Health Leaders Comment
Staffing Crisis Calls For Revised Immigration Laws
By Carl Shusterman, for HealthLeaders.com, July 29, 2002
Anyone who has examined the shortage of clinical healthcare professionals in America (including immigration attorneys such as myself) realizes that importing foreign workers is not a long-term solution to this pressing problem.
Foreign nurses, physicians and other providers, however, are an important supplement to the clinical workforce, and many hospitals and other healthcare organizations depend upon them. Foreign-born nurses, many of them from the Philippines, played a vital role in filling staffing gaps during the nurse shortage of the late 1980s and early 1990s.
For years, foreign-born physicians have provided care to many of the 20 million people who live in some 2000-plus Health Professional Shortage Areas (HPSAs). Clearly, an immigration policy that ensures reasonable access to foreign clinicians is important at a time when hundreds of thousands of job vacancies exist.
Unfortunately, current U.S. immigration policy puts unnecessary and unfair restrictions on hospitals seeking to hire foreign-born health professionals.
First, and most egregiously, there is no viable temporary visa category for foreign born nurses. While some 200,000 temporary "H-1B" visas are available each year to foreign computer professionals, scientists and even fashion models, only 500 temporary "H-1C" visas are available to foreign nurses. The H-1C is a special temporary work visa for foreign professionals, similar to the H-1B, but it is specifically reserved for registered nurses. However, due to a series of restrictions, less than 10 hospitals in the country are able to hire nurses on H-1C visas. The lack of a temporary visa category greatly compounds the difficulty of recruiting foreign nurses who must wait up to two years to qualify for permanent visas (known as green cards).
Immigration policy is similarly restrictive on the physician side. At this writing, the U.S. Department of Agriculture is not accepting new petitions for physician "J waivers." These waivers allow foreign physicians who train in the U.S. on "J visas" to remain here and take jobs in patient care positions (physicians do not need wavers to perform medical research). If they cannot obtain a waiver through an "interested government agency" such as the USDA, these physicians must return to their home countries for at least two years.
There are currently some 2,000 foreign physicians working in rural areas through the J-1 Visa waiver program - a very small number relative to the total physician population, but significant to the hundreds of communities they serve.
In the recent past, many physicians in mostly rural, Midwestern states, obtained J waivers through the USDA. With this option closed, the ability of many rural hospitals to hire foreign physicians is greatly inhibited. The Department of Housing and Urban Development (HUD) also has dropped the J visa program, limiting options for urban facilities seeking physicians on J visas.
Post 9/11, immigration processing in most visa categories has become more restrictive, as we rightly reevaluate immigration policies in light of security concerns. However, security is yet another reason to allow for the monitored admission of foreign health professionals. Foreign nurses and physicians have an established record for providing care to underserved populations, without any incidence of terror over a period of many years. Their presence will be seen by both the healthcare infrastructure and by potential victims as a tremendous asset should we experience further mass terrorist attacks. With the various licensing and background checks already in place, health professionals are more highly vetted than any of the dozens of foreign professionals who currently qualify for temporary work visas.
The solution to these problems is straight-forward and is proposed in a common sense bill (Senate 1259) introduced by Sen. Sam Brownback (R-Kansas) last year. Senate 1259 would allow foreign nurses to qualify for temporary work visas, in the same way that foreign computer professionals and fashion models do. Hospitals then would be able to recruit licensed, qualified nurses in a matter of a few months.
The bill also would double the number of J waivers available through the so-called "Conrad 20" program. Conrad 20, named for Sen. Kent Conrad of North Dakota, allows each state Department of Public Health to sponsor 20 physicians for J-waivers each year. That number would increase to 40 under S. 1259.
The bill creates no new programs and would not require additional government expenditures. However, S. 1259 will only pass with the concerted support of the healthcare industry. The American Hospital Association has specifically endorsed S. 1259, but Congressional representatives will have to hear from healthcare professionals in their districts for the bill to gain momentum.
Is immigration anything more than a bandage on what is a serious and long-term staffing problem? No. But even a bandage is good to have when you are bleeding.
Carl Shusterman is a Los Angeles-based immigration attorney and serves as health professions liaison for the American Immigration Lawyers Association, Washington, D.C. He can be reached at firstname.lastname@example.org
Loved the following response @healthleaders site.
Ease immigration laws for healthcare professionals by Leslie on July 30, 2002 at 5:56PM
Do you want a loved one or yourself taken care of by nurses who can barely understand formal English, nevermind colloquial English? I don't. Let market forces work. I say let's ease immigration laws for attorneys and bring down the cost of litigation!
Aug 6, '02
<The only way to make things different for nurses is for nurses to be outspoken, I don't see third world nurses being able to do that, and I believe that is the point.>
I think some of that is changing too. The first wave of imported Phillipine nurses have been working in my hospital for 20 - 30 yrs. Others have been here for less than 10 yrs. They do speak up. Maybe more politely than the rest of us. But they do fight for what is right & are not doormats or passive/permissive. They even have no qualms about going on strike when necessary.
The president of the board of directors of the New York State Nurses Association (which is also our labor union) is a Phillipine staff nurse who is also the past president of the Phillipine Nurses Association in this country.
Hospitals prefer to recruit from the Phillipines because their nursing school curriculums are based on & follow US nursing school curriculums. They use US textbooks & learn US standards of care. They are taught in English & graduate with a BSN. But I bet the hospitals didnt bank on these nurses actually standing up for themselves - which they are doing more & more.
Last edit by -jt on Aug 6, '02
Aug 6, '02
Immigration and the Nursing Workforce
ANA's Message to Congress
ANA believes that the U. S. healthcare industry has failed to maintain a work environment that is conducive to safe, quality nursing practice and that retains experienced U. S. nurses within patient care
. ANA supports continuation of the current
certification process to apply to all
foreign-educated health care workers regardless of their visa or other entry status. ANA opposes
efforts to exempt foreign-educated nurses from current H-1B visa program requirements.
The Issues Surrounding Immigration and the Nursing Workforce
The practice of changing immigration law to facilitate the use of foreign-educated nurses is a short-term solution that serves only the interests of the hospital industry
, not the interests of patients, domestic nurses, or foreign-educated nurses[/I].
ANA condemns the practice of recruiting nurses from countries with their own nursing shortage
The Illegal Immigration Reform and Immigrant Responsibility Act of 1996 requires that all
foreign health care professionals, except physicians, must be certified by the Commission on Graduates of Foreign Nursing Schools (CGFNS) or another independent, government-certified organization qualified to issue credentials. The certification process verifies that the foreign health care worker's education, training, or experience meets all applicable statutory and regulatory requirements for entry into the United States. In addition, any foreign license submitted must be validated as authentic and unencumbered. If the health care worker is a registered nurse (RN), the nurse must have passed an examination testing both nursing skill and English language proficiency. ANA opposes the proposal now being considered that would reduce these requirements.
The cause of instability in the nursing workforce must be addressed
Over-reliance on foreign-educated nurses serves only to postpone efforts required to address the needs of the U.S. nursing workforce
Current laws limit the recruitment of nurses from overseas to 500 per year. The proposed Senate bill would [U]increase the number of nurses recruited from overseas from the current 500 per year to 195,000
per year. The House of Representatives proposed bill removes the cap entirely
and calls for no limit
on the number of foreign-educated nurses that could be recruited to the US. The proposed bills in both the House and the Senate are similar in reducing
the current strict credential requirements for these nurses.
Additionally, foreign-educated nurses brought into the United States tend to be placed in jobs with unacceptable working conditions with the expectation that these nurses, as temporary residents and foreigners, would not be in a position to complain
To view charts comparing current visa laws along with the changes that have been proposed to reduce credentialling requirements and allow for the recruitment of many more foreign-educated nurses from oversees, see:
Last edit by -jt on Aug 6, '02