Deporting Immigrants May Further Shrink the Health Care Workforce

Abstract

This study explores the potential for health care staffing shortages in the US by estimating the number of immigrants employed in health care who could be affected by deportation or immigration restrictions.

Nearly half of US nursing homes report limiting admissions because of staffing shortages,¹ and only 19% currently meet the minimum staffing levels mandated by the Centers for Medicare & Medicaid Services by 2029.² Shortages of nurses and other personnel caused two-thirds of hospitals to operate below full capacity in 2023.³ The Trump administration’s plans to deport undocumented immigrants and some with temporary protected status (TPS)—which allows some migrants from countries with unsafe conditions to live and work in the US—and increase legal barriers even for skilled immigrants, could worsen workforce shortages. This study estimated the number of immigrants employed in health care who might be affected by deportation or immigration restrictions.

Methods

We analyzed person-level data on occupation, industry, demographics, citizenship, country of origin (TPS-eligible or not), and receipt of public benefits from the March 2024 Current Population Survey (CPS), a nationally representative sample of the noninstitutionalized US population. Using previously described methods,⁴ we imputed noncitizens’ documentation status (“undocumented” immigrants lack proper immigration papers) and calculated the numbers employed in US Census Bureau–designated health industries (hospitals, outpatient settings, nursing homes, home care agencies, other health services) and individuals reporting a health care occupation employed in private households, “individual and family services,” or residential care facilities without nursing (hereafter, nonformal settings), if and only if they reported specified health care occupations (eMethods in Supplement 1).

The analyses were conducted using SAS version 9.4 (SAS Institute) and US Census Bureau–supplied weights for national estimates (eMethods in Supplement 1). Institutional review board approval is not required by the authors’ institutions for use of publicly available, deidentified data.

Results

The 144 265 CPS respondents included 8587 health care workers (representing weighted n = 20 050 162 individuals, including 1 286 799 in nonformal settings).

Overall, 2 319 224 naturalized citizen immigrants and 1 064 147 noncitizens (697 584 documented, 366 563 undocumented) worked in health care (Table 1); among noncitizens, 161 405 were from nations qualifying for TPS. A total of 936 183 noncitizens worked in formal health care settings (607 713 documented, 328 470 undocumented) and 127 964 noncitizens (89 871 documented, 38 093 undocumented) worked in health care occupations in nonformal settings.

Table 1. Estimates of Citizenship and Immigration Status of Health Care Personnel in the US, 2024.

Health care setting or region	Weighted No. (%) [95% CI]				Total (N = 8587), weighted No.
	Citizens		Noncitizens
	US born (n = 7172)	Naturalized citizens (n = 949)	Documented noncitizens (n = 310)a	Undocumented immigrants (n = 156)a
Health care setting
Outpatient	5 217 160 (86.5) [85.1-87.9]	582 880 (9.7) [8.4-10.9]	133 393 (2.2) [1.6-2.9]	97 852 (1.6) [1.1-2.1]	6 031 285
Hospital	6 704 838 (84.6) [83.4-85.9]	881 142 (11.1) [9.9-12.3]	252 654 (3.2) [2.5-3.9]	82 945 (1.0) [0.7-1.4]	7 921 579
Nursing home	1 174 607 (82.7) [79.2-86.3]	142 019 (10.0) [7.1-12.9]	64 999 (4.6) [2.8-6.3]	37 937 (2.7) [1.4-3.9]	1 419 562
Home care	1 105 261 (74.3) [69.8-78.7]	221 821 (14.9) [11.6-18.2]	104 648 (7.0) [4.7-9.4]	55 936 (3.8) [1.6-5.9]	1 487 665
Other health care services	1 520 478 (79.9) [76.5-83.3]	276 974 (14.6) [11.5-17.6]	52 019 (2.7) [1.4-4.1]	53 801 (2.8) [1.5-4.1]	1 903 272
Nonformal health care settingb	944 447 (73.4) [69.3-77.5]	214 388 (16.7) [13.0-20.3]	89 871 (7.0) [4.6-9.4]	38 093 (3.0) [1.5-4.4]	1 286 799
Census region
Northeast	3 002 668 (74.2) [71.6-76.9]	725 385 (17.9) [15.6-20.3]	212 641 (5.3) [4.1-6.4]	105 221 (2.6) [1.7-3.5]	4 045 916
Midwest	4 070 449 (91.6) [90.1-93.2]	259 493 (5.8) [4.5-7.2]	59 774 (1.3) [0.9-1.8]	52 349 (1.2) [0.5-1.9]	4 442 064
South	6 053 732 (85.5) [84.0-86.0]	667 752 (9.4) [8.2-10.7]	238 212 (3.4) [2.6-4.1]	122 439 (1.7) [1.2-2.2]	7 082 135
West	3 539 942 (79.0) [77.0-81.1]	666 594 (14.9) [13.1-16.6]	186 957 (4.2) [3.2-5.1]	86 555 (1.9) [1.3-2.6]	4 480 047
Total, all settings/regions	16 666 791 (83.1) [82.3-84.0]	2 319 224 (11.6) [10.8-12.4]	697 584 (3.5) [3.1-3.9]	366 563 (1.8) [1.5-2.2]	20 050 162

^a Documentation was determined by a validated imputation model, which assigned documented noncitizen status to those born outside the US who met at least 1 of the following criteria: spouse of a documented immigrant or citizen, veteran or currently in the armed forces, born in Cuba, or arrived before 1980; received Social Security benefits, Supplemental Security Income, Medicaid, Medicare, or military insurance; worked in the government sector; resided in public housing, received rental subsidies, or the spouse of someone in such housing or receiving such subsidies; or had an occupation that required licensure.⁴ Noncitizen respondents with none of these characteristics were considered to be undocumented.

^b Persons working in 1 of the following Census Bureau–defined industries: private household, individual and family services, or residential care facility without nursing, if and only if they reported their occupation as physician; health manager; community and social service specialist (eg, community health workers and health educators); registered nurse; licensed practical nurse; nursing, psychiatric, or home health aide; personal or home care aide; personal care or service worker; or miscellaneous health care support occupations. Persons working in households but reporting their industry as home care were classified in the home care setting.

Noncitizen immigrants (documented and undocumented) accounted for approximately 4% of personnel in hospitals and outpatient settings, 7% of nursing home workers, and at least 10% of personnel in home care agencies and nonformal settings (Table 1). In the Northeast US, 7.9% of personnel (including 12.8% in New York) were noncitizens, as were 6.1% in the West (8.7% in California), 5.1% in the South (9.7% in Florida and 6.5% in Texas), and 2.5% in the Midwest (state data not included).

Of 55 802 noncitizen physicians (Table 2), more than three-quarters worked in hospitals (data not included), where they accounted for 8.8% of all physicians. A total of 148 445 noncitizens worked as registered nurses (98 536 of them in hospitals) and 443 958 worked as nursing aides or assistants.

Table 2. Estimates of Citizenship and Immigration Status of US Health Care Personnel in Selected Health Occupations in Formal and Nonformal Health Care Settings, 2024.

Occupation	Weighted No. (%) [95% CI]				Total, weighted No.
	Citizens		Noncitizens
	US born	Naturalized citizens	Documented noncitizensa	Undocumented immigrantsa
Physicians (n = 411)b	635 178 (70.8) [64.9-76.7]	207 070 (23.1) [18.0-29.1]	55 082 (6.1) [3.5-8.8]	0	897 330
Registered nurses (n = 1517)b	2 866 582 (82.5) [80.2-84.7]	461 497 (13.3) [11.1-15.4]	148 445 (4.3) [3.1-5.5]	0	3 476 525
Nursing aides and assistants (n = 2101)	3 770 160 (76.3) [74.3-78.2]	729 584 (14.8) [13.0-16.5]	251 078 (5.1) [4.1-6.1]	192 880 (3.9) [3.0-4.8]	4 943 703
Health technologists and technicians (n = 788)	1 548 528 (85.3) [82.5-88.0]	206 493 (11.4) [8.7-14.0]	56 049 (3.1) [1.7-4.4]	5024 (0.3) [0.0-0.7]	1 816 094
Information technology occupations (n = 111)c	188 050 (75.8) [66.2-85.5]	38 492 (15.5) [7.3-23.7]	8008 (3.2) [0.0-6.9]	13 432 (5.4) [0.1-10.7]	247 982
Housekeeping and janitors (n = 151)c	229 984 (73.7) [65.7-81.9]	24 540 (7.9) [3.2-12.5]	29 837 (9.6) [3.0-16.1]	27 835 (8.9) [4.1-13.7]	312 196

^a Documented noncitizens were defined as those born outside the US who met at least 1 of the following criteria: spouse of a documented immigrant or citizen, veteran or currently in the armed forces, born in Cuba, or arrived before 1980; received Social Security benefits, Supplemental Security Income, Medicaid, Medicare, or military insurance; worked in the government sector; resided in public housing, received rental subsidies, or the spouse of someone in such housing or receiving such subsidies; or had an occupation that required licensure.⁴ Noncitizen respondents with none of these characteristics were considered to be undocumented.

^b The algorithm used to impute documentation status classified all personnel working in occupations requiring licensure to be authorized.

^c Includes only persons employed in the formal health care sector.

Discussion

More than 1 million noncitizen immigrants (one-third of them undocumented) work in health care in the US. Their ranks include skilled personnel who would be difficult to replace, especially if legal immigration is further restricted. Many health care workers may be removed if President Trump implements plans to deport undocumented immigrants and those losing TPS status (eg, from Haiti and Venezuela). A (currently stayed) court ruling ending DACA (Deferred Action for Childhood Arrivals) could affect additional personnel, including some physicians and nurses.

Deportations could especially compromise long-term care, where immigrants play a large role. The resulting shortages could reverberate through emergency departments and hospitals, leading to the inability to discharge patients and tying up nurses and other staff.

Study findings expand an analysis of 2017 data focused on direct care workers⁵ and recent reports assessing immigrants’ role in health care without delineating the contributions of noncitizens most at risk of deportation.⁶

This study has limitations. The CPS is known to undercount undocumented immigrants and nonformal workers, and the CPS-supplied weights may not fully adjust for sampling of persons with different immigration statuses. The algorithm used to impute documentation status yields estimates of the overall undocumented population that are consistent with official estimates, but may be imprecise for subpopulations.

Study findings suggest that deportations of immigrant workers and immigration restrictions may affect the health care of all people in the US.

Supplement 1.

eMethods

Supplement 2.

Data Sharing Statement