Grand Forks and the Nationwide Shortage of Immigrant Physicians

On any given weekday, appointment slots at primary care clinics across Grand Forks can be scarce—a familiar stress point in a community that depends on a steady flow of new doctors. Roughly one in four U.S. physicians trained abroad, according to the Association of American Medical Colleges (AAMC), a pipeline that has long helped staff rural and underserved areas across the Upper Midwest AAMC.

That pipeline is wobbling. National headwinds in immigration processing and global competition for medical talent are making it harder for communities like Grand Forks to recruit and keep physicians, especially in primary care and high-need specialties. Local providers, from Altru-affiliated clinics to practices that serve military families near Grand Forks Air Force Base, say the stakes are straightforward: fewer doctors means longer waits, fewer specialty options, and more pressure on emergency rooms.

Immigrant physicians have been a quiet backbone of care in the Red River Valley. North Dakota’s Primary Care Office notes that international medical graduates (IMGs) frequently fill roles in federally designated Health Professional Shortage Areas (HPSAs) through visa waivers and targeted placements, helping stabilize access in small towns and regional hubs ND Primary Care Office and HRSA HPSA Finder.

Why the U.S. Is Struggling to Attract Immigrant Physicians

Multiple forces are converging. Visa pathways that most IMG physicians rely on—J‑1 exchange visitor visas and H‑1B employment visas—carry caps, backlogs, and geographic constraints. J‑1 visa doctors must normally return to their home country for two years unless they secure a waiver to serve in a shortage area under the state-run “Conrad 30” program; states like North Dakota can sponsor up to 30 waivers a year, and those slots are closely watched by rural hospitals and clinics ECFMG/EVSP and Congress.gov – Conrad 30 bill.

Green card queues also matter. Physicians from high-demand countries can face years-long waits due to per-country caps, complicating retention and family stability. Federal policy does offer targeted relief—such as the physician National Interest Waiver for doctors serving in underserved areas—but the process remains complex and time-consuming USCIS – Physician NIW.

A broader global talent race adds pressure. Countries like Canada, the U.K., and Australia have expanded recruitment and streamlined licensing in some specialties, making their systems more attractive to early-career doctors. While U.S. residency training remains a strong draw, the balance has shifted enough to create new uncertainty for hospitals that rely on IMGs to fill persistent vacancies, according to national workforce trackers at the AAMC AAMC physician shortage overview.

Historically, immigrant physicians helped offset uneven domestic supply. Over the past several decades, IMGs have consistently accounted for about a quarter of the physician workforce and have been overrepresented in primary care, psychiatry, and care for Medicaid and Medicare populations—roles that are essential in rural states. As North Dakota expanded training through the University of North Dakota School of Medicine & Health Sciences (UND SMHS), IMGs remained important in keeping smaller hospitals and clinics staffed, particularly outside Fargo and Bismarck AAMC.

What the Shortage Looks Like in Grand Forks

In practical terms, the squeeze shows up in schedules. Clinics report tighter availability in family medicine, internal medicine, and behavioral health—the very areas where IMGs often serve—pushing more routine care into urgent settings. For military families tied to the base or UND students balancing full course loads, delays can mean deferred care and overcrowded urgent care hours.

Altru-affiliated practices and independent clinics in the region recruit year-round; administrators say that immigration timelines now factor into start dates and contract planning more than they did a decade ago. The state’s shortage designations underscore the reality: parts of Grand Forks County and nearby communities are flagged as HPSAs, signaling a persistent need for clinicians in primary care and mental health HRSA HPSA Finder.

Faculty at UND SMHS, which anchors physician education in the state, note that training capacity has grown, but residency slots and visa pathways ultimately determine whether graduates—U.S.-trained or international—can stay in North Dakota. These constraints ripple into specialist coverage as well, as hospitals weigh call schedules, telehealth backup, and regional transfer agreements when recruitment stalls UND SMHS Graduate Medical Education.

Local Impact: Grand Forks

• Expect longer lead times for new-patient primary care appointments and some specialties if vacancies persist.

• UND students and Grand Forks AFB families may see narrower in-network options during peak demand periods.

• Regional ERs and urgent cares absorb more routine needs when clinics can’t hire fast enough, raising costs systemwide.

How Grand Forks Institutions Are Responding

UND SMHS has layered programs to grow homegrown talent and keep physicians in-state. The RuralMed program offers tuition support in exchange for service in North Dakota communities, a pipeline that complements targeted recruitment of IMGs into shortage areas UND SMHS RuralMed. Family medicine training anchored in Grand Forks remains a key feeder for the local workforce, with community rotations that expose residents to practice opportunities across the Red River Valley UND SMHS Graduate Medical Education.

On the immigration front, the North Dakota Primary Care Office coordinates the state’s share of Conrad 30 waivers, prioritizing placements that meet HPSA criteria and community needs. Hospital recruiters and clinic managers time offers around the federal match and visa calendars, a choreography that now includes contingency planning for processing delays ND Primary Care Office and ECFMG/EVSP.

Local systems are also leaning on telehealth and collaborative care. Behavioral health consults, e-consults for specialty care, and shared call arrangements help cover gaps while positions remain open. These interim steps don’t replace full-time clinicians, but they can blunt the impact on patients while recruitment continues.

Voices and Perspectives

Policy analysts warn that the broader physician shortage amplifies every friction point in immigration. The AAMC projects a national shortfall of up to 124,000 physicians by 2034, driven by an aging population and retirements—trends that fall hardest on rural regions where recruitment is already difficult AAMC physician shortage overview.

Immigration specialists who work with physicians point to a few pressure valves that could help: reauthorizing and modestly expanding Conrad 30, clarifying expedited pathways for doctors serving in shortage areas, and reducing green card backlogs for long-serving clinicians. They note that many IMG physicians already choose hard-to-fill roles; the barrier is not interest, but predictability and timing in the process Congress.gov – Conrad 30 bill and USCIS – Physician NIW.

Patients, for their part, tend to vote with their feet. When family medicine and pediatrics are accessible, preventive care goes up and ER use goes down. Clinic managers in the region say continuity of care—keeping the same doctor over time—remains the strongest predictor of satisfaction, underscoring why retention matters as much as initial recruitment.

Future Scenarios and Open Questions

If the U.S. slips further behind in attracting immigrant physicians, rural hubs like Grand Forks face a familiar fork in the road: higher reliance on locum tenens coverage, more telehealth, and longer wait times—or a stronger, more predictable pipeline into full-time roles. The first option keeps the lights on; the second stabilizes access and lowers long-run costs.

Unresolved questions sit mostly in Washington. Will Congress reauthorize the Conrad 30 program with updates that reflect today’s workforce needs? Can federal agencies shorten processing times for physicians in shortage areas without adding red tape elsewhere? And will North Dakota be able to pair these changes with expanded training capacity and targeted incentives to keep graduates—domestic and international—practicing here?

What to Watch

• Congress is considering reauthorization of the Conrad State 30 and Physician Access program; any movement this session would directly affect 2026 recruitment cycles Congress.gov – Conrad 30 bill.

• Recruitment timelines hinge on two calendars: the monthly State Department Visa Bulletin, which controls green card backlogs, and the annual residency match cycle (ERAS opens in September; Match Day is each March) Visa Bulletin and NRMP.

For residents and clinics seeking practical guidance: UND SMHS posts GME details and contacts; the North Dakota Primary Care Office lists current Conrad 30 waiver information and shortage designations UND SMHS GME and ND Primary Care Office.