The physician workforce is not just shrinking, it is redistributing.
The U.S. faces a projected shortage of 86,000 physicians by 2036, according to the Association of American Medical Colleges, but the shortage is not evenly distributed.
Florida, Texas and the broader Sun Belt have been the primary beneficiaries of physician migration, mirroring general population movement patterns. Both states rank among the top five for net domestic migration in U.S. Census data, and physician supply data from the AAMC’s Physician Workforce Dashboard reflects the same trend.
Regulatory environment is a pull factor that operates specifically on physicians beyond general population migration. Texas enacted legislation in June 2025 imposing stricter limitations on physician noncompetes, limiting geographic restrictions to a five-mile radius and duration to one year, making it a more attractive destination for physicians leaving states with broader enforcement. Florida similarly favors enforcement of noncompetes but with statutory guardrails that give physicians more negotiating leverage than many Northeastern states.
Several Sun Belt states have also moved aggressively to expand physician supply through alternative licensing pathways. The Federation of State Medical Boards found 18 states have enacted legislation allowing qualified internationally-trained physicians to gain full licensure without accredited postgraduate training as of August 2025, with 16 more states having pending or proposed similar legislation.
California, New York and Illinois have each experienced among the largest net domestic out-migration of any states over the past decade, according to Census Bureau data, which is a population trend that the physician workforce data mirrors. California faces the largest projected physician shortage of any state by 2030 at 32,669 physicians, with Illinois projected seventh at 6,203. The residency application data reinforces the pipeline concern: states with strict abortion bans saw a 4.2% drop in U.S. MD senior applicants compared to a 0.6% decrease in states where abortions remain legal, according to AAMC data.
The international exit signal is also worth noting. The Medical Council of Canada saw a 750% increase in Americans creating accounts to initiate the Canadian licensure process between November 2024 and May 2025. In addition, recruiting companies reported a 65% increase in the number of American physicians looking for Canadian jobs between January and April of 2025, with many citing the Trump administration as their primary reason, according to a May 29 report from NPR.
The U.S. faces a shortage of 64,000 physicians by the end of 2024 and 86,000 by 2036, according to global consulting firm McKinsey. This shortage is disproportionately concentrated in rural and underserved areas where physician density is already lowest.
Eighteen states have laws allowing internationally trained physicians to gain full licensure, three states grant limited licensure, three other states have pending bills related to limited licensure and another six state legislatures are considering pathway bills in 2026.
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