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HCM Challenges of Migrant Healthcare Workers (Part I of II)

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This two-blog series is brought to you by Steve Goldberg, Board Advisor at Azilen & HR Process & Tech Leader. Other insightful blogs penned by Steve can be found here ↗️.

In this first blog, I will provide various contextual data points and perspectives in relation to the blog’s title: HCM Challenges of Migrant Healthcare Workers.

Part I delves in detail into the surrounding HR challenges in healthcare to set proper context, then explores various implications and considerations for both healthcare employers and employees. HR / HCM practices, and HR technology or HCM systems aspects are also preliminarily introduced but are discussed more fully in Part II, which also includes several actionable recommendations intended to benefit all those impacted by the range of issues covered herein.

Immigrants account for a high percentage of essential workers across the U.S. economy, and they were certainly on the front lines during America’s response to the pandemic. According to the U.S. Bureau of Labor Statistics (BLS), over 2.5 million immigrants were employed as healthcare workers in the U.S. in 2021, accounting for 17-18 percent of the roughly 15 million people in a healthcare occupation here. This was around the same percentage that immigrants comprise of the U.S. civilian workforce in general. Immigrants across the healthcare sector in the U.S. were in fact over-represented among physicians and surgeons (26 percent) and among home healthcare aides (almost 40 percent).

Serious complexity enters the picture when one considers that immigrants in the healthcare sector can hold a variety of legal statuses including naturalized citizens, legal permanent residents, temporary workers, recipients of Temporary Protected Status (TPS) and those covered by the Deferred Action for Childhood Arrivals (DACA) program. Foreign-born healthcare workers initially get admitted to the United States under a variety of temporary and permanent visa categories. Temporary visa categories include H-1B (for those in specialty occupations), TN (for Mexican and Canadian professionals under the North American Free Trade Agreement [NAFTA]), J-1 (for exchange visitors), O-1 (for persons with “extraordinary ability or achievement”), and E-3 (for workers from Australia in specialty occupations). As is the case with other immigrants, those in the healthcare sector can be admitted through permanent immigration channels (like obtaining a green card) based on family, employment, or humanitarian protection routes.

While the BLS data cited above is now 2+ years old, if current trends continue, immigrant representation across this critical sector will likely rise going forward. The reasons are numerous, with aging and longer life expectancy trends in the U.S. driving the demand for care and treatment, coupled with increasing numbers of aging and/or retirement-eligible healthcare workers as well as those teaching in medical and nursing schools. Illustrating this further, about 18 percent of physicians, surgeons, and registered nurses in the U.S. are within ten years of being retirement-eligible or retiring as of the above 2021 data.

Another interesting data point is provided by the Migration Policy Institute (MPI). That agency highlighted that as many as 270,000 immigrants with a relevant college degree in medical or other health sciences were nonetheless on the sidelines during the pandemic due to systemic underutilization of skills. A classic example is when registered nurses were employed as healthcare or in-home service aides. Moreover, this apparently has had little to do with language barriers. The fact is that most of these underemployed or underutilized immigrant health-care professionals were fully bilingual. Approximately 70 percent of foreign-born healthcare workers reported speaking English proficiently, which is markedly more than among all civilian-employed foreign-born workers (57 percent). That said, while most immigrant healthcare practitioners and technicians reported high degrees of English proficiency, less than half of those serving as homecare and personal care aides were fully English proficient.

Despite the increasingly key role immigrant healthcare workers play due to rising demand for their services and expertise, especially when they are demonstrably trained if not skill-certified or licensed, the U.S. immigration system has seemingly not very adequately prioritized attracting them here. Less than 5 percent of the 123,400 H-1B petitions approved for initial employment in the same reporting year as above (2021) went to workers in healthcare and medicine occupations, including only 2 percent for physicians and surgeons. The largest share (61 percent) of approved H-1B petitions for initial employment in FY 2021 went to workers in computer-related occupations, according to the Department of Homeland Security (DHS).


Better Calibration of Supply and Demand

It seems logical to assert that the above dynamics will “self-adjust” over time as constraining the supply will not help meet the obviously burgeoning demand. There is also the length of time typically needed to acquire specialized education and/or mandatory training if not the certifications and licenses needed for different healthcare jobs. This can perhaps serve to discourage job or career track changes to pursue new and better opportunities, further constraining supply. Similar in effect, some professional licenses restrict geographic mobility, and that restriction can easily become more onerous for those trained internationally. I am alluding to the fact that a segment of healthcare employers using immigrants to address staffing needs might impose sanctions such as financial penalties if a new employee they sponsored from oversees resigns or doesn’t work out for some reason. Certainly, the desire to move home to be with family amid comfortable surroundings, and endure fewer challenging circumstances, is a thought more than a few immigrant healthcare workers might entertain.

Clearly the confluence of all these factors should also contribute to increased efforts to recruit foreign healthcare workers across all categories of jobs and professions, resulting in larger swaths of individuals relocating or immigrating to the US, especially from parts of Asia and Africa where, historically, more attention has often been given to credentialing and verification.

Successfully transplanting a healthcare worker to the U.S. obviously goes far beyond immigration-related legal and compliance hurdles and beyond all the training, licensing and credential requirements, but nonetheless, the need to continue relocating and onboarding these workers will continue for the foreseeable future. Other, perhaps more HCM-related considerations here relate to culture adaptation, socialization and support systems, and other elements and experiences needed for a reasonable level of employee engagement and productivity. The previously cited situation of some of these workers having to start in jobs that underutilize their skills doesn’t make their engagement or retention any easier to achieve.

Thus, all things considered, the effective onboarding of new healthcare workers from outside the U.S. should ideally start when the application process itself starts, and these normally take 18-24 months according to most accounts. Naturally technology can help, whether we’re referring to introducing a new employee to those they have commonality of nationality and culture with, or leveraging workflow automation to ensure proper and timely notifications occur around each step in the relocation and immersion process. Therefore, in Part II of this blog-series we will more specifically explore the role that HR technology can and should have in mitigating HR challenges in healthcare for immigrating employees and risks for employers, and in facilitating the transition to a very viable if not very satisfying existence for these sorely needed technical, professional, and support level healthcare workers coming here from abroad.

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Steve Goldberg
Steve Goldberg
‪HR Process & Tech Leader | HCM Analyst/Advisor

Steve Goldberg's 30+ year career on all sides of HR process & technology includes HR exec roles on 3 continents, serving as HCM product strategy leader and spokesperson at PeopleSoft, and co-founding boutique Recruiting Tech and Change Management firms. Steve’s uniquely diverse perspectives have been leveraged by both HCM solution vendors and corporate HR teams, and in practice leader roles at Bersin and Ventana Research. He holds an MBA in HR, is widely published and is a feature speaker around the globe. He’s been recognized as a Top 100 HRTech Influencer. Steve is also a close advisor to Azilen Technologies, this post’s sponsor.

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