Stricter immigration policies under the incoming Trump administration could exacerbate an already-dire workforce shortage in healthcare.
Providers are increasingly turning to skilled international workers to fill in care gaps, either through direct sponsorship or third-party staffing firms, but limitations on work visas and long delays in the immigration process are already creating challenges. Industry observers say the incoming Trump administration and Republican-led Congress could make the problem worse.
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Health systems are investing millions of dollars to keep the talent pipeline moving forward.
“The concern is that, particularly in the healthcare field where there are significant labor shortages anyway, they can’t afford any of their employment workforce to be at risk,” said Sherry Neal, partner at Corporate Immigration Partners.
Providers and staffing firms are advocating for policy changes to make the hiring process easier as they wait for the new administration's next steps.
New administration could mean further visa delays
The healthcare industry has faced years-long shortages of skilled workers, including doctors and nurses. Those have been intensified by growing demand from an aging population and an educational pipeline that isn’t keeping up. The Association of American Medical Colleges projects a shortage of up to 86,000 physicians in the U.S. by 2036, and the National Center for Health Workforce Analysis expects a shortage of more than 200,000 nurses by 2037.
Providers are turning to international workers for some relief, but leaders from the incoming Trump administration have repeatedly expressed their desire to enforce strict immigration policies. Policy changes could affect processes for multiple visas on which skilled international employees depend, including J-1, EB-3 and H-1B visas. Adventist HealthCare, as an example, sponsors nurses for EB-3 visas, which are reserved for professionals and skilled workers.
The federal government could further delay an already backlogged visa-processing system by issuing more unnecessary requests for information and unfounded denials — tactics used during Trump's first administration.
“It was a lot of employers and employees getting really frustrated with the system that just seemed broken. It seemed like everything came to a halt,” said Adriane Rapp, managing attorney at Beach-Oswald Immigration Law Associates. “When those processes take a very long time, it’s discouraging for employers to want to spend thousands of dollars for the potential to not even have an employee inside the United States.”
Providers are managing an uncertain environment
Adventist estimated it spends $31,000 on each international nurse in its program. The health system covers legal fees, pays for the nurse’s relocation, arranges temporary housing and helps the nurse assimilate into the U.S. healthcare system, said Opper Chiweshe, international nurses program manager at Adventist HealthCare.
Gaithersburg, Maryland-based Adventist has hired about 800 nurses since 2019, though only a quarter have made it to the U.S. due to process delays, Chiweshe said. Many foreign-born nurses are already facing a two-year backlog with their applications, she said.
“They are ready to come. They are fully experienced and knowledgeable. [But] they don’t have visas to come in, so we have to continue to rely on agency and travel staff,” Chiweshe said.
She said Adventist has never walked away from an international candidate, but she acknowledges that could be a possibility depending on the barriers to entry. Adventist is not accepting new applicants at this time.
If the wait to come to the U.S. gets too long, employees may decide to look elsewhere for job opportunities, Rapp said.
SSM Health works to keep international hires engaged while they wait for visa approval. The health system runs a Facebook group for new hires, hosts monthly webinars to answer their questions and maintains a WhatsApp group, said Seth Lovell, vice president of nursing transformation and innovation at SSM. The system has about 650 international nurses going through the immigration process.
Lovell said SSM’s goal is to go into “maintenance mode,” meaning the system has an ongoing pipeline of new international hires and doesn’t have to worry about slowdowns in the visa process. The St. Louis-based system hopes to have approximately 350 international nurses in the U.S. by next fall, and so far about 10 have arrived, he said.
“We’re going to just continue to level-set our expectations and make sure that we adjust,” Lovell said. “What we’re really hoping is that this becomes a little bit more streamlined because these are skilled professionals that are coming over that are providing a critical service that we can’t otherwise do fully.”
Sticking with current policies could also be damaging
Adventist’s Chiweshe said worrying about future policies isn't going to help — but speaking up on current policies might.
“We work with whoever is in the office. We look at this problem as not a political problem. We have real patients in real hospitals, and we hope that by working together, by partnering with any administration, they can see what we are trying to do here,” she said. “We are trying to solve a life-or-death situation.”
Providers and other healthcare organizations are advocating for policy changes while they wait for the new administration to take over.
More than 160,000 visas were available in fiscal 2024 for noncitizens immigrating based on their job skills. The number includes five categories of employment-based visas across industries.
Providers, staffing firms and healthcare advocacy organizations want the federal government to do more to increase visa capacity. For example, they have thrown their support behind the Healthcare Workforce Resilience Act, which would recapture 25,000 unused employment-based visas for nurses and 15,000 for physicians to help ease staffing shortages.
“That would address a critical workforce need without creating new visa categories,” said Kara Murphy, president at staffing firm PRS Global. “Our concern really lies more with the outdated legal immigration pathways that just aren’t meeting today’s labor demands, and so that’s where I think a lot of hospitals are frustrated.”
The legislation was referred to committees in late 2023 and has made no further progress through Congress.
At the state level, the Illinois Health and Hospital Association supported House Bill 2948, which went into effect Jan. 1, and dedicates one full-time employee to assist international applicants.
“International doctors and nurses have made a meaningful impact on our health system, and we must continue efforts to attract and retain highly skilled medical professionals in Illinois, especially in small and rural communities,” IHA spokesperson Paris Ervin said via email.
Adventist supported a Maryland law passed in October 2023 that prohibits a health occupations board from requiring a Social Security number or taxpayer identification number as a condition for nursing licensure.
