Strengthening the Internal Medicine Physician Workforce — ACP 2026 Advocacy Priority

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All patients should have access to a physician who can deliver primary, whole-person, comprehensive, and longitudinal care. Congress should invest in federal programs that support and expand the internal medicine and primary care physician workforce.

Workforce Shortages & Barriers to Physician Access

With growing demand placed on the existing health workforce, it is even more imperative for Congress to act to protect patients’ access to care by expanding the pipeline of future physicians. The United States faces a projected shortage of up to 141,160 physicians by 2038—including a shortage of over 70,000 primary care physicians.

Why Action is Needed

A 2021 report by the National Academies of Sciences, Engineering and Medicine called on policymakers to dramatically increase investment in primary care and the physician workforce. The evidence clearly shows that high-quality primary care is critical for achieving health care’s quadruple aim (enhancing patient experience, improving population health, reducing costs, and improving the health care team experience).

However, with a typical medical school graduate incurring an average of $223,000 in debt, recent policy changes are likely to make affording a medical education even more difficult and will increase the physician shortage. These changes include caps on borrowing and more limited loan repayment and forgiveness options.

• Loans for Medical Students: Loans for Medical Students: The FY2025 budget reconciliation law imposed limits for Direct Unsubsidized Loans for professional students at $200,000, including a new lifetime maximum aggregate limit at $257,000 for all student loan borrowers. These changes took effect July 1, 2026, so the impact on medical student enrollment may start having an impact by fall 2026. Throughout the budget reconciliation process, ACP expressed its strong concern about these student loan limits. These new loan limits are unrealistic for those pursuing careers in medicine. GradPLUS Loans for professional students were also eliminated. Congress needs to lower the cost of borrowing for medical students.
• Public Service Loan Forgiveness (PSLF) Program: Due to the FY2025 budget reconciliation law, beginning July 1, 2026, borrowers in the Tiered Standard Repayment Plan are ineligible to make payments to the PSLF program.
• H-1B Visas: In 2025, the administration issued a Proclamation: “Restriction on Entry of Certain Nonimmigrant Workers.” It imposed a $100,000 fee on employers for each initial H-1B application. ACP is worried that this policy threatens to harm access to care in health professional shortage areas that rely heavily on an IMG workforce for patient care. While a federal district court struck down the fee, it has temporarily paused that ruling during the appeals process, so the fee currently remains in effect.

ACP’s Policy Position on Strengthening the Physician Workforce

Congress and the Administration must act now to invest in and expand the physician workforce. If Congress is unwilling to ease or remove the newly imposed loan limits, it must lower the cost of borrowing for medical students. Additionally, Congress should ensure that any federal repayment plan authorized under the Higher Education Act qualifies for the PSLF program. ACP also urges the administration or Congress to clarify that non-U.S. international medical graduates (IMGs) are essential to the national interest and exempt from the H-1B visa fee. Congress should enact bipartisan solutions to expand the physician workforce and avoid stymieing its expansion with unnecessary restrictions.