made up nearly half of the internal medicine workforce represented in the analysis. The researchers used country of birth and medical-school location to distinguish physicians whose professional pathways crossed national borders, rather than treating all IMGs as a single category.
The patient-level analysis revealed a consistent association between non-U.S.-born IMGs and populations that have historically faced greater barriers to healthcare. Among traditional Medicare beneficiaries treated by these physicians, 9.5% were Black, compared with 7% of patients treated by U.S.-born graduates of U.S. MD or DO programs. Latino patients represented 6.6% of the population treated by non-U.S.-born IMGs, compared with 3.9% among patients treated by the U.S.-born physician group. The differences were also evident in measures of economic disadvantage. Nearly 21% of patients cared for by non-U.S.-born IMGs were eligible for both Medicare and Medicaid, a marker often associated with low income and complex healthcare needs, compared with 11.7% of patients cared for by U.S.-born U.S.-trained physicians. Almost 20% lived in ZIP codes with high poverty rates, compared with 15.9% in the comparison group.
These patterns do not mean that a physician’s birthplace determines the kind of patients they treat, nor can an observational study establish that international graduates cause better or worse access to care. Instead, the results indicate that non-U.S.-born IMGs are disproportionately present in the settings where vulnerable patients receive medical services. Factors such as hospital location, specialty choice, employment opportunities, insurance mix and physician recruitment practices may all contribute to the association. Medicare claims also capture only certain aspects of healthcare delivery and do not fully describe patients’ clinical histories, language preferences, transportation limitations or access to physicians outside the traditional Medicare system. Even with those limitations, the scale of the pattern suggests that international physicians are not a peripheral component of American medicine but a structural part of how the system functions.
Their importance was visible across internal medicine subspecialties. Non-U.S.-born IMGs represented at least 27% of physicians in every subspecialty examined by the researchers. In geriatrics, sleep medicine and nephrology, they represented more than half of all physicians. Geriatrics is especially significant because the demand for physicians trained to care for older adults is expected to rise as the population ages. Nephrology faces patients with long-term, resource-intensive conditions such as chronic kidney disease and kidney failure, while sleep medicine addresses disorders linked to cardiovascular disease, metabolic illness, impaired cognition and accidents. A shortage in any of these fields can delay diagnosis, increase reliance on emergency care and complicate the management of chronic disease.
Internal medicine also serves as a major entry point into the American healthcare system. Internists diagnose and manage multiple conditions simultaneously, coordinate care among specialists and often provide continuing treatment for patients whose illnesses become more complicated over time. Physicians who complete internal medicine training may continue into fields including cardiology, medical oncology, rheumatology, infectious diseases, pulmonary medicine and gastroenterology. The study’s workforce estimates therefore extend beyond the image of the general internist: they include doctors whose expertise supports cancer treatment, heart care, immune disorders, respiratory disease and other highly specialized services. In many regions, losing even a small number of these physicians can lengthen wait times and force patients to travel substantial distances for appointments.
The findings also place current immigration policies in a healthcare context. Physicians born in countries affected by U.S. travel restrictions accounted for about 6% of internal medicine doctors in the study. Although restrictions introduced in 2025 and 2026 ultimately exempted physicians, the researchers and physicians involved in the study noted that uncertainty can still have practical consequences. Hospitals may delay recruitment, training or credentialing decisions when visa rules are unclear, and doctors already working in the United States may face administrative disruptions. Reports that some noncitizen physicians from affected countries were placed on administrative leave illustrate how policy uncertainty can reach clinical settings even when formal exemptions exist. At the same time, the National Resident Matching Program reported that the match rate for non-U.S.-citizen IMGs entering U.S. residency programs reached a five-year low in March.
That decline matters because residency training is the principal route through which internationally educated physicians become eligible to practice independently in the United States. After passing required examinations and meeting regulatory standards, IMGs must compete for limited residency positions, often navigating visa requirements, state licensing rules and institutional policies. A reduction in successful matches can therefore produce effects years before a shortage becomes visible in hospital staffing data. The consequences may be particularly pronounced in internal medicine subspecialties that already depend heavily on physicians born abroad. If fewer international graduates enter training, the resulting gap may affect not only the number of available doctors but also the geographic distribution of care, since IMGs have historically helped staff hospitals and clinics serving lower-income and medically underserved populations.
The authors describe their work as evidence for incorporating physician migration and training pathways into national workforce planning. Alicia Fernandez, MD, an ABIM Board director and internist at Zuckerberg San Francisco General Hospital and Trauma Center, said physicians born outside the United States often care for patients with complex conditions and limited access to medical services, providing continuity in communities that may struggle to attract other doctors. Lead author Giacomo Meille, PhD, emphasized that the need is likely to grow as the population ages, especially in geriatrics. The study was conducted by researchers affiliated with ABIM, and several authors disclosed employment or leadership roles with the organization. Those disclosures do not invalidate the analysis, but they are relevant when interpreting research about the workforce of the institution that supported the study.
The central message is both straightforward and consequential: physicians born outside the United States are deeply embedded in American internal medicine, and the patients who rely on them often face greater social and economic vulnerability. In 2024 alone, their care reached tens of millions of Medicare beneficiaries. The data suggest that immigration policy, residency recruitment and specialty workforce planning are not separate from healthcare access; they are mechanisms that help determine who can receive care, where that care is available and whether the system can meet rising demand. As physician shortages intensify, the United States may find that maintaining a stable supply of internists and subspecialists depends not only on educating more doctors at home but also on preserving the international pathways that have long supported American medicine.
Subject of Research: People
Article Title: Non–US–Born Physicians in the US Internal Medicine Workforce
News Publication Date: 12-Aug-2026
Web References: American Board of Internal Medicine: https://www.abim.org/ ; National Resident Matching Program: https://www.nrmp.org/about/news/2026/03/nrmp-releases-results-of-the-2026-main-residency-match-for-more-than-38000-future-residents/ ; U.S. Health Resources and Services Administration physician projections: https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/physicians-projections-factsheet.pdf
References: JAMA, “Non–US–Born Physicians in the US Internal Medicine Workforce,” DOI: 10.1001/jama.2026.13268
Keywords: internal medicine, international medical graduates, physician workforce, Medicare, healthcare access, health disparities, geriatrics, nephrology, sleep medicine, immigration policy, physician shortages
