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