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Medical migration to the U.S.: trends and impact
Abstract
The United States is in the midst of a prolonged nursing shortage, one that could reach a deficit of 800,000 registered nurses (RNs) by 2020. Increasingly, foreign-trained nurses are migrating to the U.S., particularly from low-income countries, seeking higher wages and a higher standard of living. Increased reliance on immigration may adversely affect health care in lower-income countries without solving the U.S. shortage. This Issue Brief analyzes trends in medical migration, and explores its short- and long-term effects on the health care workforce in the U.S. and in developing countries.
... They have also come to depend on nursing temporary employ‐ ment agencies to supple‐ ment employed nurses. In addition, foreign‐educated nurses now constitute a much larger share of the workforce, albeit concentrated in relatively few ar‐ eas (Polsky et al. 2007). Shortages are periods of imbalance in nursing labor markets. ...
... Some 15.3 percent of new RNs in the 1990s were trained internationally, versus 8.8 percent in the 1980s. In the 1990s, real wages were rising steadily for the foreign nurses, but almost not at all for do‐ mestic nurses (Polsky et al. 2007). Ethical and prac‐ tical concerns about reliance on other countries' nurses have been advanced. ...
... The United States is the top destination worldwide for health professionals (Polsky et al., 2007;Aiken, 2007). Despite the fact that the share of foreign-trained and foreign-born doctors and nurses in the United States is smaller than in some other OECD countries, the sheer size of the United States workforce has resulted in very large health workforce migration in absolute terms . ...
... In fact, estimates suggest that one-fourth of all community health centers in the U.S. fill physician vacancies with foreign medical school graduates [18]. In nursing, 3.5% of the U.S. workforce in 2004 was comprised of foreign nursing school graduates [19,20]. Little is Known about the Foreign-Trained Dentist Population in the U.S In contrast to medicine and nursing, very little is known about the size and distribution of foreign-trained dentists in the U.S. dental workforce. ...
To address dental workforce shortages in underserved areas in the United States, some States have enacted legislation to make it easier for foreign dental school graduates to become licensed dentists. However, the extent to which foreign dental school graduates will solve the problem of dental workforce shortages is poorly understood. Furthermore, the potential impact that foreign-trained dentists have on improving access to dental care for vulnerable patients living in dental Health Professional Shortage Areas (HPSAs) and those enrolled in public insurance programs, such as Medicaid, is unknown. The objective of this paper is to provide a preliminary understanding of the practice behaviors of foreign-trained dentists. The authors used Washington State as a case study to identify the potential impact foreign dental school graduates have on improving access to dental care for vulnerable populations. The following hypotheses were tested: a) among all newly licensed dentists, foreign-trained dentists are more likely to participate in the Medicaid program than U.S.-trained dentists; and b) among newly licensed dentists who participated in the Medicaid program, foreign-trained dentists are more likely to practice in dental HPSAs than U.S.-trained dentists.
The authors used dental license and Medicaid license data to compare the proportions of newly licensed, foreign- and U.S.-trained dentists who participated in the Medicaid program and the proportions that practiced in a dental HPSA.
Using bivariate analyses, the authors found that a significantly lower proportion of foreign-trained dentists participated in the Medicaid program than U.S.-trained dentists (12.9% and 22.8%, respectively; P = 0.011). Among newly licensed dentists who participated in the Medicaid program, there was no significant difference in the proportions of foreign- and U.S.-trained dentists who practiced in a dental HPSA (P = 0.683).
Legislation that makes it easier for foreign-trained dentists to obtain licensure is unlikely to address dental workforce shortages or improve access to dental care for vulnerable populations in the United States. Licensing foreign dental school graduates in the United States also has ethical implications for the dental workforces in other countries.
Dans cet article, nous examinons le recrutement et l’emploi de personnel soignant d’origine immigrante dans le secteur des soins offerts aux aînés. Nos données proviennent d’interviews que nous avons réalisées avec 77 travailleurs et 24 employeurs ainsi que d’une enquête réalisée en ligne auprès de 149 employeurs en 2007–2008. Nos résultats montrent que c’est beaucoup grâce aux réseaux sociaux que les travailleurs arrivent dans ce secteur. De plus, bien que les agences de recrutement ne jouent pas un rôle important dans le recrutement et l’emploi de travailleurs immigrants, nous avons observé des cas d’abus, ce qu’une meilleure réglementation pourrait prévenir. Notre étude suggère également que les politiques d’admission des immigrants pourraient être mieux alignées sur les besoins du Canada dans le secteur des soins aux aînés.
This paper examines the employment and recruitment of immigrant care workers in the older adult care sector in Canada, based on data from interviews with 77 workers and 24 employers in care settings, as well as from 149 online employer surveys conducted in 2007–08. We find that workers enter this sector largely through social networks. Although recruitment agencies do not play a critical role in the employment and recruitment of immigrant workers, regulation could prevent instances of abuse we found. Our findings also suggest that immigration admission policies could be better aligned with Canada’s needs for older adult care.
Background: In the post-colonial period, many developing countries including India started to expand their health services and to train their nationals to staff them. Initially the prospects looked good. However, from the 1960s there were already concerns that some of these professionals were being lost to richer countries, which were expanding their own health services and lacked sufficient home-grown professionals - thus widening the divide between developed and developing countries. The use of medical education to leave India and, particularly, the training of health personnel for export at the public expense has evoked consternation in many. In the 1970s, it was estimated that about 135,000 nurses (or 4.0% of the world total) were outside their country of birth or training, 92% of these were in Europe, North America and the developed countries of the west pacific. India was a significant contributor to this. Over 14.0% of nurses newly registered in USA in 1972 were from India, Korea, Thailand, and West Indies. Similarly, 35.0% of hospital physicians in UK in the 1970s were trained overseas, 60% in developing countries. In 1996, India - the world's highest earner of remittance - received $US 7.6 billion. Kerala was the leading 'exporter' from India. Studies have shown that India has lost up to US $5 billion in investment in training of doctors since 1951 because of the out-migration. Objective: This analyzes the factors influencing the out-migration of health care workers from Kerala and its implications for the state health care system in terms of unavailability of human resources. Methodology: A cross-sectional survey among doctors (N=225 who are preparing to migrate was conducted using a prestructured questionnaire in three major cities having international airports in Kerala. Five FGDs were conducted among doctors and medical students. Secondary data from state health services and the medical education department regarding vacancies of doctors and the effect of the recruitment drives was analyzed. Qualitative study of the various stakeholders' views in this issue was done by in-depth interviews of key informants among stake holders. Results: 98% of the respondents were unsatisfied with the salary in the government sector here. Higher salary was the primary reason for their decision to go abroad in case of 62% doctors in the study. Other reasons for going abroad (primary reason) included options for higher studies/training (21%), better working atmosphere (8%), better living condition (5%) better job prospects in the Middle East nations after training in UK or US (4%). Data from state health services show that many doctors and nurses in the state service are on long leave or are absent without notification as they out-migrated. Repeated recruitment drives by the government in January, February, April and June 2005 and throughout 2006 were all failures as only less than 300 joined when 1000 odd doctors were given appointment orders. In addition, almost 30% of the specialty posts in the service are also vacant despite repeated efforts to fill the posts. The recent drive to attract doctors to work in two additional shifts in secondary level hospitals at extra pay was received well by the doctors, which again points to the fact that salary is the single most important factor which attracts the doctors to the health services. This is more evident from the fact that out of the 700 odd doctors who opted for this scheme, more than 250 were specialists. In the medical education department, almost 400 plus vacancies are remaining vacant, which is seriously compromising the quality of medical education in the state. The salary offered in the private medical colleges are almost three times that in the government medical colleges. Conclusion: The most frequently reported loss to source countries is that of health personal and the impact of under staffing of health systems. In the case of longer-term migrant the gain of the country receiving the trained personal is at the same time the lost educational investment to the sending country. Government should understand that long-term neglect of these responsibilities by successive governments has been the cause of the migration. All organizations including government should recognize the value of their staff and will have to develop some kind of attraction and retention strategies, which revolve around pay, conditions of service, working conditions and above all job satisfaction.
Here I consider the migration of health workers and propose a conception of transnational justice that can best address the concerns it raises, including the perpetuation of global health inequities. My focus will be on nurses and direct care workers (DCWs), also called paraprofessionals—the vast majority of whom are women—coming from the global South to the United States. In the first part of the paper I will identify the factors behind this flow of what I will hereafter call ‘care workers’. From there, I will describe a conception of transnational justice that seems especially promising and explore selected policy options. Finally, I will conclude by offering specific prescriptions for action on the part of a wide range of agents, including institutions as well as individuals.
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