To Immigrants: welcome. Enough with the Nazi-tinged rhetoric about keeping a blood line “pure,” free from “impure” (a.k.a. Black, Brown, colored) strains. Enough with blocking those who would pollute our native-born (not the same as our native) population. Please, Donald Trump and fans: stop lambasting the “others” in our midst.
Consider the physician workforce. In 2021 more than 200,000 physicians who were not citizens, and who graduated from medical schools abroad, were working in clinics, hospitals, and nursing homes. Put more starkly, one in five physicians in the United States was born and educated abroad. Since 2004, their numbers have increased by more than 30%. (The Association of American Medical Colleges news, Feb. 23, 2023).
Those immigrant physicians work in the places desperate for physicians. At the University of North Dakota School of Medicine and Health Sciences, roughly 50% of internal medicine residents are foreign-born, foreign-trained. Go into a hospital in any inner city: you will find physicians who hail from Lebanon, from Ghana, from India. .…
Today, the United States still needs more than 17,000 primary care practitioners and more than 8,000 mental health practitioners. By 2034, we may need 124,000 more than we train domestically. In fact, some primary care residency slots, even with foreign graduates, do not meet their “match.”
The foreign graduates run a gauntlet, from qualifying examinations to immigration hurdles. Some visas require the physician to return home after training; CONRAD 30 waivers (30 per state — a number in place for 20 years) require the physician to serve in an underserved area for three years; still other visas will let the physician remain.
In fact, one ingenious new program, The Idaho Health Neighborhood Center in rural Nampa employs three doctors from foreign countries as “physician extenders.” The clinic gets much-needed expertise, the employees get a head start on joining the ranks of physicians.
The scarcity of American-born, American-trained physicians has no one bogey, no easy fix. As the American population has aged, we have needed more physicians. Twenty-somethings might rarely see a primary care physician; sixty-somethings depend on those visits.
The correlation is direct: as we have aged, the visits per capita, the prescriptions per capita, the treatments per capita have risen. At the same time, we have not dramatically expanded the training slots. Training, moreover, remains not just lengthy, but expensive, leaving graduates in debt. While a thoracic surgeon might easily repay the debt, a primary care physician will struggle under it. To complicate the scarcity, many older physicians have tired of bureaucratic paperwork, utilization review roadblocks, and electronic records ad nauseam. They didn’t train to work in this new world, and they are exiting.
Anybody, particularly patients, concerned about healthcare in the United States should want to open the doors to more foreign-trained physicians.
On to nurses. We depend on the foreign-born, and we need more. Avant Healthcare Professionals in Florida is fielding requests for 4,000 nurses at jobs throughout the country. Billings Clinic in Montana, for instance, reached out to nurses from the Philippines, Thailand, Kenya, Ghana and Nigeria.
The shortage of nurses reflects the economics of healthcare USA. The National Nurses United cites data showing one million more registered nurses than are employed, as well as an increase in the number of candidates who pass the nursing exam. But many nurses have left the field, due to burnout, COVID, or more lucrative opportunities outside nursing. And nursing, particularly in hospitals, is difficult.
The complaint rings throughout the discussion: hospitals have been scrimping on staff, making work-conditions intolerable for too many nurses. Nurses have gone on strike, primarily because of staff shortages. California recently distinguished the “nurses per capita” number from the “nurse to patient” ratio. When California passed mandatory nurse-to-patient ratios, nurses returned to nursing. (Oregon is slated to pass such a law in 2024). Regardless of the reason behind the shortage, though, it is real — and the foreign-born, foreign-trained nurses have filled the gap.
So, to all the people who want to bar immigrants, think carefully. When you are sick, the person who treats you may hail from India or Ghana or the Lebanon. Do you want to bar them?
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email joan.retsinas@gmail.com.
From The Progressive Populist, February 1, 2024
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