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

At its core, the research highlights the urgent need for skilled providers in regions that are critically underserved. Many areas face alarming gaps in healthcare access, particularly when it comes to reproductive health services. This lack of access not only endangers women’s health but also exacerbates existing health disparities. The training program aims to empower local healthcare workers with the necessary skills to perform safe and effective procedural abortions, thus improving patient outcomes and fostering community trust in healthcare systems.

The evaluation conducted by the team consisted of rigorous data collection methods, involving both qualitative and quantitative approaches to assess the training program’s impact. Through interviews, surveys, and statistical analysis, the researchers examined not only the providers’ proficiency in delivering abortion care but also the perspectives of patients who interacted with these newly trained healthcare workers. Such comprehensive evaluation techniques ensured a well-rounded understanding of the program’s impact on the community.

Moreover, the findings reveal a notable increase in the number of trained procedures performed by providers who completed the training. This is a critical aspect as it directly correlates to access for women in their communities. The research also emphasized the importance of continuous support and mentorship for providers post-training, which is key to maintaining the skills acquired during the program. Without ongoing guidance, the benefits of initial training are at risk of diminishing over time.

Another pivotal outcome from the study was the enhanced confidence among healthcare providers in performing procedural abortions. Many providers reported a boost in self-efficacy as a direct result of their training, which in turn positively influences patient experiences. Confidence in performing such sensitive procedures is essential, as it not only affects the care patients receive but also contributes to destigmatizing abortion within communities. The study underscores the need for empowering providers, as their attitudes significantly shape the overall healthcare landscape.

In terms of patient outcomes, the research highlighted improvements in the safety and quality of care delivered. With trained providers, patients reported a more comfortable and supportive environment when seeking abortion services. This improvement can lead to higher satisfaction rates among patients, further underscoring the value of investing in healthcare provider training. In a context where abortion services often face stigma, ensuring that providers understand the nuances of compassionate care is critical.

Additionally, the study found that the training program contributed to the establishment of more robust networks within the healthcare systems. By linking newly trained providers to existing healthcare facilities, the program facilitated a more cohesive approach to reproductive health services. This interconnectedness is vital for sustainability, ensuring that trained providers can continue to receive support from colleagues and administration as they implement their newfound skills in procedural abortion care.

Financial barriers also play a substantial role in accessing healthcare services, and the study delved into this aspect as well. Many underserved areas experience significant economic challenges, making it difficult for patients to seek necessary care. The researchers advocated for policy changes that address these financial hurdles, creating a clearer pathway for women to access safe abortion services. Their findings suggest that training programs coupled with systemic changes could dramatically enhance the accessibility of reproductive health services in impoverished areas.

The implications of this study extend beyond immediate patient care; they touch upon broader issues such as public health policy and the societal acceptability of abortion. The evidence gathered may serve as a compelling argument for policymakers to invest more heavily in training healthcare providers as a way to improve health outcomes. It poses the question of how societies value reproductive health and the necessity for informed dialogues surrounding abortion services.

In discussing the role of community involvement, the research also illustrated the importance of fostering open conversations about reproductive health. Engaging local communities in discussions about the training programs and the services offered can help to dismantle misconceptions about abortions, ultimately contributing to a more informed and healthier population. Such community buy-in can create a supportive environment for women to seek care without fear of stigma or judgment.

The researchers concluded by reinforcing the critical nature of these findings in shaping future initiatives. With an ongoing demand for healthcare in underserved populations, these outcomes demonstrate a successful model that can be replicated in various contexts. Evolving the conversation around abortion services and focusing on education and provider empowerment could serve as a blueprint for addressing numerous health disparities in reproductive care.

The insights gained from this four-year evaluation may serve as a catalyst for change across multiple healthcare domains. As the study indicates, investing in provider training leads to improved care quality, greater patient satisfaction, and ultimately, a healthier society. The recommendations made by Rollison, Predmore, Miner, and their colleagues advocate for sustained efforts in training as an essential element of public health strategy.

By harnessing the momentum generated by this study, stakeholders in healthcare can work toward a more equitable future, ensuring that women everywhere have access to essential reproductive health services. Through strategic implementation and community engagement, the vision of widespread and compassionate abortion care becomes increasingly attainable, promising a brighter outlook for reproductive health in underserved areas.

The significance of this research speaks volumes about the future of healthcare education and training, emphasizing the lasting impact of dedicated efforts. As policymakers, health providers, and communities continue to engage in meaningful discussions around reproductive health services, the potential for transformative change remains within reach.

Subject of Research: The efficacy of a procedural abortion training program for healthcare providers in underserved areas.

Article Title: Outcomes from a procedural abortion training program for providers in underserved areas: findings from a four-year evaluation.

Article References:

Rollison, J., Predmore, Z., Miner, S. et al. Outcomes from a procedural abortion training program for providers in underserved areas: findings from a four-year evaluation.
BMC Med Educ (2026). https://doi.org/10.1186/s12909-025-08416-9

Image Credits: AI Generated

DOI:

Keywords: Abortion training, underserved areas, healthcare provider education, reproductive health, maternal care, health disparities.