Immigrants Make Up Large Portion of US Healthcare Workforce

Marcia Frellick

June 03, 2019

Immigrants make up 18.2% of healthcare workers, compared with 15.5% of the general population, according to an analysis of Current Population Survey (CPS) data.

The large contribution to healthcare by foreign-born workers has implications for addressing a growing shortage of providers, particularly those who care for elderly and disabled patients, and for immigration policy, the study authors say.

Leah Zallman, MD, director of research at the Institute for Community Health, assistant professor of medicine at Harvard Medical School, and primary care physician at Cambridge Health Alliance, Cambridge, Massachusetts, and colleagues analyzed data from the Annual Social and Economic Supplement of the 2018 CPS. The nationally representative survey, conducted by the Census Bureau and the Bureau of Labor Statistics, collected data on 180,084 people in March 2017.

The findings were published online June 3 in Health Affairs.

Half of Geriatricians Trained in Foreign Schools

The authors write that their study builds on others that highlight immigrants' contribution to the healthcare of US-born patients.

For this study, anyone born outside of the United States was considered an immigrant. The survey did not ask respondents about documentation status.

The data also show that 1 in 4 US physicians trained in a foreign medical school. These physicians include 38.6% of internists, 43.6% of cardiologists, and 50.7% of geriatricians.

The survey indicates that 30.4% of immigrant healthcare workers work in long-term care settings, compared with 22% of US-born workers. More than one quarter (27.5%) of direct-care workers in long-term care (those in nursing, psychiatric, home health, and personal care roles) were immigrants.

That has important implications, inasmuch as the elderly population is expected to double by 2050. The Health Resources and Services Administration projects a 34% rise in demand in the next 10 years for direct-care workers and forecasts the need for 650,000 more providers.

Naturalized citizens account for 6.8% of the US population but make up 16.2% of home health agency workers and 13.9% of all direct-care workers, the researchers explain. Although legal noncitizen immigrants make up 5.2% of the US population, they constitute 9% of direct-care workers.

Additionally, "Immigrant healthcare workers are, on average, more educated than US-born workers, and they often work at lower professional levels in the US because of lack of certification or licensure. They work nontraditional shifts that are hard to fill (such as nights and weekends), and they bring linguistic and cultural diversity to address the needs of patients of varied ethnic backgrounds, the authors write.

Financially as well, the immigrant contribution is disproportionately high. The authors write that immigrants pay "tens of billions" more in taxes to Medicare and through private insurance premiums than are paid out to them, "effectively subsidizing the care of US-born people," they write.

Current US policies seek to limit the influx of immigrants, which has implications for meeting healthcare workforce needs, the authors write.

They conclude that "curtailing immigration will almost certainly move us in the wrong direction, worsening the shortage and the availability of high-quality care for elderly and disabled Americans."

The study was supported by the Cambridge Health Alliance Foundation. The authors have disclosed no relevant financial relationships.

Health Aff. Published online June 3, 2019. Full text

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