Philadelphia, Aug. 12, 2026 — 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 (ABIM) study published today in JAMA. A close look at internal medicine physicians—including those who continued their training to practice in subspecialty fields such as medical oncology and cardiology—revealed that doctors born abroad make up nearly half (47.2%) of the field's workforce and provide essential care to patients in underserved communities.
Amid continued projections of physician shortages in most internal medicine disciplines and a shifting U.S. immigration policy landscape that has included travel bans, high H-1B visa fees and social media vetting of visa applicants, the study findings quantify the important role physicians from abroad play in caring for underserved patients across the American healthcare system.
Analysis of traditional Medicare claims found that patients treated by non-U.S.-born international medical graduates (IMGs)—physicians who graduated from medical schools outside the United States—were more likely to come from underserved populations than patients treated by doctors who were born in the U.S. and graduated from U.S. medical schools (U.S. MDs) or Doctor of Osteopathic Medicine (DO) programs (U.S. DOs). Among those patients: 9.5% cared for by non-U.S.-born IMGs were Black (vs. 7% of those cared for by U.S.-born U.S. MDs and U.S. DOs) and 6.6% were Latino (vs. 3.9%). Nearly 21% of those treated by non-U.S.-born IMGs were dually eligible for Medicare and Medicaid (vs. 11.7%) and 19.8% lived in high-poverty ZIP codes (vs. 15.9%).
The findings also reveal how integral IMGs born outside the United States are across the subspecialties. They represent at least 27% of physicians in every internal medicine subspecialty examined, and more than half of all doctors who practice geriatrics, sleep medicine and nephrology.
Researchers analyzed data from 249,679 physicians initially certified in internal medicine by ABIM between 1990 and 2025, including 178,782 doctors linked to Medicare data. About 36% were identified as IMGs born outside the United States, and 11% were born abroad and trained in the U.S., together making up 47.2% of the internal medicine workforce.
"These findings highlight the important role of non-U.S.-born physicians in our nation's healthcare system, particularly for patients who have more difficulties accessing care," said lead author Giacomo Meille, PhD, Senior Health Services Researcher at ABIM. "As the nation's population ages, demand for care continues to grow, especially for physicians certified in subspecialties such as geriatrics, which relies extensively on physicians born outside the United States."
The researchers found that doctors born in countries affected by U.S. travel restrictions accounted for 6% of internal medicine physicians. Though the travel bans that went into effect for 39 countries in 2025 and 2026 ultimately exempted physicians, the impacts of the uncertainty remain . Hospitals placed some noncitizen doctors from these countries on administrative leave, for instance, and the National Resident Matching Program reported in March that the match rate for non-U.S.-citizen IMGs in U.S. medical residency programs reached a five-year low.
"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 and ABIM Board Director Alicia Fernandez, MD , a Professor of Medicine at the University of California, San Francisco, who practices as an internist at Zuckerberg San Francisco General Hospital and Trauma Center. "They play a central role in providing consistent, ongoing care for these patients and are an important part of how America must think about healthcare workforce planning as we face physician shortages in numerous disciplines."
