Policy Solutions To Address The Foreign-Educated And Foreign-Born Health Care Workforce In The United States

Abstract

Foreign-educated and foreign-born health workers constitute a sizable and important portion of the US health care workforce. We review the distribution of these workers and their countries of origin, and we summarize the literature concerning their contributions to US health care. We also report on these workers' experiences in the United States and the impact their migration has on their home countries. Finally, we present policy strategies to increase the benefits of health care worker migration to the United States while mitigating its negative effects on the workers' home countries. These strategies include attracting more people with legal permanent residency status into the health workforce, reimbursing home countries for the cost of educating health workers who subsequently migrate to the United States, improving policies to facilitate the entry of direct care workers into the country, advancing efforts to promote and monitor ethical migration and recruitment practices, and encouraging the implementation of programs by US employers to improve the experience of immigrating health workers.I n the United States a sizable minority of health workers were born or educated abroad, or both. 1 The advantages and disadvantages of having health workers migrate between countries have been the focus of substantial debate and research globally. 2 Nevertheless, existing evidence is not consistent and has not been synthesized, which makes a cohesive discussion of policy strategies for health worker migration difficult. In this article we integrate data from the literature on health worker migration and present policy strategies that the United States might employ to optimize the benefits and mitigate the adverse effects of health worker migration.The immigrant population of health workers in the United States is heterogeneous. We focused primarily on people who immigrated to the United States after completing their professional education or training elsewhere, as opposed to people who immigrated at a young age and received their education and training in the United States. Because of the nature and timing of data collection and reporting, we generally identified this group of physicians and nurses as those who were educated abroad, except where otherwise stated. Foreign direct care workers-home health aides, nurse aides, psychiatric aides, and personal care aides who largely provide care for older adults-do not have formal educational requirements for the work they do, and thus they were identified as those who were born, instead of educated, abroad. Countries Of OriginForeign-born or -educated health workers in the US workforce come from more than 135 countries, and the leading countries of origin differ by category of worker (Exhibit 1). 1,3 Among physicians, those who are foreign-educated are classified as international medical graduates

Support for immigration reduction and physician distrust in the United States

“…28 With a looming physician shortage projected over the next decade, 29 some have argued that this shortage can be partially addressed with foreign-born and foreign-trained physicians and other health care providers. 30 If this study’s data support the proposed hypothesis, foreign physician distrust may not only arise from physician–patient interaction itself. Instead, such distrust may be part of the immigration distancing already described by social capital and civic engagement researchers.…”

Characteristics of US-Licensed Foreign-Educated Physical Therapists

“…Medical physicians who were educated outside of the United States represent 25.8% of the total physician workforce in the U.S. For nursing, this percentage is estimated to be 5.4%. 4 As such, the percentage of FEPTs in the United States (4.2%) is much smaller than medicine, but is very similar to that of nursing.…”

“…[1][2][3] Immigration of foreign educated health professionals has been identified as one component of the workforce supply picture and a potential solution to workforce shortages primarily in medicine and nursing. 4 Despite this relatively low percentage, very little is known with regard to where they were initially educated and where they choose to reside and work as well as the settings that they chose to work in. As such, whether or not FEPTs do or might contribute to addressing workforce distribution challenges in the United States is not known.…”

Relevance and Effectiveness of the WHO Global Code Practice on the International Recruitment of Health Personnel – Ethical and Systems Perspectives

“…Chen et al 14 in their 2013 study of the United States healthcare workforce, reported not only the high proportion (26%) of foreign-trained doctors, but also how foreign doctors were more likely than their UStrained counterparts to work in unpopular settings (poorer inner cities); in less popular specialties (primary care); and disproportionately serve poor and vulnerable patients. This phenomenon, where foreign-trained doctors practice in areas where there are shortages of domestically trained doctors, was reported 30 years ago 15 ; and is not unique to the United States.…”