Travel and visa restrictions imposed by the Trump administration threaten patient care at hundreds of hospitals that depend on medical residents recruited from overseas.
Foreign medical residents often serve as the frontline caregivers at busy safety-net hospitals in low-income communities. Normally the residents begin work on July 1. Orientation programs for some of them already started this week.
Now some of those hospitals are racing to prevent staffing shortages.
“If international medical graduates can’t start their medical residencies on time on July 1, the ramifications are so far-reaching that it is really unconscionable,” said Kimberly Pierce Burke, executive director of the Alliance of Independent Academic Medical Centers.
Senior residents leave hospitals in June and go on to start their careers, she noted. Hospitals rely on new residents to replenish their ranks. “If they don’t come on July 1, that leaves a hole in the patient care team,” Ms. Burke said. “Who’s going to pick up the slack?”
On May 27, the Trump administration suspended new interview appointments for foreign nationals applying for J-1 visas. The visas, for participants in cultural or educational exchange programs, are used by most medical residents arriving from overseas.
On Wednesday, the State Department lifted the pause on visa appointments, according to an official who spoke anonymously to discuss an internal policy change. It was not immediately clear how many, or how quickly, physicians could be granted their visas.
The process now includes “enhanced social media vetting,” intended to ferret out potential security risks, the official said.
The administration also has banned or restricted travel to the United States from 19 countries. The restrictions may be extended to an additional 36 countries, including many African nations, if they do not comply with U.S. demands regarding overstayed visas and security concerns.
The bans and restrictions were motivated by a commitment “to protecting our nation and its citizens by upholding the highest standard of national security and public safety through our visa process,” the State Department official said.
Foreign doctors from countries covered by the bans and other restrictions could request a “national interest exception,” according to the State Department spokeswoman. It was not immediately clear how that process would unfold.
The American medical system relies heavily on physicians from other countries. One in five U.S. physicians was born and educated overseas, according to the Association of American Medical Colleges.
New doctors from other countries account for one in six medical residents and specializing fellows at U.S. teaching hospitals. In 2024, the Educational Commission for Foreign Medical Graduates sponsored more than 15,500 doctors from over 150 countries to fill residency or fellowship training spots at 770 hospitals.
Residents are new medical school graduates who complete their training by working for several years under the supervision of more experienced doctors, gaining experience and acquiring the skills needed for various specialties. They work up to 80 hours a week on average, earning relatively low salaries.
Residents are the foot soldiers of hospitals, critical to their operations, said Dr. Douglas DeLong, a semiretired physician in upstate New York who has worked in academic training programs.
“If you’re a patient in a hospital, the resident is the first doctor you see in the morning,” Dr. DeLong said.
Many foreign medical residents stay and build their careers in the United States. Most go into primary care fields like internal medicine, family medicine and pediatrics, areas of shortage that American medical graduates tend to avoid.
Many of the 6,653 noncitizen doctors accepted for residency positions in the United States this year this year had already secured visa appointments before May 27. Those from banned countries who are already in the country are able to remain.
But an estimated 1,000 medical residents may not be able to enter the country now. The vacancies will have disparate effects on hospitals, depending how heavily reliant they are on foreign medical talent.
At Brookdale Hospital Medical Center, a busy safety-net facility in Brooklyn, people queued up for emergency care on Monday. The lobby thrummed with visitors clutching bouquets of roses, and patients nodded off on benches, waiting to be seen.
Like many hospitals in underserved communities, Brookdale relies heavily on international medical graduates who are not U.S. citizens to staff the medical and pediatrics floors and outpatient clinics.
“It’s a wait-and-watch situation,” Dr. Christos Paras, who oversees the residency program, said in an interview. “We just don’t know what the impact will be.”
“We have residents from literally all over the world,” he added. “I am not exaggerating — every continent.”
Brookdale’s internal medicine residency program relies on foreign medical graduates to staff about 90 percent of its 55 positions. So far, two noncitizens have been blocked from entering the country, said Dr. Conrad Fischer, director of the program.
“If I am missing two or three people, I can go out and get the spots filled,” Dr. Fischer added. “But next year, we’re not talking about missing two or three — we’re talking about missing thousands.”
If the travel restrictions are maintained, “it would gut the program,” he said.
Some residency programs may hire second-string applicants to fill vacancies, Dr. Paras said, an option available only to hospitals that hire residents directly.
Those that go through the national residency match program must seek waivers from their obligations to the matched residents in order to replace them.
Hospitals and clinics in rural areas of the country already struggle to recruit graduates of U.S. medical schools to their residency programs. They rely heavily on international graduates.
New foreign doctors are not taking residency positions away from American medical school graduates. Just the opposite: This year, there were about 40,000 residency positions offered through the national match system, but only 28,000 graduates of U.S. medical schools. Foreign residents fill a crucial labor shortage.
Hospitals are not allowed to overwork residents and may lose their accreditation as medical teaching institutions if they do. An insufficient number of residents could also cost them Medicare funds tied to graduate medical education.
The noncitizen international medical graduates who make it to U.S. training programs are “well-trained, well-qualified and motivated,” Dr. DeLong said.
“This is the new generation of physicians for Americans,” he added. “These are the physician who will take care of us as we age. They are the future of medicine.”
Roni Caryn Rabin is a Times health reporter focused on maternal and child health, racial and economic disparities in health care, and the influence of money on medicine.
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