The Trump administration's immigration crackdown has rolled back protections that kept immigration agents away from healthcare facilities, and it has moved to give ICE access to Medicaid data. Those changes took a measurable toll on primary care within a year, according to a new UCSF study titled "Moral Injury Among Physicians Caring for Immigrant Patients Amid Anti-Immigrant Policies."

The study, led in part by Dr. Alicia Fernandez, a professor of medicine at UCSF and a general internist at Zuckerberg San Francisco General Hospital, finds that federal immigration policy is now pushing some doctors to practice in ways that conflict with their sense of moral and professional duty.

Who is affected

The changes reach two groups at once: immigrant patients and the physicians who treat them. Dr. Miguel San Miguel Benavides, a resident physician at SF General, said patients now bring him a problem he feels unequipped to handle alongside coughs, rashes, diabetes and high blood pressure: fear of immigration enforcement.

"This is the type of care that I always wanted to give," said San Miguel, who immigrated to the United States himself. "But I think part of that has become realizing that the amount of support we can give isn't necessarily enough."

A 2025 survey of healthcare workers who serve immigrants, conducted across 30 states, quantifies the effect. Among hundreds of respondents, 84% said patient visits were down substantially, and many reported that their ability to provide preventive care and manage chronic conditions had suffered.

What changed in medical practice

Fernandez said what surprised her was how extensively doctors altered their patterns of care in response to the policy shifts. "What we saw was many physicians and practices, entire practices, altering their patterns of care," she said.

The changes she and her colleagues documented include:

• Clinics stopping accepting undocumented patients altogether, out of fear of losing federal funding.
• Physicians shifting visits to telehealth appointments so patients could avoid coming to the clinic.
• Doctors switching medications so patients would not need to visit the clinic or pharmacy as often.

Those adjustments come at a cost. "We definitely feel that our patients are getting worse, and we feel that the care that we are giving is an inferior form of care, and that's why it's associated with moral distress," Fernandez said.

She described a recent case of an undocumented patient who avoided care out of fear. "He came in already having damage from his diabetes," she said. "That's a terrible feeling."

Moral injury and burnout

Researchers describe this ethical conflict as "moral injury," a term coined by a Department of Veterans Affairs psychiatrist who worked with Vietnam War veterans.

The consequences extend beyond individual doctors. "Moral injury can contribute to burnout," said Dr. Robert Pearl, a physician and Stanford professor who served as CEO of the Permanente Medical Group for nearly two decades. Burnout, in turn, affects quality of care.

"If the patient before you required all this extra work, has had this added fear, had all these challenges, when the clinician sees you, he or she may not be as good and sharp as you would like them to be," Pearl said.

Burnout and moral injury can also drive doctors and other healthcare workers out of their professions, with especially severe effects in primary care. "We already have a shortage," Pearl said. "When you need a primary care doctor, that individual might not be there. And we're certainly seeing that in many communities across the United States, where it's almost impossible to find a primary care physician with an open panel."

The stakes are significant for the US physician workforce. Almost half of the country's internal medicine doctors are foreign-born, according to a study published in JAMA in August 2026. For the immigrant doctors in the UCSF study, the distress was compounded.

What helps

The UCSF study is small and qualitative, but it points to concrete steps healthcare institutions have taken. Doctors whose clinics protected patients' immigration-related information and expanded telehealth described how those measures helped them continue caring for patients.

Fernandez framed the broader concern plainly: "We live in fear of losing our patients, because we know that their physical health will suffer, the health of their kids will suffer, and the health of the community will suffer."

Readers seeking details on the administration's actions should consult the official announcements on Medicaid data-sharing between CMS and ICE and the rescinded enforcement guidelines for healthcare facilities.