Restricting Clinicians at Every Level—and Calling It a Shortage
As the US faces a projected shortage of 86,000 physicians by 2036, according to the Association of American Medical Colleges, Axios reports that the Trump administration’s visa restrictions are sidelining foreign-born physicians who mainly serve in underserved areas. This threatens to worsen already strained access to care. In a system that depends heavily on international medical graduates to fill workforce gaps, tightening immigration policy risks leaving patients with fewer options and longer waits.
Earlier this year, federal immigration authorities slowed or halted the processing of key benefits—such as renewals of work authorization—for individuals from dozens of countries who are already in the United States. The delays have affected employment-based visas, permanent residency applications, and citizenship processing. Although many visa holders are usually allowed to continue working while their renewals are pending—often for several months—this has disrupted that expectation. Some physicians have had to leave their jobs without pay, even though they remain lawfully in the country under employer sponsorship. As a result, many now find themselves in limbo: unable to practice, considering whether to leave, or seeking opportunities elsewhere.
But this episode doesn’t just expose an immigration problem—it exposes a system built to restrict the supply of care. The United States artificially limits the supply of clinicians through licensing rules, residency restrictions, and accreditation hurdles that restrict how many doctors we train and allow to practice. As a result, the system heavily depends on foreign-trained physicians, especially in underserved areas. Limiting their entry only worsens a shortage caused by domestic policies. The simple solution is not to tighten restrictions but to increase supply overall—by welcoming qualified physicians from abroad and removing the barriers that prevent willing and capable clinical practitioners from serving patients here at home.
This means that lawmakers must amend licensing laws to broaden the scope of practice for various health care professionals, allowing them to operate fully within their areas of training. (Ideally, they should abolish licensing laws and allow third-party certification organizations to screen providers.)
Such reforms include granting advanced practice nurse practitioners (APRNs) full practice authority; enabling physician assistants (PAs) to practice independently of physicians; expanding access to mental health services by allowing clinical psychologists with psychopharmacology training to prescribe psychotropic medications (seven states currently permit “RxPs”); permitting pharmacists to test and treat routine, self-limited medical conditions; and amending licensing laws so that medical school graduates who have not matched in a residency program can work as apprentices, called “assistant physicians,” while waiting for the next year’s residency match.
On the residency side, state lawmakers should end the ACGME’s de facto accreditation monopoly. Because licensing boards require at least one year in an ACGME-accredited program, they effectively exclude physicians trained in programs accredited by comparable international bodies or specialty certifiers, needlessly limiting the supply of doctors available to treat patients.
At the same time, federal regulators should avoid placing premature restrictions on AI-driven medical tools that can expand access to basic care and triage. Patients are already turning to these tools in response to primary care shortages. Policymakers should not respond by constraining them further, but by allowing innovation to help fill the gaps.
The lesson here is simple: when policymakers restrict supply at every level—who can enter the country, who can enter the profession, and what tools patients can use—access to care inevitably suffers. A freer system would move in the opposite direction: more openness to skilled immigration, broader scope of practice, and fewer barriers to technological innovation. Each of these reforms increases the number of ways patients can get care. Together, they begin to unwind a scarcity problem that policy itself created.