Im­mi­grants’ im­por­tance

As the pop­u­la­tion ages, the U.S. will need more non-na­tive work­ers

Modern Healthcare - - Opinions Commentary - Wal­ter Ewing

In the seem­ingly end­less de­bates over health­care re­form in the U.S., men­tion is sel­dom made of the vi­tal role that im­mi­grants play—and will con­tinue to play—in the na­tion’s health­care work­force. If im­mi­grants are men­tioned at all, it is usu­ally in the con­text of heated dis­cus­sions about whether unau­tho­rized im­mi­grants should be el­i­gi­ble for health in­sur­ance.

Lost in de­bates such as th­ese is the sim­ple de­mo­graphic fact that im­mi­grants are a crit­i­cal com­po­nent of the health­care la­bor force at both the high-skilled and less-skilled ends of the oc­cu­pa­tional spec­trum. Im­mi­grants now ac­count for more than one-quar­ter of all physi­cians and sur­geons, and roughly one-fifth of nurs­ing, psy­chi­atric and home­health aides. More­over, im­mi­grants will be cru­cial in fill­ing short­ages of health­care work­ers that are pro­jected to grow over the next two decades.

As the Im­mi­gra­tion Pol­icy Cen­ter points out in a De­cem­ber 2009 re­port, Crit­i­cal Care: The Role of Im­mi­grant Work­ers in U.S. Health Care, im­mi­grants are an in­dis­pens­able part of the work­force at all skill lev­els in the na­tion’s largest health­care oc­cu­pa­tions. Ac­cord­ing to data from the U.S. Cen­sus Bureau’s Amer­i­can Com­mu­nity Sur­vey, im­mi­grants in 2006 con­sti­tuted 27% of physi­cians and sur­geons; 20% of nurs­ing, psy­chi­atric and home-health aides; 19% of den­tists; 18% of phar­ma­cists; and 17% of clin­i­cal lab­o­ra­tory tech­ni­cians (com­pared with roughly 15% of the U.S. la­bor force as a whole).

The largest num­bers of im­mi­grant health­care work­ers are found among nurs­ing, psy­chi­atric and home-health aides (409,000 for­eign-born work­ers), reg­is­tered nurses (334,000), and physi­cians and sur­geons (219,000).

Not sur­pris­ingly, im­mi­grant health­care work­ers tend to be em­ployed in health­care oc­cu­pa­tions that are ex­pected to ex­pe­ri­ence rel­a­tively high la­bor de­mand over the com­ing decade, and in which there are al­ready pro­nounced worker short­ages in many parts of the coun­try. The U.S. Bureau of La­bor Statis­tics pre­dicts that, dur­ing the 2006-16 pe­riod, job open­ings will to­tal 648,000 for nurs­ing, psy­chi­atric and home-health aides; 587,000 for RNs; and 287,000 for med­i­cal as­sis­tants and other health­care sup­port oc­cu­pa­tions.

Even if more na­tive-born work­ers are drawn into health­care pro­fes­sions in the fu­ture, the role that im­mi­grants play in pro­vid­ing health­care ser­vices is likely to in­crease as the U.S. pop­u­la­tion con­tin­ues to age and the grow­ing num­ber of se­nior cit­i­zens re­quires more med­i­cal care. In the case of doc­tors and nurses in par­tic­u­lar, re­cent pro­jec­tions in­di­cate that even if med­i­cal-school and nurs­ing-school grad­u­a­tion rates rise among the na­tive-born, this will not be suf­fi­cient to pre­vent short­ages, at least in the near term.

For in­stance, HHS es­ti­mates that, as of Nov. 15, 2009, there were 6,216 pri­mary med­i­cal health pro­fes­sional short­age ar­eas in the U.S., and that it would take an ad­di­tional 16,680 physi­cians to ad­e­quately meet the pri­mary-care med­i­cal needs of the pop­u­la­tion in th­ese ar­eas.

Yet a Novem­ber 2008 study by the Cen­ter for Work­force Stud­ies at the As­so­ci­a­tion of Amer­i­can Med­i­cal Colleges found that “though the sup­ply of physi­cians is pro­jected to in­crease mod­estly be­tween now and 2025, the de­mand for physi­cians is pro­jected to in­crease even more sharply,” due in large part to the growth and ag­ing of the U.S. pop- ula­tion, re­sult­ing in a short­age of be­tween 124,000 and 159,000 physi­cians in the U.S. by 2025.

The study con­cludes that “sim­ply ed­u­cat­ing and train­ing more physi­cians will not be enough to ad­dress th­ese short­ages.” Even if the AAMC suc­ceeds in its stated goal of “a 30% in­crease in U.S. med­i­cal school en­roll­ment and an ex­pan­sion of grad­u­ate med­i­cal ed­u­ca­tion po­si­tions,” the study con­cludes that “will not elim­i­nate the pro­jected short­age, only moderate it.”

Sim­i­larly, de­spite a re­cent in­crease in the num­ber of RNs in the work­force, “pro­jec­tions in­di­cate a short­fall of RNs de­vel­op­ing around 2018 and grow­ing to about 260,000 by 2025,” ac­cord­ing to a study in the July/Au­gust 2009 is­sue of Health Af­fairs.

The study finds that the pro­jected short­fall of nurses stems in large part from the im­pend­ing re­tire­ment of large num­bers of baby boomer nurses, and the in­ad­e­quate num­ber of younger nurses avail­able to take their place. As a re­sult of th­ese pro­jec­tions, the study con­cludes “it is likely that the de­mand for RNs ed­u­cated in other coun­tries will in­crease.”

As the na­tive-born pop­u­la­tion grows older and re­quires more health­care ser­vices of all kinds, and as in­creas­ing num­bers of na­tive­born health­care work­ers reach re­tire­ment age, the U.S. will ex­pe­ri­ence se­ri­ous short­ages of health­care pro­fes­sion­als. Im­mi­grants will play a cru­cial role in fill­ing th­ese gaps.

Even if more na­tives re­ceive the ed­u­ca­tion and train­ing needed to move into th­ese jobs, it is highly un­likely that they will do so fast enough to fully meet the ris­ing de­mand for doc­tors, nurses, lab­o­ra­tory tech­ni­cians and health aides. The U.S. needs flex­i­ble im­mi­gra­tion poli­cies that help to ame­lio­rate the health­care cri­sis the na­tion faces—not ar­bi­trar­ily re­stric­tive im­mi­gra­tion poli­cies that de­prive Amer­i­cans of the health­care pro­fes­sion­als they need.

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