Healthcare …

In the coming years, as our country’s 76.4 million baby boomers enter their elderly years, our country’s healthcare system will face unprecedented demand, adding jobs faster than any other segment of our economy. Yet, employers are already finding that there are not enough unemployed healthcare workers to fill vacant positions, and in some rural areas, shortages are particularly acute.

For several reasons, immigrants have been a particularly important stopgap filling some of our most glaring healthcare needs. Immigrants are twice as likely as native-born to fill lesser skilled home health aide positions, but also twice as likely to fill high-skilled positions as physicians and surgeons. And because immigrants tend to be more willing to move for a job than the native-born, and there are visa provisions to encourage this, immigrants also fill doctor vacancies in some of our rural communities with the greatest need. A smarter immigration system, however, could help fill far more gaps in our healthcare system, benefiting patients.

Help Wanted

In all 50 states, there are already far more healthcare jobs open than there are workers available to fill them. Many policymakers worry that extreme demands on the healthcare system are coming at a time when many parts of the country still lack enough physicians and healthcare providers to offer adequate—or even basic—levels of care.

Key Stats
4.4: Healthcare jobs advertised online for every 1 unemployed healthcare worker in 2013.
15: Number of occupations within the health sector where vacant jobs outnumber the unemployed workers by more than 10 to 1.
14: Number of those jobs that were front-line medical positions.
Healthcare Jobs Advertised for Each Unemployed Health Worker, 2013
State Number of Jobs
North Dakota 53.8
Vermont 23.5
South Dakota 17.7
Delaware 17.6
Montana 16.4
New Hampshire 14.0
Colorado 10.4
Alaska 10.2
New Mexico 10.2
Wyoming 9.5
Iowa 9.5

Rural Provider Shortages

Rural communities, in many ways, feel healthcare worker shortages most acutely. Rural counties, on average, have far fewer doctors or home health aides per capita than more urban ones. But their healthcare needs are often greater—particularly given their older populations and higher rates of disability. Foreign-born physicians, who are often more willing to relocate than native-born colleagues, are a valuable resource for these medically underserved areas.

Key Stats
135: Number of U.S. counties lacking a single physician.
80 percent: Share of small, rural counties without a single psychiatrist.
14.5 percent: Share of physicians in small, rural counties educated abroad.
9,300: Number of doctors rural counties would gain if they recruited just 5 percent of the immigrant physicians working in the most urban areas.
Indicators of Health Demand, Metro vs. Nonmetro Areas, 2014
Metro Areas Nonmetro Areas
Share Adults Disabled 9.5% 14.4%
Share of Population Elderly 13.4% 17.3%
Ratio of Providers to Population in Different County Types, 2014
Large and Urban Small and Rural
Practicing Physicians per 100K Residents 205 82
Practicing Psychiatrists per 100K Residents 8 0.5

The Role of Immigrants

In many health occupations, from surgeons to home health aides, immigrants already make up a large share of active workers. As the U.S. population continues to age and as healthcare demands increase, immigrants are expected to play an increasingly important role in the health of the nation.

Top Healthcare Jobs by Share of Foreign-Born Workers, 2018
Profession Share of Foreign-Born Workers
Home Health Aides 38.1%
Physicians 28.7%
Personal Care Aides 25.5%
Nursing Assistants 22.1%
Clinical Laboratory Technologists and Technicians 19.2%
Registered Nurses 15.8%
Medical Assistants 15.4%
Licensed Practical and Vocational Nurses 15.1%
Medical and Health Service Managers 13.7%
All Healthcare Workers 16.5%

Aging Baby Boomers

The 76.4 million baby boomers living in America represent a major challenge to our broader healthcare system. Baby boomers are expected to live longer than past generations, while also battling chronic, longstanding conditions. If caregivers remain scarce in some parts of the country, adult children could drop out of the labor force in large numbers to care for aging parents—a potential setback for the economy overall.

Sources:
2 Wan He et al., “65+ in the United States: 2005,” Current Population Reports: Special Studies (U.S. Department of Health and Human Services, National Institute of Aging and U.S. Census Bureau, December 2005). Available online.; Carrie A. Werner, “The Older Population: 2010,” 2010 Census Briefs, November 2011. Available online.
3 Keehan, Sean P, Helen C. Lazenby, Mark A. Zezza, and Aaron S. Catlin, “Age Estimates in the National Health Accounts,” Health Care Financing Review 2, no. 2 (2003). Web Exclusive.
4MetLife, “Caregiving Costs to Working Caregivers: Double Jeopardy for Baby Boomers Caring for Their Parents,” June 2011. Available online.

Key Stats
76.4 million: Number of baby boomers in the United States.2
3x: How much more the average elderly patient spends on healthcare than the average working-age American.3
$300,000: Amount an adult over the age of 50 forgoes in wages and pensions when they leave the labor force early to provide eldercare.4
Size of U.S. Population, Age 65+
Year Number of People Share of Total Population
1950 12.3M 8.1%
2000 35.0M 12.4%
2010 40.3M 13.0%
2020 54.6M 16.3%
2050 86.7M 20.6%

Home Health Aides

As the share of the U.S. population over 65 continues to increase, demand for home health aides is expected to soar. But the U.S.-born workers who typically fill such jobs—working age women with less than a bachelor’s degree—is shrinking. Immigrants are already playing an outsized role as home health aides, and can help address our country’s growing needs for such workers in the future.

Key Stats
48.5 percent: Projected growth in number of home health aide positions, 2012-2022.
-1.5%: Amount the native-born population that typically fills such roles is projected to shrink, 2012-2022.
24 percent: Share home health aides that were foreign-born, 2014.

Psychiatrists

An estimated one in five Americans experiences a mental health issue each year, yet more than 40 percent never receive care.5 One reason why so many individuals go untreated and undiagnosed: The country’s large and growing shortage of mental health professionals, an issue that is particularly acute in America’s rural communities. While immigrants already play a large role in our psychiatry workforce, more could be done to leverage their training and skills.

Sources:
5 Pamela S. Hyde and Paolo Del Vecchio, “Five Point Plan to Improve the Nation’s Mental Health,” Substance Abuse and Mental Health Services Administration, n.d. Available online.; Patrick W. Corrigan, Benjamin G. Druss, and Deborah A. Perlick, “The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care,” Association for Psychological Science, August 1, 2014. Available online.

Key Stats
56.5 percent: Share of U.S. counties without a single psychiatrist.
25.6 percent: Share of practicing psychiatrists older than age 65.
4,870: Number of additional psychiatrists needed by 2020 to meet the minimal federal guidelines of adequate care.
4.2 million: Cumulative lost or less productive workdays experienced by U.S. workers each month due to inadequate mental healthcare.
States with the Most Days of Decreased or Compromised Worker Productivity Due to Inadequate Mental Healthcare
State Est. Number of Days Per Month
California 1,749,184
New York 583,768
New Jersey 442,307
Florida 430,731
Maryland 341,649
Massachusetts 230,473
Colorado 211,138
Connecticut 192,749
Washington 164,187
Pennsylvania 163,331
Georgia 156,900
Virginia 146,147

Visa Obstacles

Despite the critical role immigrants play in the healthcare workforce, the U.S. immigration system makes it difficult for employers to recruit immigrants, even when no U.S.-born workers are available. Many foreign medical residents who study in the United States come on the J-1 visa, a visa that requires them to return home for at least two years after completing their training. One program, The Conrad 30 Waiver, allows states to waive this return requirement for foreign medical residents willing to take jobs in underserved areas. The program, however, is far too limited to meet current needs. Expanding the Conrad 30 program and exploring other fixes—like offering a dedicated temporary work visa to health workers—would go a long way towards addressing our healthcare labor force challenges. So would streamlining the relicensing process for some foreign-trained doctors already here.

Sources:
6 José Ramón Fernández-Peña, Founder and Director of Welcome Back Initiative, August 2015.
7 Ibid.

Key Stats
8,900: Medical residents and fellows sponsored for J-1 visas in 2013-2014.
30: Number of Conrad 30 Waivers granted to each state to recruit those physicians for jobs in underserved areas each year.
500: Registered nurses who came to the United States annually on the H-1C visa, which Congress allowed to expire in 2009.
5,000: Number of foreign-trained doctors living in the United States who have attempted to go through the long process of earning a new, U.S.-based license since 2001.6
136: Number of doctors who made it successfully into U.S. practice after going through that process.7

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