The Perfect Storm in American Healthcare
Dr. Brian Moreas represents a growing frustration among American healthcare providers. The Florida nephrologist, who followed his physician parents and grandfather into medicine, finds himself increasingly unable to fulfill his primary mission: helping patients. Instead, his days are consumed by administrative hurdles and specialist referrals that grow more challenging by the month. His experience reflects a broader systemic crisis emerging in American healthcare as demographic pressures and policy changes create unsustainable conditions.
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The Specialist Shortage Crisis
Dr. Moreas spends significant time attempting to connect patients with geriatric specialists, psychiatrists, endocrinologists, and rheumatologists – all of whom are becoming increasingly scarce. “I don’t talk to any medical students who say, ‘Oh, I want to go into geriatrics when I get out,’” he notes. “Everybody says, ‘I want to go to dermatology or orthopedics.’” This specialty preference mismatch creates critical gaps in care for aging Americans, particularly as the population over 65 is projected to increase from 58 million in 2022 to 82 million by 2050.
The situation creates a vicious cycle: as specialists retire early due to overwhelming workloads, the remaining physicians face even greater burdens. Dr. Moreas observes that his peers are “retiring earlier, inadvertently increasing the burden still on those still in the field.” This trend is particularly concerning given the dual crisis facing American healthcare as both domestic workforce participation and immigration patterns shift.
Immigration Policy’s Unintended Consequences
Recent policy changes have accelerated healthcare workforce challenges. Since the 2024 election, the Trump administration has implemented several immigration restrictions, including adding a $100,000 price tag to highly-skilled H-1B visas and proposing caps on international students. The effects are already measurable: America’s foreign-born population declined by over one million people between January and June 2025 – a reduction not seen since the 1960s.
According to preliminary data, student visas declined by 19% in August compared to the previous year, particularly significant since August typically represents a peak month for student arrivals. These trends concern healthcare providers who rely on international talent to fill critical roles. As Dr. Moreas observes, “If you go to a nursing home or you go to a hospital on the night shift, it’s almost all international aides and nurses.”
The Economic Impact
The economic consequences extend beyond healthcare. A working paper from the American Enterprise Institute found that current immigration policies will likely result in negative net migration in 2025, shrinking U.S. GDP by 0.3% to 0.4%. Meanwhile, economic analysts continue to monitor how labor force changes affect various sectors of the economy.
The healthcare sector faces particular pressure because immigrant workers disproportionately fill high-demand, lower-paid positions and work in regions that struggle to attract domestic talent. Between 2007 and 2021, while the total number of workers in nursing care facilities declined, the portion of foreign-born workers in the sector increased from 16.43% to 18.21%.
Technological Solutions and Limitations
Some hope technology might alleviate workforce pressures, but implementation challenges remain. Recent cloud infrastructure vulnerabilities demonstrate the risks of over-reliance on technological solutions in critical sectors. Similarly, debates around digital regulation frameworks highlight the complex interplay between technology, policy, and practical implementation in healthcare.
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The Human Cost
For physicians like Dr. David Shusterman, a Soviet refugee who came to the U.S. in the 1980s, the current situation represents a mathematical impossibility. “Our medical schools are filled with foreign-born people,” he notes. “There’s a lot of positions that need filling right now – it’s hard to find a urologist, hard to find other specialties.”
Dr. Shusterman estimates that 5-10% of urology program participants are on visas, creating uncertainty for precisely the skilled professionals the system most needs. “These are people who are in super high demand,” he emphasizes. “They would love to stay, mainly because of the reimbursement – they make more here than other places – and the reason they make more is because they’re needed.”
Potential Pathways Forward
The White House suggests domestic talent could fill healthcare gaps, noting that “over one in ten young adults in America are neither employed, in higher education, nor pursuing some sort of vocational training.” However, Dr. Moreas warns that motivating domestic talent into less lucrative medical roles could “pile further pressure on an already stretched sector.”
Meanwhile, global investment patterns suggest other countries are increasingly competing for the same skilled healthcare workers that America appears to be discouraging. As Dr. Moreas observes, “Other countries are actually economically starting to do better and it may be more lucrative. Once upon a time it was a very good lifestyle to come to the United States, but now there are so many other countries that people can choose from.”
Broader Implications
The healthcare workforce crisis reflects larger market trends and innovations affecting multiple sectors of the economy. What makes healthcare particularly vulnerable is the combination of specialized training requirements, demographic inevitability, and the immediate human consequences of workforce shortages.
Dr. Shusterman advocates for clearer immigration benchmarks for skilled healthcare workers: “My suggestion to the immigration department is to be much clearer about [saying] ‘This is what we need, if you study in these fields you have a clearer pathway.’” Such clarity could help address what he describes as the “fear” and uncertainty causing skilled professionals to choose other destinations.
An Uncertain Future
The American healthcare system faces a critical juncture. With an aging population requiring more care and a shrinking pool of professionals available to provide it, the need for strategic workforce planning has never been more urgent. The solution will likely require a multifaceted approach including:
- Clear immigration pathways for healthcare professionals in high-demand specialties
- Domestic training incentives for less popular medical fields
- Technological innovation to extend the reach of existing providers
- Workplace reforms to improve retention of current healthcare workers
Without coordinated action, the situation Dr. Moreas describes – where patients discharged to home care must return to outpatient centers because care workers cannot be found – may become increasingly common. The consequence will be diminished care quality, overwhelmed providers, and ultimately, worse health outcomes for Americans of all ages.
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