A new cross-sectional study published in JAMA highlights the central role of non-US-born physicians in sustaining the nation’s internal medicine workforce, particularly in communities that face persistent shortages of medical professionals. According to the study, physicians born outside the United States—including both US medical graduates (USMGs) and international medical graduates (IMGs)—account for nearly half of all physicians practicing internal medicine in the country. The analysis also found that these physicians provide a disproportionate share of care to underserved patient populations, underscoring how migration, medical education, and workforce distribution are closely linked to access to care in the United States.
The findings arrive as the US health care system confronts a complex combination of demographic change, rising chronic disease, geographic maldistribution of doctors, and growing demand for primary and specialty services. Internal medicine physicians are particularly important within this system because they care for adults across a broad spectrum of conditions, from hypertension and diabetes to cancer, kidney disease, infectious illnesses, and multiple chronic disorders occurring at the same time. Their work spans outpatient clinics, hospitals, academic medical centers, rural practices, and safety-net institutions. The study suggests that the physicians most essential to this broad care network are not distributed evenly across the population, and that non-US-born doctors often serve where the need is greatest.
The researchers used a cross-sectional design to examine the composition of the US internal medicine workforce and the populations served by different groups of physicians. In epidemiology, a cross-sectional study captures information at a defined point or period rather than following participants over time. This design can reveal patterns and associations across a large workforce, although it cannot by itself prove that a physician’s birthplace causes a particular practice location or patient-care pattern. In this case, the approach allowed the authors to compare the representation of US-born and non-US-born physicians and to assess whether their work was concentrated in areas or settings serving underserved communities.
The study’s definition of non-US-born physicians includes two groups with distinct educational pathways. US medical graduates are physicians born outside the United States who completed their medical education at a US medical school. International medical graduates, by contrast, completed medical school outside the United States, regardless of where they were born. Combining these categories focuses attention on birthplace and workforce contribution, while also recognizing that physicians may enter the US system through different training routes. Those routes involve licensing examinations, credential verification, residency training, certification, and, in many cases, adaptation to a new health care system and patient population.
Nearly half of the internal medicine workforce being non-US-born is a striking measure of the specialty’s international character. It also indicates that the American medical system depends on a workforce shaped by global educational and migration patterns. Physicians trained or born abroad bring clinical experience from different health systems, languages, cultural backgrounds, and public health environments. These characteristics can be particularly valuable in communities with large immigrant populations or limited access to clinicians who understand patients’ linguistic and cultural circumstances. However, the study does not imply that birthplace alone determines quality, commitment, or clinical ability. Rather, it reveals a structural pattern in who is available to provide care and where that care is delivered.
The disproportionate care provided to underserved populations is one of the study’s most consequential findings. Underserved communities may include people living in rural or remote areas, low-income urban neighborhoods, regions with few physicians, and populations facing barriers related to insurance, transportation, language, housing, or immigration status. These communities often experience higher rates of preventable illness and delayed diagnosis while having fewer local medical resources. When non-US-born internists practice in such settings, they can become critical points of entry into the health system, managing complex disease, coordinating referrals, and providing continuity for patients who might otherwise struggle to obtain care.
This pattern has implications for workforce planning and medical education policy. Simply increasing the total number of physicians may not solve shortages if new doctors remain concentrated in affluent metropolitan areas. Policymakers and training institutions must also consider how physicians are recruited, educated, licensed, and supported in places with the greatest need. Residency programs, loan-repayment initiatives, immigration policies, visa regulations, and institutional hiring practices can all influence where doctors ultimately practice. The findings suggest that any national strategy for strengthening internal medicine must account for the contributions of non-US-born physicians rather than treating them as a marginal component of the workforce.
At the same time, reliance on internationally connected physicians raises important questions about fairness and sustainability. International medical graduates often undergo lengthy and costly certification processes before entering residency or independent practice in the United States. They may face restrictions related to immigration status, difficulties transferring credentials, and professional uncertainty even after completing rigorous training. The United States also benefits from physicians educated in countries that may themselves experience shortages. A responsible workforce strategy therefore requires attention not only to domestic access but also to the ethical consequences of recruiting medical professionals from health systems with limited resources.
The study’s cross-sectional nature means that its results should be interpreted as a detailed snapshot rather than a forecast of future workforce trends. It cannot establish how physicians’ practice locations changed over time, why individual doctors chose particular communities, or whether the distribution of non-US-born physicians will remain stable. Further research could examine retention, specialty choice, patient outcomes, language concordance, rural practice, and the effects of immigration and training policies. Even with these limitations, the findings provide a clear signal: non-US-born physicians are not simply filling isolated gaps in American medicine. They are an essential part of the internal medicine workforce and are helping maintain access to care for populations most likely to be left behind.
As the United States debates how to expand medical capacity, improve health equity, and prepare for future shortages, the study places physician origin at the center of a broader workforce conversation. The evidence shows that internal medicine already depends heavily on doctors whose life histories connect the US health system to the wider world. Their role is especially visible in underserved communities, where the presence of a physician can determine whether a patient receives preventive care, timely treatment, or ongoing management of a serious chronic condition. Recognizing and supporting this workforce may be one of the most immediate ways to strengthen access to adult medical care across the country.
Subject of Research: The role and distribution of non-US-born physicians, including US medical graduates and international medical graduates, in the US internal medicine workforce and their contribution to care for underserved populations.
Web References: https://doi.org/10.1001/jama.2026.13268
References: Meille G, et al. Cross-sectional study of non-US-born physicians in the US internal medicine workforce. JAMA. doi:10.1001/jama.2026.13268.
Keywords: Internal medicine, physician workforce, international medical graduates, US medical graduates, non-US-born physicians, underserved populations, health care access, medical workforce, physician distribution, health equity
Tags: demographic changes affecting US medical workforcediversity in internal medicine specialtygeographic distribution of non-US-born doctorshealthcare access in rural and safety-net clinicsimpact of migration on US healthcare systeminternational medical graduates in healthcarenon-US-born physicians in US internal medicine workforcephysician distribution and healthcare disparitiesphysician workforce shortages in underserved communitiesrole of immigrant physicians in US primary careunderserved patient populations and physician workforceUS healthcare workforce demographics
