July 2025 - Working Immigrants

What is impacting our dependence on foreign-trained doctors?

25% of practicing doctors in the U.S. are foreign born, a share which has been roughly stable for some time, rising from single digits since the 1980s. While the total number of physicians grew from 700,000 in 2000 to about one million in 2024, during that time foreign-trained doctors rose from about 140,000 to 250,000. Thus foreign-trained doctors appear to have accounted for a third of the increase in the total.

Is it not reasonable to project that more foreign-born doctors will be needed in the future. But by how much?

The drivers of doctor supply and shortages are mainly (1) the production of new domestically educated doctors, (2) the pace of retirement of doctors, (3) the distribution of care among doctors and other medical professional categories, and (4) the supply of foreign-born doctors.

Supply of U.S. trained doctors: In 1980s and 1990s, when the foreign-born doctor population surged, the nation’s population grew by 24% while the number of students matriculating at American medical schools was flat – about 16,000 a year.

Some 124 medical schools existed in the U.S. in 2000; 158 in 2024. The number of students matriculating grew from16,000 to 23,000, a 40% increase. The total population grew from by 20%. 65s and over increased by 74%. This elderly population is less than 20% of total population but is responsible for 40% + of all medical spending. This population will continue to grow much faster than the rest.

The “cartel” critique: the Heritage Foundation says that the medical education establishment’s policy is to restrict the growth of medical education slots and residencies. A similar critique can be levelled against the forces which control the flow of foreign-trained doctors into the country – spear-headed by the Educational Commission for Foreign Medical Graduates

The distribution of new doctors: pretty much left to newly minted doctors is what area of medicine they go into. Psychiatry and geriatric medicine have severe shortages, more acute than in other areas.

Allied medical professionals, the number of physician assistants grew from about 50,000 in 2000 to over 168,000 in 2024, per the National Commission on Certification of Physician Assistants. The number of nurse practitioners in practice rose from about 80,000 to 300,000 over the same period. In other words, in the combined number of PAs and NP in 2000 was about 18% of physicians and in 2024 45% of physicians. Until one digs down into the details, it is not clear if these professions are taking care of the doctor supply in some major areas such as internal medicine.

Abrego Garcia case and US El Salvador agreements

Bryan Finucane of Just Security writes that released notes between the U.S. and El Salvador, two dated immediately before the March 15, 2025 transport Abrego Garcia and some 300 Venezuelans, smacks of “legal lipstick,” “legal fig leaf,” a deal crafted to effect U.S. control over the disposition of the deportees while on paper denying it.

“The underlying arrangement is described in a pair of notes dated March 13 and March 14—an outgoing U.S. note and the incoming Salvadoran note respectively. A subsequent U.S. diplomatic note dated March 31 was also released. Consistent with my prior assessment, the notes constitute a legally non-binding arrangement rather than a legally binding agreement having the status of a treaty under international law. The documents eschew language typically reserved for binding instruments such as “agree” in favor of formulations commonly used for non-binding arrangements such as “understands” and “requests.” This conclusion on the legal status of the diplomatic notes is reinforced by the fact that the State Department released them explicitly pursuant to 1 USC 112b(b)(1), a provision of the amended Case-Zablocki Act for “qualifying non-binding instruments.”

“The lack of detail on these critical elements of the arrangements—the U.S. quid for the Salvadoran quo—strengthens the impression that these diplomatic notes memorialize only part of the deal between the United States and El Salvador.”

“Taken together, these diplomatic notes appear to represent an attempt by State Department lawyers to establish a legal fig leaf after the fact for U.S. government policies and actions they were unable or unwilling to stop or substantially influence at the front end. The humane treatment assurances and reminder contained within these documents appear intended to counter claims that the United States is violating the prohibition on transfer to torture as well as allegations that individual U.S. officials aided and abetted torture (actions that could expose them to legal jeopardy overseas).”

These kinds of local articles can blunt mass deportation

As ICE expands its arrest of unauthorized persons who have settled into the local economy and social networks within politically moderate or conservative communities, local media coverage can raise awareness among people who are otherwise indifferent to mass deportation.

Yamhill County a largely farming and wine grape growing area in rural Oregon. Its undocumented worker populations has been estimated at about 3,000/. The county has voted Republican since 1964.

According to the NT Times’ Nichola Kristoff, who was born there. ICE arrested in June and deported Moises Sotelo, an unauthorized Mexican who had lived in the county for 31 years and owns a vineyard management company employing 10 people. He has two American born children.

The local newspaper, the News Register, ran an editorial on June 20, “Immigration raids violating our nation’s proud heritage.” This kind of local press coverage of mass deportation in politically conservative communities are a crucial element in blunting and perhaps immobilizing the Trump administration’s deportation policy.

Excerpts from the editorial:

As long as federal immigration policy remains nothing more than fare for political debate in Washington, D.C., it may seem a matter of little consequence to people immersed in their daily routines in other parts of the country.

Even the occasional isolated raid or seizure — shocking as it may seem when targets are flown to prisons in Sudan or El Salvador in the middle of the night, without even the pretense of due process — typically fails to fully puncture the protective shield of not-in-my-backyard complacency.

But when heavily armed Immigration and Customs Enforcement agents raid a packing plant in Omaha or a restaurant in Los Angeles — and haul scores of unsuspecting workers off to federal detention centers, leaving a trail of broken families in their wake — it becomes a watershed locally.

We experienced one of those moments here last week, when vineyard supply company owner Moises Sotelo-Casas was scooped up in Newberg, along with one of his employees, and spirited off to a federal detention center in Tacoma. His daughter learned of his fate not by getting official word from ICE, but by tracking his cell phone.

…. Sotelo was a 30-year resident who had peacefully and lawfully gone about raising a family, launching a successful, highly respected business, and sinking deep church and community roots. A GoFundMe campaign launched on his behalf raised more than $116,500 in the first week, attesting to his standing.

ICE said he had once been convicted of driving under the influence in Newberg. However, the district attorney’s office has no record of such a case and none could be found in the state’s criminal justice database.

Besides, a one-time DUI would hardly qualify him for “worst of the worst” status as a hardened criminal. And according to their daughter, both he and his wife have begun a legalization process under rules established during the Biden administration.

One local winery posted a message terming him “truly one of the most humble, kind and generous individuals we’ve met in Newberg.” It went on to say, “He poses ZERO threat to public safety. His family is justifiably distraught and we share their distress.”

Another local winery posted, “He is deeply involved in his church, pays taxes, and is the central moral and financial support of his family, including wife, children and grandchildren.” It concluded, “Moises meets all with a smile on his face and generosity in his heart.”

….. millions of workers are needed to tend, harvest and process fruit, vegetable and meat products for the American table. It’s hot, dirty, demanding work, and the American workforce is already at full employment.

Removing the immigrant element, or even a significant portion of it, is a recipe for economic disaster. And economic reverses tend to almost inevitably trigger political reverses.

The truth is, the labor of hard working and highly motivated immigrants, legal or not, has underpinned our economy throughout our history. A sudden cutback could thus carry serious consequences, especially in a nation experiencing a persistent, long-running decline in its birth rate.

Here’s hoping those realities will persuade the administration to ease back on its wrenching immigration crackdown, which is becoming a growing stain on our national heritage.

Stunning shift in immigration polls

Trump’s zero-sum argument against immigration–that it is taking our jobs– appears to have influenced some Democrats whose background includes a history of social and economic suppression to vote for Trump in 2024 (go here). His argument that immigrants destroy neighborhoods and bring in crime appears to resonate with a large majority of Republicans and with some Democrats, with a sharp increase in concerns about crime (Gallup). As of late 2024, polling was considerably more anti-immigrant than in the past.

In a June 2025 Gallup poll, support of immigration surged, notably among Republicans. What happened? The virtual disappearance of a Mexican border crisis almost certainly had something to do with it. Anti-immigrant sentiment may well have been driven by a perception that immigration under Biden was out of control, and that Trump has quickly brought it back in control. The fundamentally positive view of immigration in the country (excepting in particular rural Republicans) may never have eroded.

Another factor may be fatigue over news about harsh deportation practices, norm-busting rhetoric (such as Alligator Alcatraz) and an increasingly strained argument that ICE is after criminals. Every raid on Home Depot and a farm refutes that argument. And it may do with a perception that the country’s low wage workforce is heavily immigrant – a reality most Americans can see with their eyes.

Support for mass deportation policy has been negative for some months. A CNN poll taken in early July showed that 59% opposed ICE going after persons in the U.S. for a long time without a criminal record. And Republican support appears to be wavering; “While only about one-quarter of Republicans and Republican-leaners are opposed to arrests aimed at this group, just shy of half — 47% — offer outright support, far below the 83% who approve of his handling of deportations overall.”

A progressive plan for immigration reform

Six months into the Trump Administration and we are seeing the emergence of proposals for legislative reforms of immigration laws. A reference point for A Republican reform package is Senator Cotton’s 2017 RAISE Act.

The Center for American Progress, a self-described progressive organization, proposes a comprehensive overhaul of the U.S. immigration system. (At this time, view this proposal against Cotton’s RAISE Act.) Key legislative provisions include: modernizing border infrastructure and surveillance; reforming asylum to speed up decisions and bar misuse; expanding legal immigration and green card availability; introducing a points-based visa system; and creating an earned path to citizenship for longtime undocumented residents. The plan also urges Congress to investigate executive overreach in immigration enforcement and to fully fund a fair, efficient legal immigration system that reflects American values and economic needs.

I note three recommendations:

Major overhaul of asylum system, which would restrict who is eligible to apply for asylum and speed up the process of review. “The asylum system has, over time, been abused by human smuggling networks.7 It has become a backdoor way for people to come to the United States and work without valid asylum claims while it takes far too long to render decisions.8 At the same time, Americans must not abandon people with true asylum claims to face death or torture because of who they are or what they believe. Our asylum laws must be modernized, and the system appropriately resourced, so final decisions are rendered in weeks—not years.”

A points based system: “Supplement the existing family-and employment-based system with a new, targeted points-based system driven directly by the labor demands of the U.S. economy. Allocate additional visas based on a regularly updated Department of Labor assessment of shortage occupations and high demand occupations. Other countries, such as Australia and Canada, regularly assess their labor markets and allow applicants to qualify using a points-based system. Award points to applicants according to key characteristics including work experience, occupation, entrepreneurship experience, English language proficiency, and family ties in the United States with a priority given to individuals with a confirmed job offer in the United States. Create a program for states and cities to identify worker shortages in their communities and directly petition for more labor visas.”

Normalization for unauthorized persons: “Establish a secure, fair, workable pathway for longtime undocumented immigrants who have lived in the United States for more than ten years—more than five years for Dreamers—to obtain lawful permanent residence, followed by eligibility to receive citizenship in the future. Bar eligibility for anyone who has committed a serious crime or is a security threat in order to ensure public safety. To qualify for an earned pathway to citizenship, undocumented immigrants must: Pass a thorough criminal and national security background check. Demonstrate continuous presence in the country. Prove economic self-sufficiency. Pay any taxes owed. Pay a fine.”

The Trump Administration cannot coerce state+local governments

On January 21 the DOJ issued a directive establishing its policy of arrest and deportation of unauthorized persons. It starts off by focusing on behavior of Latin American gangs (“cartels”) but extends to all unauthorized persons. I want here to focus on the administration’s goal to coerce state and local governments to participate. The Immigration Legal Resource Center analyzed the document: “MEMORANDUM FOR ALL DEPARTMENT EMPLOYEES,FROM: THE ACTING DEPUTY ATTORNEY GENERAL. January 21, 2025.SUBJECT: Interim Policy Changes Regarding Charging, Sentencing, and Immigration Enforcement.” (Go here for this memo, go here for another memo).

The ILRC comments, “The directive orders federal prosecutors to investigate and prosecute state and local actors who may be carrying out sanctuary policies or otherwise not agreeing to assist with immigration enforcement. Prosecutors who decline such cases will be required to document their reasons.”

Language in the memo: Assertion that state and local jurisdictions most comply: The Supremacy Clause and other authorities require state and local actors to comply with the Executive Branch’s immigration enforcement initiatives. Federal law prohibits state and local actors from resisting, obstructing, and otherwise failing to comply with lawful immigration-related commands and requests pursuant to, for example, the President’s extensive Article II authority with respect to foreign affairs and national security, the Immigration and Nationality Act, and the Alien Enemies Act. The U.S. Attorney’s Offices and litigating components of the Department of Justice shall investigate incidents involving any such misconduct for potential prosecution, including for obstructing federal functions in violation of 18 U.S.C. § 371, and violations of other statutes, such as 8 U.S.C. §§ 1324,1373.

Commentary by ILRC: This section threatens sanctuary jurisdictions with various legal actions. It makes some sweeping claims that misstate the law, such as the first sentence which erroneously claims that state and local actors have to comply with immigration enforcement initiatives. The U.S. Supreme Court has clearly held that the federal government can’t require states or localities to use their resources to enforce federal programs, such as immigration. This section also directs US federal prosecutors and other DOJ divisions to investigate incidents of resistance to federal immigration enforcement, including but not limited to federal crimes of conspiracy and harboring. This is not limited or specific to local governments or sanctuary policies, but could also potentially apply to organizations or individuals. This section provides motivation for the DOJ to focus prosecutions on immigration advocates and activists for their work.

Anti-commandeering doctrine: The Supreme Court has three times since 1992 affirmed that the federal government cannot compel state or local governments to enforce federal law. This has been called the “anti-commandeering” doctrine. In New York v. United States (1992), the Court struck down a provision of a federal statute that required states to take ownership of radioactive waste or face penalties. Printz v. United States (1997) concerned a provision of the Brady Handgun Violence Prevention Act that required local law enforcement officers to conduct background checks on prospective gun purchasers. The Court ruled that compelling state officers to execute federal laws violates the Constitution. in Murphy v. NCAA (2018), the Court invalidated a federal law that prohibited states from authorizing sports betting.

Also from the memo, a top line focus on immigrants who commit crimes. This is the main justification for the entire memo – mass deportations per se are not envisioned explicitly.

From the Memo, the mission: First, Cartels and other Transnational Criminal Organizations, such as Tren de Aragua (TdA) and La Mara Salvatrucha (MS-13), are a scourge on society resulting in an unstable and unsafe border and huge flows of illegal immigration in violation of U.S. law. Second, brutal and intolerable violent crime by members of these organizations and illegal aliens is escalating rapidly across the country. Third, the fentanyl crisis and opioid epidemic are poisoning our communities and have inflicted an unprecedented toll of addiction, suffering, and death. The Justice Department must, and will, work to eradicate these threats.

[Focus on persons with associations with crime]: Consistent with the core principle of pursuing the most serious, readily provable offense, U.S. Attorney’s Offices and the other components shall pursue charges relating to criminal immigration-related violations when such violations are presented by federal, state, or local law enforcement or the Intelligence Community.

Where are ICE detainees held?

As of mid-2025, ICE maintains a largely outsourced detention system, with a total contracted capacity of approximately 62,913 beds. These fall into three main categories: privately run detention centers, local and state jails operating under intergovernmental agreements, and a small set of federally owned and ICE-controlled service processing centers.

Privately operated Contract Detention Facilities (CDFs): Run by corporations such as GEO Group and CoreCivic, an estimated 100 to 130 facilities and housing roughly 54,000 to 57,000 beds—nearly 90% of ICE’s total detention capacity.

State and local jails, typically county jails: Around 200 to 240 jails under contract, only a subset houses large numbers of detainees on a regular basis. An estimated 6,900 to 7,600 beds, or approximately 11% of total capacity.

Federally owned Service Processing Centers (SPCs): eight, including those in El Paso, Miami (Krome), and Batavia, New York. Some are operated by private contractors. An estimated 3,100 to 6,300 beds, or around 5–10% of the national detention capacity.

The One Big Beautiful Bill Act provides funding to double capacity by close 116,000. Geo Group and Core Logic today each control about 65,000 prison beds, suggesting that about 40% of their beds are dedicated to ICE. Major expansion of prison capacity to service ICE will most likely go to these companies.

Go here, here, and here.

Grandparents arrested by ICE

Three recent cases involving persons in Louisiana, Florida and Colorado with average tenure in the U.S. of 50 years.

In the Baton Rouge area a 64-year-old grandmother who arrived in the U.S. in1978 on a student visa was detained by ICE in June while gardening outside her home. House Majority Leader Steve Scalise and State Representative Stephanie Hilferty engineered her release.

In Florida a 75-year-old man of Cuban origin, who came to the U.S. in 1966, died on June 26 while in ICE detention. He had been convicted of possession of an illegal substance in 1981 and 1984.

A 68-year-old grandfather who has lived in the U.S. since 1980 was arrested on June 8 while walking his dog in Colorado and deported. He was one of the Muriel Boat Lift refugees.

Projected impact of reduced foreign workers on the economy 2025- 2027

The Federal Reserve Bank of Dallas estimates that the rapid growth in the number of temporary visa holders and “get-aways” under Biden added to the GDP and that a significant drop of these workers between 2025 and 2027 will lower GDP growth. With the border crossings shut down and mass deportation, it estimates that GDP growth in 2027 will be 1.49% lower than had Trump-induced border shutdown, self-deportations and mass deportations not occurred.

The authors cite a Brooking’s study of October 2024 which forecasted that a Trump administration’s immigration policies will reduce 2025 GDP by 0.5%. a September 2024 Peterson Institute also forecasted a decline of GDP.

These three forecasts make different assumptions about the size of the workforce reduction. So far, I believe that the workforce has declined by at least one million through June 2025 due to immigration law enforcement. I think it is reasonable to estimate a reduction of at least 3 million workers by 2027 if the pace of enforcment stays where it is now. That comes to about 2% of the workforce, with the losses concentrated in farm, construction hospitality and personal care sectors where the workforce reduction can be 10%-20% or higher. These are generally $15 an hour jobs for which it is hard to believe that legal workers will flock to. So wages would have to increase, pretty quickly.

Big impact of mass deportation in the hospitality sector

Mass deportation could gut the sector, as to fill the jobs by American citizens will likely involve them taking a cut in wages, from the mid $20s per hour to the mid $10s per hour. Many immigrant-filled jobs are not automatable — at least for now.

The hospitality sector includes hotels, restaurants, and bars. This sector is very dependent on immigrant labor. The following figures come from 2020 Census analysis. The Census focuses on full time, year-round employment. Industry associations most likely include part-time or casual workers, thus showing larger counts. I use the Census figures because, while they leave out many part time workers, the Census takes care to estimate the number of immigrant workers and within that group the number of unauthorized workers.

Using Census figures, of the 8.5 million persons employed, about 2 million are immigrants. Of them, one million are unauthorized. For example, there are about 800,000 housekeeping staff (Census code 4230). 400,000 of them unauthorized. There are 900,000 food preparation workers (4030), below the level of chefs and service managers. 250,000 of them are immigrants, and half are unauthorized.

To show the extent to which immigrants are crowded into lower status positions, take the example of bartenders who need to be able to talk it up with customers and can make a good income from tips. Of the half million bartenders in the United States, less than 10% or immigrants, and among immigrants less than 10% are unauthorized.

Thus, the immigrant workforce in hospitality is generally in low paid jobs, and jobs that are not customer-facing. For example, hotel housekeepers likely earn about $15 an hour, as to dishwashers. Bartenders earn about the same, $15, but receive an equal if not more amount from tips. The average hourly wage of American citizens with only a high school degree is $20-25.