HCM Challenges of Migrant Healthcare Workers (Part I of II)

Immigrants account for a high percentage of essential workers across the U.S. economy, and they were certainly on the front lines during America’s response to the pandemic. According to the U.S. Bureau of Labor Statistics (BLS), over 2.5 million immigrants were employed as healthcare workers in the U.S. in 2021, accounting for 17-18 percent of the roughly 15 million people in a healthcare occupation here. This was around the same percentage that immigrants comprise of the U.S. civilian workforce in general. Immigrants across the healthcare sector in the U.S. were in fact over-represented among physicians and surgeons (26 percent) and among home healthcare aides (almost 40 percent).

Serious complexity enters the picture when one considers that immigrants in the healthcare sector can hold a variety of legal statuses including naturalized citizens, legal permanent residents, temporary workers, recipients of Temporary Protected Status (TPS) and those covered by the Deferred Action for Childhood Arrivals (DACA) program. Foreign-born healthcare workers initially get admitted to the United States under a variety of temporary and permanent visa categories. Temporary visa categories include H-1B (for those in specialty occupations), TN (for Mexican and Canadian professionals under the North American Free Trade Agreement [NAFTA]), J-1 (for exchange visitors), O-1 (for persons with “extraordinary ability or achievement”), and E-3 (for workers from Australia in specialty occupations). As is the case with other immigrants, those in the healthcare sector can be admitted through permanent immigration channels (like obtaining a green card) based on family, employment, or humanitarian protection routes.

While the BLS data cited above is now 2+ years old, if current trends continue, immigrant representation across this critical sector will likely rise going forward. The reasons are numerous, with aging and longer life expectancy trends in the U.S. driving the demand for care and treatment, coupled with increasing numbers of aging and/or retirement-eligible healthcare workers as well as those teaching in medical and nursing schools. Illustrating this further, about 18 percent of physicians, surgeons, and registered nurses in the U.S. are within ten years of being retirement-eligible or retiring as of the above 2021 data.

Another interesting data point is provided by the Migration Policy Institute (MPI). That agency highlighted that as many as 270,000 immigrants with a relevant college degree in medical or other health sciences were nonetheless on the sidelines during the pandemic due to systemic underutilization of skills. A classic example is when registered nurses were employed as healthcare or in-home service aides. Moreover, this apparently has had little to do with language barriers. The fact is that most of these underemployed or underutilized immigrant health-care professionals were fully bilingual. Approximately 70 percent of foreign-born healthcare workers reported speaking English proficiently, which is markedly more than among all civilian-employed foreign-born workers (57 percent). That said, while most immigrant healthcare practitioners and technicians reported high degrees of English proficiency, less than half of those serving as homecare and personal care aides were fully English proficient.

Despite the increasingly key role immigrant healthcare workers play due to rising demand for their services and expertise, especially when they are demonstrably trained if not skill-certified or licensed, the U.S. immigration system has seemingly not very adequately prioritized attracting them here. Less than 5 percent of the 123,400 H-1B petitions approved for initial employment in the same reporting year as above (2021) went to workers in healthcare and medicine occupations, including only 2 percent for physicians and surgeons. The largest share (61 percent) of approved H-1B petitions for initial employment in FY 2021 went to workers in computer-related occupations, according to the Department of Homeland Security (DHS).

Successfully transplanting a healthcare worker to the U.S. obviously goes far beyond immigration-related legal and compliance hurdles and beyond all the training, licensing and credential requirements, but nonetheless, the need to continue relocating and onboarding these workers will continue for the foreseeable future. Other, perhaps more HCM-related considerations here relate to culture adaptation, socialization and support systems, and other elements and experiences needed for a reasonable level of employee engagement and productivity. The previously cited situation of some of these workers having to start in jobs that underutilize their skills doesn’t make their engagement or retention any easier to achieve.

Thus, all things considered, the effective onboarding of new healthcare workers from outside the U.S. should ideally start when the application process itself starts, and these normally take 18-24 months according to most accounts. Naturally technology can help, whether we’re referring to introducing a new employee to those they have commonality of nationality and culture with, or leveraging workflow automation to ensure proper and timely notifications occur around each step in the relocation and immersion process. Therefore, in Part II of this blog-series we will more specifically explore the role that HR technology can and should have in mitigating HR challenges in healthcare for immigrating employees and risks for employers, and in facilitating the transition to a very viable if not very satisfying existence for these sorely needed technical, professional, and support level healthcare workers coming here from abroad.