America’s Doctors Are on the Move: And the U.S. Healthcare System Is Paying the Price

The United States is losing doctors, and the US physician shortage is becoming impossible to ignore. More American physicians are moving to Canada, cutting clinical hours, or leaving medicine altogether. Nearly 1 in 5 doctors plan to reduce hours or exit practice within two years. Burnout rates remain above 50% in major specialties. At the same time, restrictive visa policies are pushing foreign-trained physicians out. This comes even as international graduates make up about a quarter of the workforce. The result is a physician shortage that the Association of American Medical Colleges projects could reach up to 86,000 doctors by 2036.

For millions of Americans, especially in rural and underserved communities, the crisis is already here.

This article breaks down the data behind the physician shortage, explores why doctors are looking beyond US borders, and examines what this means for patients, hospitals, and the future of healthcare delivery in the United States.

 

How Bad Is the US Physician Shortage Right Now?

The numbers paint a stark picture of the healthcare workforce strain across the country. According to the AAMC’s March 2024 projections, the nation faces a shortage of between 13,500 and 86,000 physicians by 2036. The breakdown is alarming across every specialty. Primary care faces a deficit of 20,200 to 40,400 physicians.

Surgical specialties are facing a significant gap of 10,100 to 19,900 doctors, reflecting the broader US physician shortage. Medical specialties like cardiology and oncology are also impacted, needing an additional 3,800 to 13,400 physicians. Other specialties, including anesthesiology and emergency medicine, face shortfalls of 10,300 to 35,600 doctors.

The December 2025 report from the National Center for Health Workforce Analysis projected an even larger combined shortage, reaching approximately 158,990 full-time equivalent physicians by 2038. Moreover, the report highlighted that supply adequacy in non-metropolitan areas stands at just 42%. As a result, rural America faces a 58% shortfall in physician availability compared to demand.

More than 83 million Americans currently live in federally designated Health Professional Shortage Areas (HPSAs) for primary care. The American Medical Association has noted that 90% of US counties lack a pediatric ophthalmologist, 80% lack an infectious disease specialist, and more than one-third of Black Americans live in a cardiology desert.

Related – The Best Cities with Medical Jobs in the United States

 

The 2026 Match – Growth, But Not Enough

The 2026 National Resident Matching Program (NRMP) was the largest in history. A total of 44,344 residency positions were offered across 6,809 programs, and 41,482 positions were filled, a 93.5% fill rate.

However, the Match also exposed persistent gaps contributing to the US physician shortage. Primary care specialties offered over 20,700 positions but achieved only a 92.1% fill rate, continuing a downward trend. Family medicine, the backbone of American primary care, continues to struggle with recruitment. A Blue Ribbon Panel has been convened to examine family medicine recruitment challenges following the 2026 Match results.

The core problem remains: physicians choose specialties and geographic locations based on personal preferences, compensation, and lifestyle factors. These choices often do not align with where the greatest patient need exists. For physicians considering a geographic move, understanding the doctor relocation timeline from offer letter to hospital onboarding can help streamline the transition into a new practice environment.

 

Why Are US Physicians Leaving Amid the US Physician Shortage?

The drivers behind the US physician shortage mirror many of the same forces pushing doctors out of countries like Italy, the UK, and Germany. However, several uniquely American pressures are accelerating this shift. Rising administrative burden continues to consume physician time, often pulling focus away from patient care. At the same time, compensation structures remain uneven across regions and specialties, creating growing dissatisfaction.

In addition, burnout has reached critical levels, reshaping how many physicians view long-term careers in medicine. As a result, shortage is no longer driven by workforce numbers alone. Quality of life, flexibility, and professional autonomy now play a central role in career decisions.

Now, let us look at the key factors driving this shift –

 

Burnout Has Reached a Breaking Point

Physician burnout in the United States hit record levels during the COVID-19 pandemic, with 62.8% of physicians reporting burnout in 2022. While that number has declined below 50% in 2024, the damage has been lasting. A 2024 survey found that 62% of physicians had made a career change in the previous two years.

One in five doctors planned to quit medicine or substantially reduce clinical hours by 2025, accelerating the US physician shortage. The pandemic did not create physician burnout; it amplified a crisis that had been building for decades due to administrative burdens, insurance bureaucracy, and unsustainable workloads.

 

The Administrative Burden Is Uniquely American

Unlike physicians in most developed nations, American doctors spend an extraordinary amount of time on insurance paperwork, prior authorizations, and billing disputes. Consequently, studies have shown that US physicians can lose up to 30% of their earnings due to insurance company denials and billing complications.

In systems like Canada’s single-payer model, a family physician may need one or two administrative staff. In contrast, in the US, that same physician could require ten support staff just to handle insurance communications. As a result, this administrative overhead is a significant driver of career dissatisfaction and, consequently, a major reason physicians cite when exploring opportunities abroad. Ultimately, the burden reshapes career decisions.

 

Political and Policy Uncertainty

Since 2025, a notable wave of American physicians has explored relocating to Canada. The Medical Council of Canada reported a 750% increase in US physicians creating licensure accounts between November 2024 and May 2025. Ontario alone registered 116 US-trained physicians in Q1 2025, while British Columbia tripled its annual US physician licensures.

Physician recruiting firms have reported a 65% increase in American doctors exploring Canadian job opportunities between January and April 2025, reflecting the growing US physician shortage. While political dissatisfaction is frequently cited as a motivating factor, professional dissatisfaction with the American healthcare model plays an equally important role.

Reproductive healthcare restrictions following the Dobbs decision have added another layer of complexity. This has been particularly significant for female physicians evaluating where to practice in the United States, with many resolving the dilemma by relocating, either to different states or out of the country entirely.

 

Compensation Paradox

The US has the highest-paid physicians in the world. Medscape’s global survey data shows that 38% of US physicians earn over $300,000 annually, the highest proportion of any country surveyed. Yet despite these earnings, many physicians feel their compensation does not adequately reflect the administrative burden, malpractice liability, educational debt, and lifestyle sacrifices required.

The average US medical student graduates with approximately $200,000 in educational debt. When combined with the years of below-market-rate compensation during residency and fellowship, the true financial return on investment for a medical career is far less impressive than headline salaries suggest. For physicians managing this financial burden during a career move, understanding relocation expenses and taxes becomes essential.

Also read – Healthcare Relocation Packages for Nurses and Doctors That Actually Cover the Cost of Starting Over

 

The Immigration Crackdown Is Making the US Physician Shortage Worse

While some American physicians are choosing to leave, the US physician shortage is also being intensified by shrinking access to international talent. International medical graduates have long played a critical role in filling workforce gaps across underserved regions.

However, tightening visa policies and regulatory uncertainty are making it harder for these physicians to enter or remain in the system. Delays in processing and limited residency pathways further restrict supply at a time of rising demand. As a result, healthcare systems face growing strain, especially in rural and high-need areas.

Know how immigration policies are influencing this growing gap –

 

Foreign-Trained Physicians Are the Backbone of Underserved Care

There are an estimated 200,000 to 300,000 foreign-born physicians currently practicing in the United States, according to a Harvard Gazette analysis. Many work in primary care and in the least lucrative specialties, the same areas where domestic graduates are least likely to practice. They disproportionately serve underserved urban and rural communities, where there may be only one physician for every 3,500 residents.

The largest numbers of IMGs come from India, Pakistan, the Philippines, and Nigeria. Their contributions are not supplementary; they are foundational to healthcare delivery in much of the country.

 

Visa Restrictions Are Creating a Healthcare Emergency

In December 2025, the US implemented stricter immigration screening for applicants from 39 countries, further intensifying the US physician shortage. As a result, visa processing for physicians from these nations was paused or indefinitely delayed, directly affecting doctors already employed in US hospitals. Consequently, as CNN reported, the policy has left thousands of immigrant doctors in limbo, threatening patient care in communities that rely on them.

The American Medical Association, American College of Physicians, and other major medical organizations have formally lobbied the Department of Homeland Security and Congress to exempt physicians from these restrictions, characterizing the situation as a threat to national health security.

At UConn, 20 residents experienced visa issues in a single month in 2025. Program directors report that uncertainty around immigration status is now a routine staffing crisis, not an exception. Meanwhile, Canada has moved aggressively to attract these same physicians, expediting hiring processes and creating fast-track permanent residency streams specifically designed for US-based foreign-trained doctors. Those affected may benefit from understanding the Canada Express Entry process as an alternative pathway.

 

How the US Physician Shortage Compares Globally

The Medscape Professional Network’s global survey of 1,271 physicians across dozens of countries reveals that physician migration is a worldwide phenomenon. The key motivators are universal: better quality of life (70%), higher financial incentives (46%), and family benefits (46%).

But while countries like Italy are hemorrhaging doctors to France, Belgium, and the Gulf states, the US faces a different challenge. The US is simultaneously a top destination for foreign physicians and an increasingly difficult place for them to practice. This contradiction creates a unique vulnerability.

In 2024, nearly 25% of practicing physicians in the US were international medical graduates. Yet only 60% secured residency positions on their first attempt. Visa delays stretched from 3 months to over 12 months. Licensing requirements varied across 50 states. Nearly 30% reported administrative barriers as a primary obstacle. The pipeline leaks at every stage.

Globally, the contrast sharpens. The OECD average stands at 3.7 physicians per 1,000 people. The US lingers near 2.6. Germany reports 4.5. Italy holds at 4.1 despite outflows. By 2030, demand in the US is expected to exceed supply by up to 124,000 physicians. Demand rises by 1.2% each year. Supply struggles to keep pace. The numbers tell a quiet, persistent story.

 

Italy vs. the United States – Different Crisis, Same Root Causes

Italy lost nearly 180,000 healthcare professionals to emigration between 2000 and 2022. Roughly 1,000 Italian physicians request foreign certification annually. The Italian National Health Service sees seven physicians leave per day.

The US crisis differs in scale and mechanism but shares root causes. Both countries face aging physician workforces, insufficient pipeline expansion, and working conditions that drive doctors out of their national healthcare systems. Both countries are experiencing a mismatch between where doctors want to work and where patients need them most.

The critical difference is that the US has historically compensated for domestic shortages by importing international talent. That pipeline is now under threat. Physicians exploring international opportunities may find value in reviewing the easy relocation guide for physicians to understand what a move involves.

 

Which US States Are Hit Hardest?

The physician shortage is not evenly distributed across the country. Rural and southern states face the most severe deficits.

Mississippi, New Mexico, and Louisiana are projected to have the largest shortage ratios by 2030. California, despite producing more physicians per year than nearly any other state, has more federally designated physician shortage areas than any state in the nation, with 661 primary care HPSA designations as of December 2025.

In Northern California counties like Shasta, Lassen, and Trinity, the physician supply is only about two-thirds of the state average. Patients in these communities wait months for primary care appointments, when a primary care physician is available at all.

The Inland Empire (San Bernardino and Riverside counties) represents one of the largest metro areas in the US by land area, with a growing population that has far outpaced provider supply. Rural areas from the Central Coast to the Sierra foothills face geographic HPSAs where the nearest physician may be a significant drive away. For doctors considering a move to fill these gaps, understanding jobs that offer relocation assistance can make the financial side of relocating far more manageable.

 

What Can Be Done?

Addressing the US physician shortage requires a multi-pronged strategy that goes beyond simply training more doctors. The scale of the challenge calls for structural changes across education, policy, and workforce planning. Expanding residency slots remains critical, but it must be matched with better distribution across underserved areas.

At the same time, reducing administrative burden can help retain experienced physicians who might otherwise leave practice early. In addition, reforming immigration pathways can restore access to international medical talent. As pressure builds across the system, long-term solutions must balance supply, efficiency, and physician well-being.

A closer look at the solutions shaping the path forward –

 

Expand Graduate Medical Education Funding

The AAMC and the GME Advocacy Coalition, representing over 100 physician, hospital, and patient care organizations, support bipartisan legislation to expand Medicare-supported residency positions by 14,000 over seven years. Without this expansion, training capacity will remain the bottleneck regardless of how many students enter medical school.

 

Fix the Immigration Pipeline

Foreign-trained physicians are not a temporary fix; they are a structural component of US healthcare delivery. The Healthcare Workforce Resilience Act, first introduced in 2020, would recapture tens of thousands of unused employment-based visas for physicians and nurses. Congress has yet to act on this legislation despite bipartisan support.

At least 20 states have moved independently to reduce licensing barriers for immigrant healthcare professionals with overseas credentials, a step aimed at addressing the US physician shortage. This state-level action is encouraging but insufficient without federal immigration reform. Physicians navigating the challenges of international relocation face additional hurdles beyond licensing that require careful planning.

 

Address Burnout Systemically

Reducing physician burnout requires systemic changes to how medicine is practiced in the United States. Prior authorization reform, reduced documentation requirements, and meaningful investment in team-based care models can all contribute to making American medicine more sustainable for those who practice it. Physicians evaluating whether a fresh start in a new market could help should explore the best cities to relocate based on quality of life, cost of living, and healthcare demand.

 

Leverage Technology and Team-Based Care

Nurse practitioners and physician assistants can help mitigate the US physician shortage in primary care, though their impact on specialty shortages is more limited. Telehealth expansion, particularly in rural areas, can extend the reach of existing physicians. AI-assisted diagnostics and documentation tools offer the potential to reduce administrative burden, one of the primary drivers of physician dissatisfaction.

Recommended read – Healthcare Employee Relocation to Attract Talent in a Staffing Shortage

 

The Bottom Line for US Healthcare

The United States is at an inflection point. The physician shortage is not a future problem; it is a current crisis that is measurably worsening. Doctors are burning out, retiring early, leaving the country, and are increasingly unable to be replaced by the international physicians who have historically filled the gaps. For the 83 million Americans living in physician shortage areas, the consequences are not abstract. They are longer wait times, fewer preventive screenings, delayed diagnoses, and worse health outcomes.

The solutions exist. What remains to be seen is if the political will exists to implement them before the crisis becomes irreversible.

 

How Relo.AI Helps Physicians Navigate Relocation Decisions

For physicians planning their next career move across state lines or international borders, clarity often becomes the biggest challenge. Relo.AI offers practical, data-driven tools built for high-income professionals managing complex relocations.

With the Relo.AI relocation calculator and global relocation estimator, physicians can assess cost differences, tax exposure, and lifestyle changes before making a decision. These tools replace guesswork with clear comparisons, helping doctors evaluate opportunities with confidence.

In a market shaped by workforce gaps and shifting priorities, informed decisions carry real weight. If you are considering a move, we help you explore options in detail and understand the financial reality before taking the next step.

Book a FREE session with us to receive a personalized relocation assessment aligned with your career goals.

 

Sources –

• Association of American Medical Colleges (AAMC) — Physician Supply and Demand Projections, March 2024
• National Center for Health Workforce Analysis (HRSA) — Physician Projections, December 2025
• Medscape Professional Network — Global Physician Survey, November 2025
• Medical Council of Canada — Physician Licensure Data, 2025
• American Medical Association — Physician Shortage Reports
• National Resident Matching Program (NRMP) — 2026 Match Data
• Harvard Gazette — How Immigrant Doctors Fill Critical Gap in US Healthcare
• CNN Health — Trump Immigration Crackdown Impact on Doctors, April 2026