We’re Running Out of Healthcare Workers. A Rose Gold Immigration Card Can Help.

Earlier this fall, President Trump signed an executive order establishing his “Gold Card” program, a $1 million pathway for the global wealthy to achieve legal U.S. residency, with the twin goals of increasing investment in American business and paying down the national debt. 

While the program may not pass legal challenges, it highlights something worth imitating at both the state and federal level: using immigration strategically to solve real domestic shortages. States should work with the federal government to create a “Rose Gold Card,” designed to retain immigrant healthcare workers in communities where staffing gaps are most severe.

Hospitals are short-staffed, and the American healthcare system is bracing for the dual pressures of Baby Boomer retirements and an aging population. Staffing shortages – exacerbated by delays in foreign residency visa processing – are compounding pressure on a system already struggling to meet rising demand. By 2036, the U.S. could face a shortfall of 13,500 to 86,000 physicians. That doesn’t account for the additional 9 million home health aides, behavioral health providers, and support staff also in critically short supply.

These gaps threaten the quality, accessibility and safety of care, particularly in rural and underserved areas where about 75 million Americans are affected. Federal and state initiatives are investing in efforts to help American-born citizens fill workforce gaps by expanding clinical training and education pipelines. Congress has approved new residency slots. States are growing community college programs for nursing and allied health. “Earn-and-learn” apprenticeships help students avoid debt while training in clinical settings. 

These efforts are working – but even under the most optimistic scenarios, they won’t scale fast enough to meet demand. That’s where targeted immigration reform can help, and states can lead the way. A parallel track is needed: one that allows states to designate high-need areas, streamline licensing and partner with federal programs to place qualified professionals quickly and responsibly.

Foreign-born clinicians already play a vital role in U.S. healthcare. One in four physicians, nearly one-third of home care workers, and 22 percent of long-term care nursing assistants are immigrants. But the visa channels they depend on are clogged or outdated. The H-1B cap has been hit every year since 2008, and many nurses don’t qualify under its academic requirements. The Conrad 30 Waiver lets international medical graduates remain in the U.S. if they serve in underserved areas – but it’s capped at 30 slots per state. More recently, the State Department’s 2024 freeze on nurse-visa processing landed just as vacancy rates hit record highs.

Other countries in similar situations are moving with urgency. In 2023, the UK issued 146,000 Health and Care Worker Visas. Canada’s Economic Mobility Pathways Pilot has welcomed 2,000 skilled refugees and their families, many of whom are being trained and placed in healthcare roles. There is no reason for the U.S. to fall behind.

Congress should act by creating a targeted visa program that delivers skilled clinicians to the communities in need. The Rose Gold visa puts this vision into action. Modeled in part on the Conrad 30 Waiver, it would place licensed professionals in designated shortage areas, with renewable terms based on performance and continued need. It’s a smart, responsive model for high-need, high-skill immigration.

It would also be politically viable, receiving support from both political sides. Just 32% of Republican-leaning voters initially supported increasing legal immigration in healthcare – until they learned more. Support for the Conrad 30 Waiver, for example, climbed to 76% when voters understood its purpose and how it functions. Nearly three-quarters of Americans already support a merit-based approach to skilled immigration. When immigration policy is tied directly to healthcare access, the public gets on board.

The current system can’t meet growing demand. The H-1B annual visa cap is perennially maxed out. Past stopgap efforts – like the defunct H-1C visa, which was limited to a few hundred nurses – fell far short. The Conrad 30 waiver remains under-resourced, and the 2024 nurse-visa freeze has deepened shortages rather than alleviating them.

Congress has a rare opportunity to build long-term healthcare capacity while addressing immediate staffing crises. That means expanding domestic training and allowing states to take the lead in deploying skilled immigrant clinicians where they are needed most. Healthcare workforce policy isn’t just about staffing levels or shift schedules. It’s a matter of public health, economic stability and national resilience. 

With his Gold Card proposal, President Trump has signaled a willingness to increase immigration that serves America’s tactical advantage. Few challenges facing our aging country are as grave as workforce shortages that limit access to life-saving care. 

Americans suffer when hospitals close, nursing homes fall below care standards and mental health services become inaccessible. Immigration should be part of the solution. The Rose Gold visa and similar reforms offer a strategic path forward – one that strengthens our healthcare system by opening doors to those who are ready and willing to serve.

Photo: Evgenia Parajanian, Getty Images

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