Michael Liu grew up in Toronto, Canada, then moved to the United States to attend college and medical school because America was the primary destination for him to pursue his aspirations of becoming a doctor and researcher.
“You know, chasing the American dream and understanding all the possibilities, that really attracted me,” says Liu, who attended Harvard University. Now 28 years old, he has deep personal and professional roots in Boston, where he is an internal medicine resident at Mass General Brigham.
But this spring he was appalled by the Trump administration's cuts to research at the National Institutes of Health and the Department of Health and Human Services. “It was a really amazing moment for me,” Liu says. “It got me thinking about where professionally this makes the most sense for me. I still have strong ties to Toronto and my mentors.”
Then, in September, Liu was making rounds with two doctors from Mexico and Costa Rica when Administration Increases H1B Visa Fees Almost 30-foldwhich are intended for highly qualified specialists, up to $100,000. He watched his colleagues' tearful reactions to the sudden uncertainty that had derailed their careers, knowing that employers such as hospital systems were unlikely to be able to afford to pay for such drastic increases.
“It was terrible to see,” Liu says. He has a green card because he married a US citizen earlier this year. But he said the Trump administration's actions are affecting him.
“It feels like my contributions—simply because I wasn’t born in this country—are less valued,” Liu says. “I hadn’t really thought that deeply about coming home before, but it was definitely more important.”
Rural labor force
Immigrants make up about a quarter all the country's doctors, and the US health care system largely depends on them. There are approximately 325,000 doctors — No including nurses or other health care workers living and working in the United States who were born and trained elsewhere.
In rural communities and in some areas of medicine, the dependence on immigrant doctors is much higher. IN primary care and specialties such as oncology, e.g. foreign-born doctors make up about half labor force.
Meanwhile, healthcare is already burdened retirement and burnout. Many experts say recent immigration and health care policies are only making the situation more difficult and less attractive for foreign-born talent to expand staffing shortages in the American healthcare system.
“This is a defining moment where decades of progress could be at risk,” says Dr. Julie Gralowhead doctor of the hospital American Society of Clinical Oncology.
She says policies that prohibit funding for everything from scientific research to public health have damaged the US's reputation to the point that she hears from hospitals and universities that top international talent is no longer interested in coming to America. “Until this year it was a dream – a wish! – so you can get a job and come to the USA. And now no one wants to come.”
Meanwhile, Gralow says other countries such as China, Denmark, Germany and Australia are taking advantage of this by recruiting international talent from outside the US, including American-born doctors and medical researchers, with the promise of stable grant funding and state-of-the-art equipment overseas.
American patients will feel the ripple effects of this for generations, Gralow said.
Immigrant doctors have historically found work in U.S. communities that had serious shortages of medical staff to begin with, so those places may also see a greater effect from the decline in international hiring, says Michael Liu, a medical resident in Boston.
He points to his recent co-authored work. research in JAMA An estimated 11,000 doctors, or roughly 1% of the country's doctors, currently hold H1B visas. “This may seem like a small number, but the percentage varies greatly by region,” he said, and they tend to congregate in areas with the fewest resources, reaching up to 40% of physicians in some communities.
“In high-poverty counties, the prevalence of H1B physicians is four times higher; we also saw the same pattern in rural communities,” he says. (Many doctors and doctors residents may have different types of visas, such as J-1and others.)
Groups such as the American Medical Association asked the administration to release doctors from new H1B fees. HHS did not respond to requests for comment on recent visa policies and health care workers., although some opposition has seems to have softened the president's position.
History of immigration
Over the past six decades, immigrants have contributed greatly to strengthening the United States' reputation as the undisputed world leader in medical research and practice. The US is second to none in terms of pay and prestige, helping to attract the world's best talent – at the expense of their home countries.
It began in 1965, during a period of expanding federal investment in public health and scientific research, spurred by international and Cold War rivalries due to events such as the launch of Satellite. That same year, Medicare and Medicaid were created, and with them came a sudden demand for doctors, says They were Alamprofessor of history of science at Harvard.
“Overnight, approximately 25 million people can now access health services,” says Alam. Passage this year Hart-Celler Immigration and Nationality Act opened U.S. borders to doctors and other people with in-demand skills, says Alam, who recently published book, Caring for foreignersabout the history of immigrant doctors in the USA.
Over the next decade, the US granted visas to 75,000 doctors, and by 1975, approximately 45% of all US doctors were immigrants, Alam said. The US's top-notch reputation allowed it to attract more talented doctors than America could train and train: “More immigrant doctors entered the job market each year than US-trained doctors joined,” she says.
Now, Alam says, the US is reversing much of that, eroding its role as a global leader in medicine and science and narrowing its borders.
