Written by NPA Board Members Richard Seifman, JD, MBA and Kate Tulenko, MD, MPH, MPhil
Every year the US imports tens of thousands of foreign-born, foreign-trained health workers. Many of these workers provide critical services in rural areas, other underserved areas as well as in major cities. These workers often come from developing countries, some of which are now included in the Trump Administration Executive Order immigration ban. According to a study undertaken by immigrationdoctors.org, taking into account only the six countries in the Executive Order, every year 14 million doctors’ appointments are provided by physicians from Iran, Libya, Somalia, Sudan, Syria and Yemen. These health providers are spread across America, including providing vital services throughout the Rust Belt and Appalachia, especially in Ohio, Michigan, West Virginia, Indiana and Kentucky.
And these six countries represent only a small percentage of the US national reliance on health professionals from developing countries. They are recruited or come to the U.S. because the U.S.– and other developed countries– fail to invest in training sufficient personnel in their own countries.
In the short run remittances from developing country health professionals benefit their countries of origin, but there is an even higher cost for the countries in which they are trained. Developed countries often hire the most qualified developing country health workers, many of which come from among the world’s poorest and sickest countries. These societies not only bear the cost of health education but are less able to provide essential health care services to their own populations. For example, the Philippines and India have long had policies promoting the emigration of their health skilled citizens to reap the rewards of remittances. China, somewhat of an outlier as an economic power, is a newcomer to the health worker export market; it currently trains such an excess of nurses (500,000 per year) that the U.S. Committee on Graduates of Foreign Nursing Schools, the organization that accredits foreign nurses to practice in the U.S. has opened offices in China.
In the long run there is another and better choice, one that would have multiple benefits for the U.S. economy, health services, our social fabric and equity. Every year U.S. nursing schools, medical schools, and other health professional schools turn away tens of thousands of qualified applicants simply because there are no spaces available. This underinvestment in training Americans to be health workers hurts economically because our communities lose out on the roughly $90 billion in wages that would have been available to their trained U.S. health professionals. African American and Latino communities are particularly hard hit because they are under-represented in the health workforce; the US is currently training fewer African Americans men to be physicians than we were trained in the 1970s. Further, minority communities, even when there is affordable health insurance, face barriers to accessing healthcare. Part of the remedy is to build on evidence that shows that minority health workers are more likely to practice in minority communities
This paradigm can be changed by targeted investments in expanding training in health professions and supporting states to realign public educational funds with national needs. The U.S. Job Corps would be one such avenue to train people in health, one of the fastest growing sectors in our economy. Reform of the Affordable Care Act offers another approach by building on the White House Health Career Pathways initiative which links health professional schools and employers to train more health workers to meet employers’ needs. In sum, the current debate in the United States on health access and availability has to consider workforce capacity; this is a way forward which addresses many of the bipartisan concerns.