Hospitals are being stretched. Clinics are shutting down units. Patients are waiting longer than ever. And now with the 2025 numbers out, things are worse than most of us thought.
But as U.S.-born nurses and doctors leave, immigrant workers are stepping in to fill the gaps. And depending on where you live, the paycheck you bring home could be double—or half—what someone else earns doing the same work in another state.
This is the environment we’re walking into.
The Shortage Crisis
Between 2020 and 2021, more than 100,000 nurses left the workforce. That’s the biggest drop in forty years. Burnout, retirements, and people leaving the profession all hit at once, and the system hasn’t recovered.
Right now, we’re short about 78,000 full-time nurses. By 2030, 37 states are projected to face significant nurse shortages. If millions of patients suddenly got access to care? That gap could explode to half a million nurses missing.
Doctors are in no better shape. The U.S. already needs 19,000 more physicians just to cover primary care and mental health. By 2036, that shortage is expected to hit 86,000. Some models show it pushing past 120,000.
For patients, that means longer waits. For nurses, it means an increased reality of being overworked—and in some cases, chances to step into bigger roles.
Immigrants Filling the Gaps
Walk into almost any hospital in New York, California, or Texas, and you’ll see who’s keeping the system running: immigrant healthcare workers.
1 in 5 U.S. healthcare workers is foreign-born.
1 in 4 doctors trained overseas.
1 in 6 nurses are immigrants.
In 2022, around 500,000 immigrant nurses were working in the U.S.—double the number from a decade earlier. About a third of hospitals reported hiring foreign-educated nurses that year.
These workers are covering the roles nobody else is filling: rural towns with no doctors, elder care that Americans are aging into faster than we can staff, and bilingual care in cities with growing immigrant populations.
Without them, the system would be in freefall.
Not All States the Same
The shortage doesn’t hit evenly across the country.
California: short by 44,000+ nurses by 2030.
Texas: down about 16,000.
New Jersey, South Carolina, Alaska: also facing severe shortages.
A few states like North Dakota may actually see surpluses. But for most of the country—especially large states and rural areas—the shortage will be felt in real time. That means heavier patient loads, more overtime, and more open positions.
The Pay Gap
This is where it gets wild.
National median RN salary (2024): $93,600
California median salary: $134,000
Alabama median salary: $65,900
That’s a two-to-one difference.
Yes, California’s cost of living is higher—about 28% more than Alabama’s—but even after adjusting, California nurses come out ahead. Hawaii, Oregon, and Washington also top six figures, while Mississippi and South Dakota sit at the bottom.
Two nurses. Same job. Different states. One could be taking home double what the other earns.
What This Means for You
Hospitals know they’re in trouble—and that gives you leverage. Pay raises are happening. Signing bonuses are back, and some hospital systems are even offering loan repayment or tuition reimbursement just to fill jobs.
And it’s not just bedside care anymore. The shortage is opening up new doors:
Nurse practitioners are filling primary care positions.
Nurse educators are needed to train the next generation of nurses.
Telehealth is pulling nurses into tech-based roles like virtual care and informatics.
So this isn’t just a crisis. It’s also a chance.
The Bottom Line
The future of healthcare isn’t U.S. citizens versus immigrants. It’s about too much demand and not enough workers. Both groups are needed to keeping the system standing.
There’s also more opportunity—higher wages, better incentives, and the ability to choose where and how you want to work.
The real question isn’t “Who gets the jobs?” anymore.
It’s “How do you put yourself in the best position to take advantage of the shortage?”
So…It’s official—Map My Pay is now available on both the Apple App Store and Google Play.
If you haven’t downloaded it yet, you can do it right now. No more waiting. No more guessing your real take-home pay.
Here’s what you’ll get inside:
✅ See after-tax nursing salaries across 1,000+ U.S. cities
✅ Compare leftover income after rent or mortgage
✅ View crime stats, housing costs, and cost-of-living in any city
✅ Filter by shift, role, or how much money you want left over
✅ Join a private, nurse-only community where receipts (and pay stubs) speak louder than opinions
We built this for you—because you deserve to know where your money goes and where it goes further.
👇 Haven’t downloaded it yet? Grab it now:
Talk soon,
Jason from Map My Pay
P.S. We’re posting daily in Map My Pay’s community section. Make sure to join us there and ask your most important questions.