Category Archives: Foreign-born healthcare workers

Immigrant Labor to Impact Care for America’s Elderly and Disabled

For all of those who support the efforts of the current fascist regime to stem the tide of immigration into this country, the following abstract and article from Health Affairs  from Zalman, Finnegan, Himmelstein, Touw, and Woolhandler, suggests that such policies will be detrimental to the care elderly and disabled Americans will receive in the future.

It is another example of the racist, wrong-headed, and neanderthal thinking on the right that will hurt millions of Americans who otherwise will not be able to care for their personal needs as they age, or should suffer a life-altering disability.

ABSTRACT As the US wrestles with immigration policy and caring for an
aging population, data on immigrants’ role as health care and long-term
care workers can inform both debates. Previous studies have examined
immigrants’ role as health care and direct care workers (nursing, home
health, and personal care aides) but not that of immigrants hired by
private households or nonmedical facilities such as senior housing to
assist elderly and disabled people or unauthorized immigrants’ role in
providing these services. Using nationally representative data, we found
that in 2017 immigrants accounted for 18.2 percent of health care
workers and 23.5 percent of formal and nonformal long-term care sector
workers. More than one-quarter (27.5 percent) of direct care workers and
30.3 percent of nursing home housekeeping and maintenance workers
were immigrants. Although legal noncitizen immigrants accounted for
5.2 percent of the US population, they made up 9.0 percent of direct care
workers. Naturalized citizens, 6.8 percent of the US population,
accounted for 13.9 percent of direct care workers. In light of the current
and projected shortage of health care and direct care workers, our
finding that immigrants fill a disproportionate share of such jobs
suggests that policies curtailing immigration will likely compromise the
availability of care for elderly and disabled Americans.

According to the article, the Institute of Medicine projects that 3.5 million additional health care
workers will be needed by 2030.

Currently, the authors state, immigrants fill health care workforce shortages, providing disproportionate amounts of care overall and particularly for key shortage roles such as rural physicians.

In addition, they report, Immigrant health care 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.

Finally, they work nontraditional shifts that are hard to fill (such as nights and weekends),6 and they bring linguistic and cultural diversity to address the needs of patients of varied ethnic backgrounds.

Along with the role immigrants play in the health care space, the size of the elderly population is expected to double by 2050, raising concern that long-term care workers will be in particularly short supply, according to the article.

Direct care workers—nursing, psychiatric, home health, and personal care aides—are
the primary providers of paid hands-on care for more than thirteen million elderly and disabled
Americans, the authors contend, and these workers help elderly and disabled people live at home, which is the preferred setting for most people, by providing assistance
with daily tasks such as bathing, dressing, and eating.

They also help elderly and disabled people in nursing or psychiatric facilities when living at home is not possible and during transitions home after hospitalization.

These workers are already in short supply, and the authors state that the Health Resources and Services Administration projects a 34 percent rise in the demand for direct care workers over
the next decade, equivalent to a need for 650,000 additional workers.

The projected shortages are compounded by high turnover and retention challenges, creating ongoing challenges to maintain a sufficient labor supply for-long-term care.

The rest of the article is divided into three main sections: Study Data & Methods, Study Results, and Discussion. Throughout the article are exhibits, and each section is further broken down into sub-sections.

The authors have done a serious effort to examine the impact current immigration policies will have on the future health care of the American people, but knowing this regime and their base of xenophobic, racist, paranoiac extremists, the American people will be the ones who will suffer, and many of them are the very people agreeing with these policies.

Number of Foreign Doctors Coming to US Dropping

As reported this morning in the weblog, Working Immigrants, the number of foreign born doctors wanting to come to the US is dropping, which may have a significant impact on the availability of doctors in certain parts of the country and in many hospitals and clinics, especially those that serve underserved and lower-income communities.

According to Working Immigrants, there are more than 247,000 doctors with medical degrees from foreign countries practicing in the US.

They make up slightly more than one-quarter of all doctors, and most are not US citizens, and are foreign-born as well.

One of the channels of immigration of foreign-born and foreign trained doctors is through graduate medical study. This year, just over 7,000 international medical graduates applied to study in the US, representing a downturn of 217 from last year, and nearly 400 from 2016.

Nearly 25% of residents across all medical fields were born outside the US in 2015, and in subspecialty residency programs, foreign medical graduates accounted for more than one-third of residents.

As I indicated above, foreign-trained doctors are more likely to practice in lower-income and disadvantaged communities than their American counterparts,

Where more than 30% of the population lives below the poverty rate, nearly one-third of the doctors are foreign-trained. And where per-capita income is below $15,000 per year, 42.5% of all doctors are foreign-trained. Finally, where 75% or more of the population is non-white, 36.2% of the doctors are foreign-trained.

This trend will most likely impact the predicted physician shortage that has been previously reported in this blog. In addition, it will add to the burden hospitals are facing in providing care as many of these immigrants work in hospitals to augment the staff shortages they already have.

If this trend continues thanks to current administration policy and xenophobia, the problem will only get worse. The reader should be aware that to even get into the US to practice medicine is a long and difficult process and many physicians do not get in to the country.

Instead of turning away good doctors from foreign countries, we should welcome them and keep them working in the areas of the country where they are practicing and providing care to those who otherwise would not have a doctor to go to.

Foreign-born, US-trained Physicians in Medical Travel vs US-born, Foreign-trained Physicians Practicing in the US and Foreign-born, Foreign-trained Physicians Practicing in the US

Those of you in the Workers’ Comp space have probably read my earlier posts extolling the benefits of medical travel, and promoting its implementation into workers’ comp.

Yet, in all those posts, hard evidence of the quality of care provided by physicians in these destinations was not presented.

However,  there is evidence that foreign trained, US  born doctors practicing in the US, provide as good as or better care than that provided by graduates of US medical schools, according to a recent study mentioned over the weekend in a post by Peter Rousmaniere, in his blog, Working Immigrants.

From this data, it may be possible to suggest that foreign-born doctors, trained in US schools provide the same good or better care than their American-born classmates, when they return to their home countries and work in medical travel facilities.

Before beginning to write this post, I tried to research some data on this, but was unable to find any recent information. However, it is well known that there are considerable numbers of foreign-born, US trained and Western trained physicians in medical travel facilities, which is one key factor in choosing to go abroad for medical care.

As Peter reported, among the 12.4 million workers in the health care field in 2015, 2.1 million, or 17% were foreign born. Of these, the foreign born accounted for 28% of the 910,000 physicians and surgeons practicing in the US. 24% of that number are in nursing, psychiatric and home health care.

How many of the foreign-born physicians trained in the US return home is not certain, but given the fact that many foreign born, foreign trained physicians have a hard time gaining access to practice in the US, it is not difficult to ascertain that those who do not enter the US end up working in their home country. In order to practice in the US, they must pass tests by a special commission and enter a residency program, even if they have done them before.

How many foreign trained, US born physicians practice in the US? According to Peter, about 25% of practicing physicians graduated from foreign medical schools. About a third of them are Americans. They are more likely, Peter says, to practice in rural and poorer communities, and are overrepresented in primary care. Given the physician shortage that I and others have commented on, there will be a need for more foreign-born doctors, and perhaps, more US trained, foreign-born doctors to work in medical travel facilities.

The Education Commission for Foreign Medical Graduates (ECFMG) gave roughly 10,000 certifications in 2015. 30.9% were issued to US citizens, 18.9% were issued to citizens of India and Pakistan, and 7.9% from Canada.

The states with the highest percentage of practicing physicians who graduated from foreign medical schools are New Jersey (40%), New York (38%), and Florida (35%).

Most of the New Jersey physicians no doubt practice in the Metropolitan New York Area, given the state’s proximity to NYC. And Florida has a large percentage given the demographics of that state.

So, if foreign-born, US trained physicians are ok for treating injured workers here, why can’t their fellow countrymen do the same back home if an injured worker, or his employer choose that as an option to expensive surgery at an American hospital?

Don’t tell me there is a difference, because there isn’t. It is only ignorance and prejudice that prevents foreign-born, US trained physicians from treating injured workers in medical travel facilities. That is another problem our health care and workers’ comp systems need to deal with.

H-1B Visa Order To Limit Number of Foreign-Born Doctors

Before most of the Risk Management and Workers’ Comp industry goes to Philadelphia for next week’s Risk and Insurance Management Society (RIMS) annual conference, I want to share an article on Kaiser Health News about what the recent executive order on H1-B visas will have on healthcare, and by extension, workers’ comp.

I wrote about this two weeks ago when I said that the travel ban will affect the physician shortage in the United States.

According to Kaiser, limiting the number of foreign doctors who can practice in the US could have a significant impact on certain hospitals and states that rely on them.

A study in JAMA found that more that 2,100 US employers were certified to fill nearly 10,500 physician jobs nationwide in 2016, representing 1.4% of physician workforce overall.

States such as New York, Michigan, and Illinois account for most of the H1-B visa applications for foreign physicians. a third of the total.

North Dakota, on the other hand, had the most applicants as a percentage of its workforce, or 4.7%.

While the focus of the executive order was to clamp down on the loopholes in the program that allowed tech companies to hire foreign workers for high skilled jobs that Americans could take, it will also have a negative effect on how patients will receive care in some US hospitals.

And coupled with the fact that the process of getting to practice here without an executive order is difficult and time-consuming, means that both general health care and workers’ comp patients may not be able to get necessary treatment due to the predicted physician shortage.

So while general healthcare can offer an alternative in the form of medical travel, it is high time that work comp does the same.

Or do you really want your claimant patients to wait months before getting needed surgery or other medical procedures?

 

Travel Ban to Affect Physician Shortage: What Medical Travel Can Do

The following post, from fellow blogger, Joe Paduda, who has a guest post from former WCRI CEO, Dr. Rick Victor, states that the current political regime in Washington’s ban on travel from certain countries and ban on allowing a certain religious minority into the country will further exacerbate the already projected physician shortage that this writer had previously discussed in earlier posts on the subject.

Here is the link to Joe’s and Dr. Victor’s posts.

If there ever was a good enough reason for the implementation of medical travel into general health care, and into workers’ comp medical care, this is it.

Do you really want to see injured workers go without treatment or without needed surgeries because there aren’t enough US-born physicians and surgeons, because some narcissistic, egomaniacal, billionaire con artist has banned needed foreign-born physicians from entering the country?

Who knows? Maybe one of these doctors has a revolutionary new treatment or therapy that can bring relief to millions of Americans, or can cure a terrible disease?

Banning them only makes America weaker, not Great Again.

P.S. Here is a follow-up post from Peter Rousmaniere’s Working Immigrants blog.