Foreign-born workers help the United States stem a tidal wave of provider shortages
With more Americans living to an advanced – albeit often comorbid – age, the expanding need for healthcare workers bobs on the rough seas of shortages. With an already too-small base of available providers, the healthcare ship is in danger of crashing on rocks without the aid of extra hands on deck. Ready to assist are foreign-born workers, many of whom are already impacting healthcare in this country. Statistics about immigrants in healthcare clarify their importance. Immigrants represent just 13% of the U.S. population, and yet:
- 28% of physicians and surgeons
- 40% of medical scientists in pharmaceutical research and development
- 50% of medical scientists in biotechnology in states with a strong biotechnology sector
- 22% of nursing, psychiatric and home health aides
- 15% of registered nurses.
Furthermore, 46% of foreign-born (immigrant) physicians and surgeons go into internal medicine where there are shortages of practitioners, whereas only 15% of U.S. medical graduates do so.1 In addition, immigrant physicians more frequently practice in rural and inner-city areas where physician shortages persist.2
These telling facts, and more, are culled from a major study from George Mason University’s Institute for Immigration Research (IIR) in Fairfax, Va., and The Immigrant Learning Center of Malden, Mass. Titled Immigrants in Healthcare: Keeping Americans Healthy Through Care and Innovation, the study was published in June and drives home the point that immigrants are the human stabilizers integral to keeping the U.S. healthcare ship on course.3
Immigrant Contributions Needed
“Improving the health of all Americans cannot be possible without the vital contributions immigrants provide in the areas of medicine, medical science, long-term care and nursing,” said Monica Gomez Isaac, executive director of George Mason’s IIR. “The skills and education they bring from their homelands and often hone here in the U.S. are especially crucial as American society continues to experience an increased aging populace, which also makes up an increasingly diverse patient population.”
Additionally, Isaac noted that as American society continues to become increasingly diverse, cultural competence is required to deliver effective care. “Immigrants bring vital language skills, awareness of different cultural orientations and health practices to meet this demand,” she told ADVANCE.
“The cumulative competence they possess makes it possible to serve patients who reflect a wide range of racial and ethnic backgrounds. Additionally, immigrants in the various fields of the healthcare industry also extend a cultural bridge to the people they serve. They contradict stereotypes and serve as stewards who connect and assist all members of the community,” said Isaac, adding that their innate ability to understand the needs of a diverse populace is unique. “It allows for the delivery of effective medical treatment that is also culturally appropriate. Immigrants reduce racial and ethnic health disparities.”
Diversity aside, foreign-born healthcare workers are also needed to stem the expected tide – or tidal wave – of provider shortages. Isaac reminded, “With the implementation of the Affordable Care Act, the number of Americans with health insurance has increased, resulting in an increased demand for nurses, as well as other healthcare workers. It is projected that more than one million new and replacement registered nurses will be needed in the U.S. by 2022.4 Furthermore, the rapid increase in the number of Americans aged 65 and older is driving a greater need for workers in home care and personal assistance. The number of immigrants working in the paraprofessional workforce makes it possible for more Americans to stay in their homes longer.”
Barriers for Foreign-Born Workers
That said, there remain challenges to taking full advantage of foreign-born healthcare professionals, particularly nurses.
“There are multiple barriers affecting foreign-born healthcare workers. They range from recognizing the educational and professional qualifications to language barriers,” Isaac said. “In the instance of nurses, the lack of an international standard for qualifying registered nurses is absent. The varying degrees of training based on the standards of individual nations make it complex to recruit and fill nursing shortages. Meanwhile, home health workers receive insufficient preparation and compensation in a field impacted by high turnover and recruitment challenges.”
According to a report by Migration Policy Institute in 2012, there are roughly 7.2 million immigrant adults in the U.S. who have college degrees, about half of whom received their degrees abroad, and “approximately 23% are un- or under-employed in low-wage jobs… Many have backgrounds in health and medicine in critical shortage areas.”5
The report concludes that the U.S. “is losing the talent and skills of these professionals” and delineates steps that U.S. healthcare can take to close the gaping hole in the allegorical lifeboat by utilizing foreign-born providers.
Proactive Changes Recommended
“Important stakeholders in the health sector, ranging from large hospitals to pharmaceutical companies and trade associations, should pay close attention and devote resources to facilitate the meaningful incorporation of foreign-born workers into the health sector,” said authors of this healthcare report.
More specifically, the report recommends investments in workforce development including programs to improve the long-term labor market prospects of foreign-born workers.
“Differentiated workforce development strategies are critical to improving the insertion of new entrants, especially in low-wage occupations of the sector, such as nursing aides.”
The report also suggests the financial bolstering of programs to assist long-term healthcare workers – especially those in home health occupations – through practice redesign and training on team-based care. Moreover, it points out a need for defined healthcare career ladders and training programs starting at the aide level (such as CNAs) to professional levels at community colleges and other public education/nonprofit institutions. Such education must ultimately link to job redesign, with opportunity for promotions and wage increases.
On a national scale, the study urges support of proposed Congressional legislation, introduced in June 2015, called the Professional Access to Health (PATH) Workforce Integration Act. This bill is “designed to create a place in America’s health workforce for internationally trained health professionals who reside legally in the U.S. but do not work in the health field,” according to the study. If passed, the legislation would provide for counseling and training opportunities, access to accelerated courses in English and assistance in having foreign credentials evaluated. The bill also calls for education for employers about the competency of health professionals trained outside of the U.S.
A continuing dependence on foreign-born healthcare workers will increase significantly in the future as the U.S. faces a growing shortage of homegrown healthcare workers, from physicians to nurses to researchers, say study authors. This, coupled with the increase of an aging U.S. population, will create a greater demand for healthcare workers. Preparing to utilize the skills of immigrant healthcare workers is not only smart business, it is also essential to the health industry’s shared objectives of providing adequate quality care and improved patient outcomes across the continuum of U.S. healthcare.
- Rao, R, ed. International Medical School Graduates in American Medicine (Washington, DC: American Medical Association, 2013), p. 21.
- Khan, Z. Immigrants and the Medical Profession: Good for Our Health (Fairfax, VA: Institute for Immigration Research, George Mason University, May 2014).
- Hohn, M, Witte, J, et al. Immigrants in Healthcare: Keeping Americans Healthy through Care and Innovation, (Fairfax, Va.: Institute for Immigration Research at George Mason University and The Immigrant Learning Center, June 2016).
- IMPRINT, Talent is Ready: Promising Practices for Helping Immigrant Professionals Establish Their American Career (Chicago, IL: IMPRINT, 2011).
- McCabe, K. Foreign-Born Health Care Workers in the United States (Washington, DC: Migration Policy Institute, June 27, 2012).