The impact of immigration policy on the healthcare workforce

A disproportionate number of US healthcare workers are immigrants. According to the Migration Policy Institute (MPI), in 2015 almost 17% of the healthcare workforce was foreign-born. This includes 12% of physicians and 24% of registered nurses.

The worsening healthcare workforce shortages

This is exactly the wrong time to cut off the supply of incoming healthcare workers. According to the Association of American Medical Colleges, the physician shortage in the US could reach 120,000 by 2030. A recent NBC report noted that substantial numbers of US medical school graduates are leaving the medical workforce or choosing not to practice medicine at all.

The shortfall affects both primary care physicians and specialists. The number of healthcare professionals is likely to grow 16% over the next ten years, but demand will far exceed supply. A shortfall of foreign medical graduates due to reduced immigration will deepen the physician shortage even further.

If the situation is bad for physicians, it’s much worse for lower-wage positions in the healthcare workforce such as certified nursing assistants (CNAs). According to Kaiser Health News, in Massachusetts alone, the CNA shortage is already at 3,000. MPI adds that the most substantial growth is in the healthcare support occupations (e.g. IT technicians) which are expected to increase 23% between 2014 and 2024. If trends continue, there is no way the workforce supply can meet these requirements.

The changing face of healthcare

Immigrant healthcare workers come from all over the world. Eighteen percent of foreign-born physicians are from Asia, including the Middle East. Almost half of nursing, psychiatric and home health aides are from the Caribbean. They are male and female, young and old.

Foreign-born healthcare workers defy the negative stereotypes that are often applied to immigrants. They tend to be well-educated. Immigrant healthcare workers are more likely than their American-born counterparts to have graduated from a university. They tend not to consume public benefits: foreign-born health care workers are more likely to have private health insurance than are immigrants not in the healthcare workforce.

The places where foreign-born physicians practice in the US also defy usual expectations. Instead of concentrating in urban areas, where native-born physicians and non-healthcare immigrants tend to congregate, foreign-born physicians often practice in rural hospitals that have difficulty attracting doctors. An unanticipated benefit of this phenomenon is the increase in cultural diversity and tolerance in areas that tend to be ethnically homogeneous.

Policies that directly threaten immigration of healthcare workers

The most controversial immigration policies put in place by the Trump administration will have had a direct and immediate damaging effect on the healthcare workforce. Banning immigration from the seven majority-Muslim countries is foolish on a number of levels, including the damage it does to foreign-born healthcare workers. According to Health Affairs, 7,000 physicians in the US were born in one of the countries affected by the travel ban. These physicians make up a disproportionately large segment of the physician labor force in Appalachia and the Rust Belt. Who is going to deliver babies in rural West Virginia when there aren’t enough obstetricians?

The Trump Administration also recently decided to end Temporary Protected Status for Haitians living in the US. As a result, many elderly and disabled Americans may lose their home health aide. 

Anti-immigration rhetoric has an impact beyond our borders, even when not coupled with policy. For example, physicians in India may now think twice before deciding to apply for a visa to practice in the US, especially since options at home and in other countries are expanding. Why take the risk of establishing a practice in America if you run the risk of prejudice and hostility towards you and your family?

When the current anti-immigration trend ends—let’s hope that’s soon—the damage will continue. Physicians, once they become established, are unlikely to pull up roots and move to another country mid-career. We could lose an entire generation of foreign-born healthcare workers.

What if the current trends continue?

The shortage of healthcare professionals has serious, negative consequences. The widening deficit of primary care physicians means that patients will have to travel farther and wait longer for an appointment. Underserved rural communities will be particularly hard-hit. The even larger deficit of low-skilled workers such as home health aides will mean that family members will be compelled to leave the workforce and stay at home to care for loved ones. Short-staffed pharmacies will be forced to cut back on hours.

How will the market react?

A reduction in the supply of healthcare workers will compel provider organizations to increase prices and limit choice.

It is unlikely that Americans will be recruited to fill the gaps left by the missing immigrant healthcare workers. Traditionally, many of these jobs have not been all that attractive to the native born. High-skill positions require lengthy training and preparation, so there is a substantial lead time before an individual can qualify for the job.


The views expressed here are those of the author and do not reflect the views of Becker's Healthcare.

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