Foreign-born professionals dominate US healthcare industry

Membes of the public put messages in crayons supporting healthcare workers. This sign was on the caregivers walk between the garage and their work at a hospital in Florida. (Photo: courtesy Nurse Marina Bijoy)

NEW YORK – Medical professionals have been at the front and center of the spotlight and debates in the wake of the coronavirus pandemic globally. A new study released today pinpoints the critical role and contribution of the foreign-born healthcare workers in the United States, who dominate the industry with their sheer numbers.

The study, released by the Migration Policy Institute (MPI), on May 15, 2020, highlight that as per the latest figures available, from 2018, more than 2.6 million immigrants, including 314,000 refugees, were employed as health-care workers, with 1.5 million of them working as doctors, registered nurses, and pharmacists, in the US.

Immigrants are overrepresented among certain health-care occupations. Even as immigrants represent 17 percent of the overall US civilian workforce, they are 28 percent of physicians and 24 percent of dentists, for example, as well as 38 percent of home health aides.

Immigrants from the Philippines accounted for 28 percent of the 512,000 immigrants working as registered nurses, followed by those from India (6 percent), Nigeria (5 percent), and Mexico and Jamaica (4 percent each), MPI said.

Among the 269,000 immigrant physicians and surgeons, Indians were the top group with 22 percent, followed by those from China/Hong Kong (6 percent), Pakistan and Canada (5 percent each), and the Philippines (4 percent).

Among 186,000 immigrant home health aides, the top countries of origin were the Dominican Republic (19 percent), Mexico (10 percent), Jamaica and China/Hong Kong (8 percent), and Haiti (6 percent). Mexico (21 percent), the Philippines (12 percent), and China/Hong Kong (6 percent) were the top three countries of birth of the 377,000 immigrants who worked as personal care aides.

Asia was the leading region of birth of immigrant health-care workers in 2018, with 40 percent, followed by the Caribbean (16 percent); Mexico and Central America (14 percent); Africa (12 percent); Europe, Northern America, and Oceania (12 percent collectively); and South America (6 percent).

Overall, immigrants ranging from naturalized citizens, legal permanent residents, and temporary workers to recipients of Temporary Protected Status and the Deferred Action for Childhood Arrivals program accounted for nearly 18 percent of the 14.7 million people in the United States working in a health-care occupation in 2018, the MPI study said.

Even before the COVID-19 pandemic, a number of health-care occupations were among the fastest-growing occupations, as projected by the US Bureau of Labor Statistics (BLS) for the 2018-28 period. The more immediate trends now are less clear. Like other parts of the US economy, the health-care sector has suffered job losses since February 2020, which may continue until the economy rebalances.

Nonetheless, the main drivers for a greater demand for health-care services—population aging and longevity—remain valid. As in the past, immigrants can be expected to play a significant role in the future of US health care, the study analyzed.

Health-care occupations employed approximately 14.7 million native-born and immigrant workers in 2018, up from 12 million in 2010. Before recent significant shifts in the labor market as a result of the COVID-19 disruptions to daily life, health-care occupations were projected to account for 1.9 million of the 8.4 million jobs expected to be newly created in the United States between 2018 and 2028.

Among the 14.7 million workers employed in health-care occupations in 2018, 2.6 million (18 percent) were foreign born. The immigrant share of health-care workers was a fraction higher than that of all employed civilian workers ages 16 and over, the study said. Immigrants accounted for 28 percent of the 958,000 physicians and surgeons practicing in the United States, and 38 percent of the 492,000 home health aides.

The immigrant share of the health-care workforce was roughly twice the national level in three states: New York (37 percent), California (35 percent), and New Jersey (34 percent). Other states with high shares were Florida (30 percent), Maryland (28 percent), and Nevada (26 percent), according to the MPI study.

In a number of states, immigrants made up much higher shares of physicians and surgeons than of all health-care workers or all workers in general. In Michigan, for example, while immigrants accounted for just 8 percent of all workers and 9 percent of health-care workers, their share was three times as high (28 percent) among physicians and surgeons. Other states that have a relatively low share of immigrant workers overall while relying heavily on foreign-born physicians include New Jersey (39 percent), Nevada (38 percent), Florida and New York (36 percent each), and Massachusetts (34 percent).

Several states also had high shares of registered nurses who are immigrants: Nevada (36 percent), California (35 percent), Maryland (30 percent), and New York (29 percent).

Significantly, both immigrant men and women employed in health-care occupations in 2018 were more likely than their US-born counterparts to work as physicians and surgeons: 25 percent and 5 percent of foreign-born men and women employed in health care, respectively, worked in these professions, compared to 17 percent and 3 percent of native-born men and women, the study noted.

Foreign-born health-care workers overall were also more likely than their native-born peers to work as nursing assistants, personal care aides, and home health aides: For the foreign born, 38 percent of women and 19 percent of men worked in these occupations, compared to 22 percent and 14 percent of US-born women and men, respectively.

Women accounted for 75 percent of the 2.6 million foreign-born health-care workers in 2018. Among the native born, this share was even higher: 80 percent. Women represented the lion’s share of both foreign- and native-born registered nurses (83 percent and 89 percent, respectively). Similarly, both foreign- and native-born women accounted for approximately 88-92 percent of low-paid home health aides. In contrast, 38 percent of foreign- and US-born physicians and surgeons were women, the study said.

The study also touched upon a critical aspect of the future of foreign-born healthcare professionals in the US, in the wake of recent legal immigration restrictions.

“It is hard to assess how many foreign health professionals arrive annually, whether via temporary or permanent visa channels, because for the most part visa data are not broken down by occupation. Since most occupations in health care require a professional license, relatively few foreigners meet the requirement unless they obtain a U.S. degree and complete the necessary postgraduate training first. Some doctors with foreign degrees are able to apply for a J-1 visa to complete a medical residency in the United States,” the MPI study said.

Despite the key role immigrants play in providing health-care services, the US immigration system has not typically prioritized attracting foreign-born health-care professionals, the study noted. Just 5 percent (or 4,771) of the 93,615 H-1B petitions approved for initial employment in fiscal year 2018 went to workers in occupations in health care and medicine, according to Department of Homeland Security (DHS) data. Fifty-one percent of annual H-1B petitions in 2018 went to workers in computer-related occupations.

While the Trump Administration has said that medical professionals would be not be part of the visa restrictions imposed via executive order, it remains to be seen how many foreign health professionals would be allowed to emigrate to the US this year.

More importantly, it remains to be seen if foreign healthcare professionals are allowed to avail of work visas or allowed to work under an Optional Practical Training program, after graduating from accredited education institutions, once the pandemic subsides.

(Sujeet Rajan is Executive Editor, Parikh Worldwide Media. Email him: Follow him on Twitter @SujeetRajan1)



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