Where Immigration Medical Exams Are Hardest to Get: Civil Surgeon Offices per 1,000 Adjustments, by Metro

Civil surgeon offices per 1,000 adjustments, by metro

Rank 1 has the fewest civil surgeon offices for its demand. The hardest metros with at least 10 offices are Austin, TX; Cape Coral, FL; Tampa, FL; Las Vegas, NV; Sacramento, CA. The best supplied are Cleveland, OH; New Orleans, LA; Detroit, MI. A low rate means more applicants for each office, which can mean longer waits and fewer choices. It does not measure price or quality.

Estimated share marks the 17 metros whose adjustment estimate relies, at least in part, on the combined share for states outside the 20 largest. Small count marks the 18 metros with fewer than 10 offices, where one office more or less moves the rate a lot. Metro names are the Census Bureau’s July 2023 definitions, so each one includes its suburbs and outlying counties.

To find an office near you, search the USCIS Find a Civil Surgeon locator by ZIP code. Published exam prices are in the 2026 I-693 price index.

Why this study counts adjustments of status

Only people already in the United States see a civil surgeon. Applicants who adjust status with Form I-485 need a civil surgeon’s Form I-693. People who arrive on an immigrant visa had their exam abroad with a panel physician. In fiscal year 2024, 782,800 of the 1,364,090 new green cards (57.4%) went to people adjusting status, so adjustments, not all green cards, are the measure of civil surgeon demand.

An adjustment of status is counted in the year the green card is granted. The exam itself happens before Form I-485 is filed, because the Form I-693 must go in with the application. So these counts are a yearly measure of how many people in each metro needed a civil surgeon, not a count of exams in a given month.

How metro demand is estimated

DHS publishes green card totals by metro, but splits adjustments from new arrivals only nationally and for the 20 largest states. Each metro’s adjustments are therefore an estimate: its fiscal 2024 total times its state’s adjustment share. A metro in more than one state uses a blend of those states’ shares, weighted by where its new residents live. States outside the top 20 use the share for all other states combined. Metros marked “Estimated share” rely on that combined share for some or all of their total.

Nationally, 57.4% of fiscal 2024 green cards were adjustments. Among the 20 largest states, the share is highest in Florida (73%) and Nevada (69%) and lowest in Ohio (42%), Pennsylvania (43%) and New York (46%). Using each state’s own share instead of one national figure keeps that difference in the metro estimates.

How this study was built

Demand is the number of people who obtained lawful permanent resident status in fiscal year 2024 in each metro (DHS Yearbook of Immigration Statistics, LPR Supplemental Table 3), multiplied by an adjustment share from DHS state tables. Supply is the number of distinct office addresses in the USCIS Find a Civil Surgeon locator, read on November 4, 2026 and assigned to metros by ZIP code using Census Bureau files. The ratio is offices ÷ estimated adjustments × 1,000.

• Metros: the 75 metropolitan areas with the most new permanent residents in fiscal 2024. Micropolitan areas and people with no metro on record are not ranked.
• Estimated adjustments = fiscal 2024 permanent residents × the state adjustment share, rounded to the nearest 10.
• Offices = distinct street addresses (first address line and ZIP code) among USCIS locator listings in the metro’s counties. The full locator had 6,813 listings at 6,211 addresses.
• Offices per 1,000 = offices ÷ estimated adjustments × 1,000. Adjustments per office = estimated adjustments ÷ offices.
• Placing offices in metros: each listing’s ZIP code is matched to its Census ZIP Code Tabulation Area, then to the county that holds most of that area’s land, then to the metro. 7 listings whose ZIP code is not a tabulation area were placed by the nearest one to their map point.

Limitations

• A listing in the USCIS locator does not mean the office is taking appointments, sees the public, or still does immigration exams. Some listings may be occupational health or hospital clinics that serve only their own employees or patients.
• Offices are distinct street addresses. A practice with two addresses counts twice. Several civil surgeons at one address count once.
• Adjustments by metro are estimates (see above). DHS rounds every published cell to the nearest 10. In fiscal 2024, 101,280 new permanent residents had no metro on record (1,120 in fiscal 2023), so some metro totals are low.
• Connecticut metros do not appear in the DHS metro table, so they are not in this study.
• Adjustments are approved cases in fiscal 2024 (October 2023 to September 2024). Exams happen before filing, often months earlier, and today’s demand can differ.
• People cross metro lines for an exam. A metro with few offices may border one with many.
• Of fiscal 2024’s adjustments, 18,080 were refugees and their families under the Refugee Act. USCIS says they generally do not repeat the full exam but still submit the vaccination part of Form I-693, which state and local health department doctors are also designated to complete. They are counted with everyone else. DHS also files 159,960 Cuban Adjustment Act cases under its refugee class. USCIS asks those applicants for Form I-693, or a partial form where it applies, with Form I-485.

Sources

• DHS OHSS, 2024 Yearbook of Immigration Statistics, LPR Supplemental Table 3 (persons obtaining LPR status by CBSA of residence, FY2024). Retrieved November 4, 2026.
• DHS OHSS, 2023 Yearbook of Immigration Statistics, LPR Supplemental Table 3 (FY2023). Retrieved November 4, 2026.
• DHS OHSS, 2024 Yearbook, Table 6 (LPRs by type and major class of admission) and Table 4 (by state of residence). Retrieved November 4, 2026.
• DHS OHSS, Lawful Permanent Residents by Type, Broad Class of Admission, and Sex and Broad Age Group: Top 20 States, FY2024. Retrieved November 4, 2026.
• DHS OHSS, New LPRs by state, county, country of birth and major class of admission, top 200 counties, FY2024 (used only to weight states inside multi-state metros). Retrieved November 4, 2026.
• U.S. Census Bureau, CBSA delineation files, July 2023 (List 1 counties, List 2 principal cities). Retrieved November 4, 2026.
• U.S. Census Bureau, 2020 ZCTA to county relationship file and 2023 Gazetteer ZCTA file. Retrieved November 4, 2026.
• USCIS, Find a Civil Surgeon locator (every listing, via the JSON endpoint the page uses). Retrieved November 4, 2026.
• USCIS Policy Manual, Volume 8, Part B, Chapter 3 (refugees adjusting status generally do not repeat the full exam but submit the vaccination record part of Form I-693). Retrieved November 4, 2026.
• USCIS, Green Card for a Cuban Native or Citizen (Form I-693 or partial Form I-693 filed with Form I-485). Retrieved November 4, 2026.

No clinic or doctor is named or ranked in this study. National Immigration Medical Exams is not a government agency and is not affiliated with USCIS or DHS.

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