For more than six decades, immigrants have made up at least a quarter of the United States’ physician workforce. Many of these doctors — arriving from countries such as India, Pakistan, the Philippines and Nigeria — have staffed public safety-net hospitals and rural clinics that often struggle to attract U.S.-trained graduates.
Dr. Eram Alam, a historian at Harvard University and author of "The Care of Foreigners: How Immigrant Physicians Changed U.S. Healthcare," said the United States’ reliance on immigrant physicians developed alongside major policy shifts in the 1960s.
During the Cold War, Congress passed the Immigration and Nationality Act of 1965, also known as the Hart-Celler Act. The law reshaped immigration policy and helped signal openness to people from newly independent nations.
“Immigration policy becomes this really important tool to signal to these countries that we want to be friends with you,” Alam said. “If we open up immigration to you, that means that we want movement from these countries.”
The policy change came as Medicare and Medicaid expanded access to health care, bringing millions of new patients into a system already facing a shortage of physicians,
Paperwork, exams and visas shape the path to practice
Immigrant physicians, Alam said, also had to navigate complex administrative systems to practice medicine in the United States. She describes the process as "bureaucratic detminism," where global medical training must be translated into U.S. licensing standards.
For many physicians trained abroad, passing the certification exam administered by the Educational Commission for Foreign Medical Graduates serves as the entry point to practicing medicine in the United States.
Even after meeting those requirements, some physicians faced professional setbacks over administrative details, such as naming conventions or document delivery methods that did not fit rigid U.S. bureaucratic systems.
Despite those hurdles, Alam said immigrant physicians have long performed essential work across the U.S. health care system.
“They’re doing the triage work that’s necessary to sustain the health of the United States,” she said.
For many physicians today, the process remains complex.
Somnath Ghosh, a pulmonary and critical care physician in Medford with Asante, said some immigrant doctors face long waits for permanent residency because of visa backlogs.
“Especially for physicians of Indian origin, it still is a challenge because the wait times are exceedingly long, because of a bottleneck created in the early 2000s by other sectors,” Ghosh said.
Ghosh said the United States allows physicians to practice high-level medicine with fewer financial constraints than in many countries. But immigration logistics remain burdensome.
For example, some physicians must travel outside the country to renew visa stamps.
Mujahid Rizvi, a physician with Hematology Oncology Associates, said doctors sometimes must travel to Canada for visa processing.
“Sometimes you have to fly to Canada to get your passport stamped,” Rizvi said.
Ghosh said increasing representation within the medical workforce can also improve trust between doctors and the communities they serve.
“Representation is key,” he said.
Alam said immigrant physicians have played a foundational role in sustaining the U.S. health care system, particularly in rural areas where doctor shortages persist.
She said maintaining a stable physician workforce remains essential to the country’s long-term health care capacity.
Guests
- Elam Alam, associate professor of the history of science, Harvard University
- Dr. Somnath Ghosh, critical care and pulmonary disease physician, Asante
- Dr. Mujahid Rizvi, physician, Hematology Oncology Associates
