Healthcare in the U.S. is really stretched thin.
The staffing shortages keep growing.
And new employment data finally shows who’s propping up the system—and how things are shifting.
Fewer immigrants are entering the labor force.
More U.S.-born workers are stepping in.
Yet hospitals and clinics still rely overwhelmingly on immigrant labor to keep their doors open.
Let’s unpack this.
Who’s Filling the Gaps
Immigrants now make up 19% of the U.S. labor force, a drop from 20% earlier this year.
That’s a loss of about 750,000 workers.
At the same time, U.S.-born employment increased by 2.7 million.
Unemployment rates are nearly identical:
• Immigrants: 4.4%
• Citizens: 4.6%
But healthcare tells a different story.
• 16% of hospital workers are immigrants.
• In California, New York, New Jersey, Maryland, and Florida, it’s over 25%.
• 15.6% of nurses and 28% of health aides were born overseas.
• Over 26% of physicians received their medical training outside the U.S.
From ICUs to home health, immigrant workers provide the staffing that keeps American healthcare from failing.
The Expanding Shortage
Even with more U.S.-born workers entering the field, supply still falls far short of demand.
By 2037, the U.S. is projected to be short:
• 187,000 doctors
• 200,000–450,000 nurses
• 100,000 healthcare workers by 2028, according to Mercer
That’s roughly 1.9 million new hires every year just to maintain the same level of care.
This isn’t a competition—it’s a crisis of supply and demand.
Different Strengths, Same Purpose
Both groups bring something vital to the table.
| U.S.-Born Workers Often Move Into | Immigrant Workers Are More Concentrated In |
|---|---|
| Management and leadership roles | Direct care and bedside nursing |
| Education and training positions | Primary care and specialty physician roles |
| Patient communication and cultural orientation | Home health and elder care |
| Advanced residencies or graduate programs | Bilingual and culturally bridging care |
It’s not “us against them.”
It’s a partnership.
Without both, healthcare doesn’t exist.
The Reality of Wages
When demand is high and staff are scarce, wages rise.
That’s exactly what’s happening now.
States with large immigrant workforces—California, New York, and Texas—also have the highest healthcare wages.
Immigrant doctors often work in high-demand specialties, which push up salary averages.
American-born nurses are filling advanced roles in leadership and education, also driving pay upward.
Rural hospitals are doing whatever it takes to bring in qualified staff:
• Relocation bonuses
• Housing benefits
• Student loan forgiveness
Healthcare wages aren’t falling—they’re rising since facilities have no other choice.
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Where the Opportunities Exist
Here’s what the map looks like:
• High immigration = high wages: California, New York, Texas
• Midwest and rural South: new opportunity zones with signing bonuses and faster promotions
• Rural America: crisis areas where hospitals offer extra pay, housing, and debt assistance to attract workers
If you’ve ever thought about relocating, now’s the time to take a closer look.
What’s Coming Next
Over the next five years, things will get worse before they get better.
Telehealth and digital tools will become standard across hospitals and clinics.
The nurses who master them early will lead the next wave of high earners.
Value-based care models are growing fast.
That means wages will increasingly reflect communication skills and patient outcomes—not just bedside ability.
And as rural hospitals compete harder for talent, the wage gap between big cities and small towns is starting to close.
Healthcare isn’t shrinking. It’s changing.
How to Stay on Top of the Change
| If You’re Currently Working | If You’re Starting or Changing Careers |
|---|---|
| Learn new tech tools—telehealth, EMR, digital charting | Choose a high-demand specialty like geriatrics, psych, or telehealth |
| Strengthen leadership and cultural competency skills | Learn a second language |
| Research sign-on bonuses and relocation incentives in rural areas | Target programs offering tuition assistance or loan forgiveness |
Final Thought
Healthcare in 2025 won’t be about who’s taking jobs.
It’ll be about who’s staying in the workforce.
Immigrants continue to fill the hardest roles.
U.S.-born workers are stepping into leadership.
Both are key to keeping the system alive.
The smartest nurses aren’t panicking—they’re adapting.
They’re using this data to negotiate better pay, plan smarter moves, and stretch their dollars further.
They’re not just surviving the change—they’re taking advantage of it.