Mind the Gaps

Nearly one in four physicians worldwide is 55 or older. In high-income countries, it’s nearly one in three. By 2030, 67 countries won’t have enough health workers to meet their own needs. The United States needs international physicians, and the question now is whether its immigration system is built to attract and keep them as global competition for physicians intensifies.

Only 25 of the nation’s 1,052 OB/GYN residency training sites are in rural areas, and six states have no OB/GYN residency program at all. Until that changes, rural communities will have to recruit most of their OB/GYNs from urban training programs. Immigration policy is already part of that recruitment: J-1 waivers and the physician NIW support international physicians who practice in designated shortage areas.

One-third of nephrology fellowship positions went unfilled in 2026, even as the specialty faces a growing shortage of physicians. International medical graduates account for 61% of nephrology fellows and 54% of practicing nephrologists—the highest share of any medical specialty. U.S. medical graduates have shown declining interest in nephrology, while international physicians have become an increasingly important part of the specialty. International physicians aren't a temporary answer to nephrology's physician shortage. They're central to the specialty's future.