Across XXX, primary care relies heavily on immigrant clinicians—family physicians, nurse practitioners, and aides who sustain access in communities that would otherwise go without. Yet the very people who keep clinics open often face the narrowest pathways to leadership, fair pay, and professional belonging. This study quantifies their contribution and the inequities that persist within the workforce they help sustain. To describe the scope, distribution, and advancement of immigrant clinicians in XXX primary care and to examine disparities in compensation and leadership representation compared with locally born peers. We analyzed pooled workforce microdata from XXX covering the period 2003–2023. Variables included occupation, work hours, region, gender, earnings, and supervisory roles. Weighted regression models adjusted for education, hours, and geography to estimate adjusted odds of leadership and pay gaps. Sub-analyses explored gender and region-of-birth differences.Immigrant clinicians comprised roughly one-third of the primary-care workforce and were over-represented in safety-net and shortage areas. After adjustment, they earned less and held fewer leadership roles than locally born counterparts despite equivalent hours and qualifications. Gender and region-of-birth stratification revealed compounded inequities: immigrant women experienced the steepest gaps. Workforce diversity aligned closely with local patient demographics, underscoring a missed opportunity for language and cultural concordance.Findings highlight a paradox: the same clinicians bridging national access gaps face systemic barriers that limit their own advancement. Equity in recognition, compensation, and leadership is not only a matter of fairness but of health-system resilience.Primary care in XXX depends on global talent, yet the structures governing that talent remain exclusionary. Policies that streamline credentialing, modernize visa pathways, value linguistic and cultural labor, and track equity metrics in pay and promotion could transform this dependence into shared belonging. Keywords: workforce diversity; immigrant clinicians; primary care; underserved areas; equity; leadership