Immigration is a hot-button issue right now and whether or not reform will be passed in the near future is very much up in the air. The numbers show, however, that foreign-born and -educated workers are here and they are filling major gaps in the healthcare system. Harnessing this group of workers can help hospitals solve workforce challenges, as well as cost concerns.
A study published in November’s Health Affairs found that foreign-educated individuals make up 24 percent of the nation’s physicians and foreign-born individuals account for up to 15 percent of U.S. nurses and up to 24 percent of U.S. direct care workers.
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Peggy Chen, study author and associate natural scientist at RAND, said it will be important in the coming years to focus on non-controversial workforce, like people who are already here legally but not working at the top of their training, and educated students wanting to get into the nation’s residency programs.
“Our main point was to spur ways we might implement a comprehensive solution,” she said. “One of the goals is to get healthcare organizations thinking beyond what they are doing for this specific organization and what they can do more broadly for the healthcare workforce of this country.”
Some of the challenges this workforce faces are the lack of healthcare-specific visas available, unethical recruitment, discrimination and navigating cultural differences in the workplace.
“Our structures and systems aren’t tailored to ways international medical graduates are trained and they shouldn’t be,” Chen said. “They are structured to the way our healthcare is delivered and paid for. But given they are one-quarter of the workforce, we have to look at what we are doing to make sure people they treat are optimally cared for.”
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Instead of recruiting people and releasing them into the workforce, Chen said it is important to make sure organizations help them so they can provide the best care possible to patients. There isn’t a comprehensive national strategy for addressing the issue.
One way to do this is through healthcare societies. Having a relationship with groups like the American Association of Physicians of Indian Origin can help physicians integrate into a new job.
Hospital associations are a powerful group, Chen said, and can lobby for things like a formal visa program. Hospitals could also push for more comprehensive regulations for the direct-care workforce, which is a group that is more unprotected and susceptible to abuse than others.
Chen said hospitals should understand the Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Health Professionals released by the Alliance for Ethical International Recruitment Practices. This lays out some practices for recruiting from foreign countries. This protects both the worker and the hospital – if a new physician knows what he or she is getting into, it will help reduce turnover, and costs, for employers.
One program Chen said does a good job at integrating foreign-born and -educated physicians into the workforce is the University of California Los Angeles’ International Medical Graduate Program. The organization’s family medicine program uses private donations and foundation monies to support foreign medical graduates through their medical program.
“Our dream is to harvest these people and get them back into the healthcare profession,” said Michelle Bholat, co-director of the IMG program.
Bholat said they have placed more than 20 people in the workforce from the program since its inception in 2006 and have 66 in residence training. About 80 percent of students who start the program complete it. They take part for anywhere from three months to two years, depending upon their previous education.
One of the benefits to having foreign individuals in the healthcare industry is having a good cultural match for areas like Southern California. One requirement of the IMG program is that graduates must spend two to three years working in an underserved community in California.
“We are able to get people that are bilingual and bicultural into communities that need it,” she said. “We are trying to address culture and language because it decreases medical errors, which impact patient safety, quality and cost.”
Bholat said two major things that would help foreign students get through medical school in the states are looking at creative ways to get student loan funding and sorting out visas.