What Role Do Immigrants Play in the Hospital Workforce?

The Trump Administration has implemented numerous immigration policy changes to restrict entry into the US and deport immigrants. Although many of these policies have focused on undocumented immigrants, they likely will have ripple effects across immigrants of all statuses, and some actions have directly targeted lawfully present immigrants. Most lawfully present immigrants worry that they or their family could be detained or deported according to a recent KFF poll. Some proposed policies could make life more difficult for immigrants to remain in the United States, such as restrictions on health insurance coverage that were included in the One Big Beautiful Bill Act passed by the House. The Trump Administration has also established a new registry requirement along with financial incentives to encourage immigrants to leave the country voluntarily. Collectively, these changes could encourage or force immigrants to leave the country and deter future immigration.

Immigrants play a significant role in the U.S. workforce, filling jobs in many industries, including agriculture, construction, and health care and the hospital workforce. Many geographic regions and health care occupations already face workforce shortages, some of which are expected to grow. Reducing the number of immigrants, or discouraging immigrants from entering the U.S., could exacerbate these shortages, which in turn could reduce access to care, lead to understaffing and poorer quality of care, and increase hospitals’ labor costs, some of which could be passed onto patients and other payers.

This issue brief analyzes the role that immigrants play in the hospital workforce, overall and by occupation and state, based on data from the 2023 American Community Survey (ACS) (see Methods for more details). Immigrants include noncitizen immigrants (both undocumented immigrants as well as those who legally reside in the US, including through a green card or a student or work visa) and naturalized citizens.

Immigrants account for about one in six hospital workers, including among clinical and nonclinical workers

About one in six hospital workers are immigrants, overall (16%) and among clinical and nonclinical workers (17% and 15%, respectively) (Figure 1). Clinical workers are those who are health care professionals involved in diagnosing, treating, or otherwise caring for patients, including physicians, pharmacists, and technicians, as well as health care support occupations like nursing assistants. Nonclinical workers include building cleaning and maintenance, food preparation and service, office and support, and all other nonclinical workers. Immigrants make up about the same share of hospital workers (16%) as they do of workers overall (17%). Noncitizen immigrants make up a smaller share of hospital workers compared to workers overall (4% versus 8%) while naturalized citizens make up a larger share (12% versus 9%). Most immigrant hospital workers are citizens (74%), but about a quarter are noncitizen immigrants (26%). About seven in ten (69%) immigrant hospital workers are women and most are Asian (40%), Hispanic (22%), or Black (19%) (results not shown). The share of hospital workers who are immigrants has stayed constant at 16% since 2018 (result not shown).

Immigrants account for more than a quarter (27%) of all physicians at US hospitals

Among clinical occupations, immigrants represent a relatively high share of physicians working in hospitals (27%) (Figure 2). About one in five (19%) physicians are naturalized citizens and another 8% are noncitizen immigrants. Certain physician specialties are already experiencing shortfalls, some of which are projected to worsen by 2037. Reducing the number of immigrant physicians and surgeons or limiting pathways for immigrants to work in the US could exacerbate these shortages. Immigrants also account for a relatively high share of nursing assistants (22%).

Sixteen percent of registered nurses (RNs) are immigrants, which is the same as the share of all hospital workers that are immigrants. RNs account for the largest percentage of clinical hospital workers by occupation (43% in 2023) (result not shown). An increasing share of hospitals are hiring foreign-educated nurses to fill RN vacancies according to prior KFF analysis, including about one third of hospitals (32%) in 2023 representing nearly half of hospital beds (45%).

Immigrants account for almost three in ten (29% of) building cleaning and maintenance workers at US hospitals

Immigrants account for a relatively high share of building cleaning and maintenance workers at US hospitals and almost double the share of nonclinical workers generally (29% versus 15%) (Figure 3). This includes 17% of building cleaning and maintenance workers who are naturalized citizens and another 12% who are noncitizen immigrants. A larger share of immigrant building cleaning and maintenance workers are noncitizens compared to immigrant nonclinical hospitals workers overall.

Immigrants account for at least one in five hospital workers in nine states, including in the four largest states: California, Florida, New York, and Texas

Immigrants account for at least one in five (20%) of hospital workers in nine states, which were in the West (California, Hawaii, and Nevada), South (Florida and Texas), and Northeast (Maryland, Massachusetts New Jersey, and New York) (Figure 3). California has the highest share of hospital workers who are immigrants at 32%. The relatively high shares of immigrant hospital workers in these states likely reflects that a relatively large share of immigrants live in them.

Immigrants represent more than three in ten physicians working in hospitals in the four largest states: California (33%), Florida (37%), New York (33%), and Texas (31%) (results not shown; data were insufficient to evaluate the share of physicians who are immigrants in many states).