More than 500 federal immigration actions taken in the first year of the second Trump administration now restrict foreign-born health professionals' ability to live and work in the United States, according to a California Health Care Foundation explainer.

California carries one of the heaviest exposures of any state. Roughly 34% of the state's nearly two million health care workers were born outside the United States — a share nearly double the national average. In high-demand occupations the dependency runs higher still: 48% of dentists, 46% of direct care workers, and 45% of pharmacists were foreign-born.

One in three California physicians was born abroad. These clinicians practice disproportionately in underserved areas of the state, staffing clinics and hospitals that already face provider shortages.

How dependent is California's health workforce on immigrants?

California ranks second in the nation for the foreign-born share of its health workforce. The 34% figure leaves the national rate well behind. The foundation's analysis breaks down the dependency by occupation:

• 48% of dentists
• 46% of direct care workers
• 45% of pharmacists
• One in three physicians

Foreign-born clinicians do more than fill staffing gaps. They "strengthen the care experience for millions of Californians by helping to address racial, ethnic, and linguistic concordance between patients and providers," the foundation wrote.

Which federal policy changes hit health worker visas?

The 500-plus actions include three measures that directly touch the visa pathways clinicians rely on to train and work in the United States. They appear on the foundation's list of the most consequential changes:

• A federal pause in visa processing for individuals from 90 countries
• A new $100,000 H-1B visa fee, with no exemption for health care workers
• A weighted H-1B lottery that favors higher-paid positions — a shift that disadvantages safety-net employers and early-career hires

Federal law contains no visa category built specifically for health workers. Clinicians typically rely on general employment-based visas such as the H-1B, which were not designed for the health care workforce. That structural gap means immigration shifts can ripple through hospital staffing plans, residency programs, and clinical training pipelines without a dedicated channel to absorb the disruption.

Who bears the greatest risk from these changes?

The federal actions will not affect every community equally. Rural hospitals, community health clinics, and teaching hospitals — many operating on thin margins — depend most heavily on foreign-born clinicians. They will absorb the impact first. Safety-net providers rely most on immigrant clinicians, and their patients already have the fewest alternatives for care when a position goes unfilled.

Patients most likely to lose access are those already facing the greatest barriers: communities of color, rural residents, low-income families, and households that speak languages other than English at home.

Which state programs face the greatest exposure?

State and local programs that recruit immigrant clinicians to address provider shortages could also be caught in the policy shifts. The foundation flags the Licensed Physicians from Mexico Pilot Program as one program at risk. Workforce planners, recruiters, and educators across the state will need to track the federal changes closely as they plan staffing for the coming years.

CHCF's explainer is written for policymakers, health system leaders, educators, and advocates. It documents who makes up California's immigrant health workforce, how the visa pathways work and where they fall short, and what the recent federal changes mean for workforce planning, recruitment, and patient access across the state.