Key Takeaways
- California’s health workforce is uniquely dependent on immigrants. 34% of health workers are foreign-born, including roughly half of dentists, direct care workers, and pharmacists.
- Federal policy is shifting rapidly. More than 500 federal actions have restricted foreign-born health professionals’ ability to live and work in the US.
- Safety-net providers and underserved patients face the greatest risk. Rural hospitals, community clinics, and teaching hospitals rely most heavily on immigrant clinicians, and their patients have the fewest alternatives.
California’s health system depends heavily on immigrant health workers. More than a third of the state’s nearly two million health care workers were born outside the United States. They include physicians, nurses, dentists, pharmacists, and direct care workers who provide care in communities across the state, including many that have long faced shortages. New federal immigration policies now put that workforce, and access to care for the patients who depend on it, at risk.
This explainer is for policymakers, health system leaders, educators, and advocates. It breaks down who makes up California’s immigrant health workforce, how visa pathways work and where they fall short, and what recent federal policy changes mean for workforce planning, recruitment, and patient care.
California’s Health Workforce Depends on Immigrants
California ranks second in the nation for the share of its health workforce that is foreign-born — 34%, nearly double the national average. In high-demand occupations, that share is even larger: 48% of dentists, 46% of direct care workers, and 45% of pharmacists were born outside the United States. One in three California physicians was born outside the US, and these doctors are far more likely than their US-trained peers to practice in underserved communities.
These workers do more than fill staffing gaps. They strengthen the care experience for millions of Californians by helping to address racial, ethnic, and linguistic concordance between patients and providers. Yet federal immigration policy limits the contributions immigrants can make, in part because federal law does not include visas specifically for health workers.
More Than 500 Federal Actions, and Counting
In its first year, the second Trump administration has taken more than 500 actions that limit foreign-born health professionals’ ability to live and work in the United States. Many of these changes directly affect the immigration and visa pathways health professionals depend on to train and work in the country, including:
- A federal pause in visa processing for individuals from 90 countries
- A new $100,000 H-1B visa fee, with no exemption for health care workers
- A weighted H-1B lottery that favors higher-paid positions, disadvantaging safety-net employers and early-career hires
What’s at Stake for California’s Communities
These policy changes will not affect all communities equally. Rural hospitals, community health clinics, teaching hospitals, and other safety-net providers, already operating on thin margins, depend heavily on foreign-born health workers and will feel the impact first. State and local programs designed to address shortages by recruiting immigrant clinicians, including the Licensed Physicians from Mexico Pilot Program, could also be affected.
The patients most likely to lose access are those who already face the greatest barriers to care: communities of color, rural residents, low-income families, and people who speak languages other than English at home.
Read the full analysis to understand what federal immigration policy changes mean for California’s health care workforce and the patients who depend on it.
