Alabama must act to save medical residency programs
This July, hundreds of newly matched medical residents are expected to begin their postgraduate training in hospitals and clinics across Alabama. It’s a timehonored transition that sustains the future of health care in our state — particularly in underserved and rural areas. But this year, a crisis threatens to halt that process entirely, with devastating consequences for communities already struggling to access care.
Many of Alabama’s residency programs, especially those in primary care and rural medicine, rely heavily on International Medical Graduates (IMGs). These physicians, like myself seven years ago, match into U.S. training programs after years of rigorous preparation, eager to serve where the need is greatest. They arrive on J-1 or H-1B visas, contributing essential services to communities that would otherwise go without.
This year, however, the United States has delayed or suspended visa interviews for many incoming residents, placing the July 1 start date in serious jeopardy. Without immediate action, many residency programs in Alabama may be left without the physicians they spent months, even years, recruiting. This isn’t a problem isolated to coastal states or academic hospitals — it’s a looming crisis in Selma, Dothan, Demopolis, Anniston and towns and cities across our state.
I speak from personal experience as I came to Alabama from Canada to train in family medicine. Against my prior expectations, Alabama became home. My wife — one of only three spinal cord injury specialists in the state — and I chose to stay and build our lives here. I am grateful every day for the opportunity to practice in a state that has given me so much.
But now, Alabama, like many other states across the U.S., is at risk of losing the next generation of physicians who want to do the same.
According to 2023–24 data from the Accreditation Council for Graduate Medical Education (ACGME), nearly 22% of incoming residents are international medical graduates. Many more are osteopathic or U.S. medical school graduates willing to serve in rural and underserved communities. When even a fraction of these trainees is prevented from starting on time, the ripple effect is immediate: longer wait times, reduced services and deepening health disparities.
The long-term effects of this will be devastating for Alabama. Over half of all internal medicine physicians in the state are IMGs, as are all the medical genetics and genomics physicians.
This is not hypothetical. I know of multiple programs already facing disruptions. Patients in rural Alabama will feel these impacts first. With provider shortages already widespread, we cannot afford to turn away bright, motivated physicians simply because of red tape.
We must act now. The U.S. State Department needs to immediately resolve the processing delays that are preventing incoming physicians from starting their residencies. Our state’s federal leaders need to press the State Department to resolve this crisis before July 1.
If you’re a patient, a health care provider or hospital administrator, you can help. Call attention to this issue and share your story. Contact our elected leaders. Reach out to the media. Speak up in professional organizations, at hospital boards and local meetings. Let others know how our community will be affected by losing access to vital health care.
Health care in Alabama is in a fragile state. The resident physicians delayed today will be the providers missing from tomorrow’s clinics, hospitals and emergency rooms. Let’s not compound our physician shortage by standing idle. Time is running out.
Dr. Kuntal Desai is a family medicine doctor in Birmingham and is chair of the Young Physicians Section of the Medical Association of the State of Alabama. He received his medical degree from Saba University School of Medicine.
