Is Immigration the Answer to America’s Health Care Worker Shortage?
April 2, 2004

A report recently issued by the American Immigration Law Foundation (AILF) brings to light an issue of great urgency and importance to our society. The report, entitled, Health Worker Shortages & the Potential of Immigration Policy, was published in February of this year, and addresses the current shortcomings in U.S. immigration policy governing foreign healthcare workers and the ramifications for a rapidly aging U.S. population.

Medical care in the U.S. is world-renowned for its sophistication and quality. As the report illustrates, however, high-quality health care is unavailable to millions of U.S. residents. According to the U.S. Department of Health and Human Services’ figures listed in the report, nearly 35 million Americans live in “health professional shortage areas.” At this time, the federal government estimates that in order to relieve this shortage, the U.S. would require an additional 126,000 nurses, 16,000 doctors, 8,500 dentists and 4,000 mental health professionals to enter our health care system. That amounts to an additional 154,500 positions in those fields alone that badly need to be filled at this very moment in the U.S. If nothing is done to remedy this situation, AILFA warns, the U.S. will be short over 50,000 physicians by 2010 and more than 200,000 by 2020. The lack of nurses in the future will be exponentially worse.

One might think that a logical, and relatively quick, solution to this shortage of health care workers would be for U.S. immigration authorities to implement new immigration programs, or adjust existing immigration programs, to allow more qualified health care workers to enter the U.S. Ironically, the report shows, the opposite has occurred in recent years. As the shortage of healthcare workers is reaching a critical stage in many communities, immigration policy regarding doctors and nurses has become more restrictive. Fewer workers in these essential fields are given permission to practice in this country now compared to a decade ago.

Immigrants have long played an important role in increasing the availability of health care in the U.S. A table provided by AILF illustrates that on average, almost 13% of all medical professionals, in all fields, are born outside of the U.S. Over 25% of physicians are immigrants, along with 17% of all nurses and 15% of clinical lab technicians. In nursing care facilities alone, the number of immigrants utilized for such care increased by 72% in the last decade, as immigrants stepped up to take positions that American workers either did not want or for which they were not qualified.

The importance of immigrants in the U.S. health care system cannot be ignored. Yet, the report illustrates that immigration policy continues to put roadblocks in the way of medical professionals practicing in the U.S. The means by which qualified nurses can enter the country has been limited in recent years, for example. With the expiration of the successful H-1A temporary worker visa program in 1995, many qualified nursing professionals were restricted from filling the U.S. worker shortage. As of this time, no comparable temporary visa program has been enacted, further exacerbating nursing shortages nationwide – although the infinitely slower, immigrant visa option continues to be available to facilitate entry of R.N.’s from overseas. The Immigration Act of 1990 also limited foreign-born nurses’ options for immigration by requiring all H-1B visa holders to obtain a four-year college degree (while nursing certification in 49 of 50 states does not require a bachelor’s degree, but rather a nursing training program).

Ensuring that foreign-born medical professionals are qualified to perform their job duties is obviously important. The process of meeting the requirements under U.S. immigration law, however, is slow, expensive and duplicative according to AILA. Completing the testing and certification requirements for nurses can take an entire year, while hospitals and nursing facilities wait for essential medical personnel to care for their patients. Obviously, the inefficiencies of this year-long process inhibit many qualified nurses from bringing their necessary skills to the U.S.

Given the growing shortage of U.S. health care workers, something has got to give. The report recommends that a logical change is an enhancement of U.S. immigration policy and lists several recommendations to remedy the situation, including reestablishing the nurses H-1A visa program, among others. In any case, I suspect that policymakers will soon no longer be able to ignore the growing need for foreign health care workers and will, inevitably be forced to take steps to adjust the U.S. immigration system to accommodate them. How long this will take, however, is anybody’s guess.

If you wish to view the entire contents of the AILF report, you may access it on the web at http://www.ailf.org/ipc/ipf031104.asp.