Foreign-Born Health Care Workers in the United States

By Kristen McCabe
Migration Policy Institute

June 27, 2012

Employment in health care occupations increased despite the recession and is projected to outpace almost every major occupational group in terms of job growth between 2010 and 2020, according to the US Bureau of Labor Statistics. Amid this growth, the number of foreign-born health care workers has also been on the rise, increasing from 1.5 million to 1.8 million between 2006 and 2010.

Today, immigrants make up a sizeable proportion of the US health care workforce. In 2010, the foreign born accounted for 16 percent of all civilians employed in health care occupations in the United States. In some health care professions, this share was larger. More than one-quarter of physicians and surgeons (27 percent) were foreign born, as were more than one out of every five (22 percent) persons working in health care support jobs as nursing, psychiatric, and home health aides.

Although the characteristics of health care workers varied across occupational categories, as a group foreign-born health care workers were more likely than their native-born counterparts to have obtained a college degree and more likely than employed immigrants overall to speak English fluently or be naturalized US citizens.

This Spotlight provides a demographic and socioeconomic profile of foreign-born health care workers residing in the United States. The data come primarily from the US Census Bureau's 2010 American Community Survey (ACS) and the US Bureau of Labor Statistics. All data refer to employed civilians age 16 and older unless otherwise noted.

Click on the bullet points below for more information:

• Health care occupations are projected to account for about one in every six newly created jobs in the United States between 2010 and 2020.
• Foreign-born health care workers can be admitted to the United States under a variety of temporary and permanent visa categories.
• In 2010, 16 percent of all US health care workers were foreign born.
• The foreign born accounted for more than one in four US doctors (physicians and surgeons) in 2010.
• Nearly one-third of foreign-born women employed in health care occupations in 2010 worked as in health care support jobs as nursing, psychiatric, or home health aides.
• Foreign-born health care workers, regardless of gender, were more likely to be physicians and surgeons than their native-born peers.
• In 2010, women accounted for three of every four foreign-born health care workers.
• About 40 percent of all foreign-born health care workers residing in the United States in 2010 were born in Asia.
• About one-third of foreign-born workers employed as registered nurses in 2010 were born in the Philippines.
• Foreign-born health care workers were more likely to have a college education than their native-born counterparts in 2010.
• The majority of immigrants employed in health care occupations in 2010 had naturalized as US citizens.
• In 2010, 73 percent of foreign-born health care workers spoke English fluently.
• In 2010, almost one-quarter of foreign-born workers employed in health care support jobs as nursing, psychiatric, or home health aides lacked health insurance.

Health care occupations are projected to account for about one in every six newly created jobs in the United States between 2010 and 2020.
According to the US Bureau of Labor Statistics (BLS), health care occupations accounted for about 8 percent (12 million jobs) of total US employment in 2010. Jobs in this occupational group fell into two broad categories: health care practitioners and technical occupations (7.8 million), and health care support occupations (4.2 million).

Health care occupations are projected to be among the fastest-growing professions from 2010 to 2020, adding 3.5 million jobs. This represents 17 percent of the 20.5 million total jobs predicted to be added to US employment during this period. In addition, among all occupational groups, health care support occupations are projected to grow at the fastest rate (34.5 percent), and health care practitioners and technical occupations the third fastest (25.9 percent).

Note: The BLS estimates and projections described above provide a measure of jobs rather than individuals. For example, one individual who holds two jobs will be counted twice in the BLS estimates. The ACS estimates included in this article provide a measure of individuals rather than jobs. For more information on the methodology used to derive the BLS estimates and projections, click here. For more information on the methodology used to derive the ACS estimates, click here.

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Foreign-born health care workers are admitted to the United States under a variety of temporary and permanent visa categories.
Different temporary work and exchange visitor visa categories are used to admit foreign-born health care workers into the country. These categories include H-1B (specialty occupations), H-2B (nonagricultural workers), H-3 (trainees), TN (Mexican and Canadian NAFTA professionals), J-1 (exchange visitors), and O-1 (persons with "extraordinary ability or achievement").

Doctors with foreign degrees often apply for a J-1 visa to complete a medical residency in the United States, which is required of most foreign-educated doctors. Doctors may also apply for a temporary visa, such as an H-1B, to complete residency training or to work in the medical field after completing their US residency program.

As is the case with other immigrants, foreign-born health care workers can be admitted through permanent immigration channels based on family or employment connections and through humanitarian and other routes.

Two temporary work visa categories designated for nurses have been discontinued. The H-1A visa category, created exclusively for temporary employment of foreign-born nurses under the 1989 Immigration Nursing Relief Act, expired in 1995. The other was the H-1C visa program, which ended in 2009. Established through the Nursing Relief for Disadvantaged Areas Act of 1999, only hospitals in designated "health professional shortage areas" serving a minimum share of Medicaid and Medicare patients were eligible to petition for H-1C nurses.

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In 2010, 16 percent of US health care workers were foreign born.
Among the 11.1 million workers employed in health care occupations in 2010, 1.8 million (16 percent) were foreign born. The immigrant share of health care workers was similar to the immigrant share (16 percent) of all civilian employed workers ages 16 and over (see Table 1).

The number of foreign-born workers employed in health care occupations has risen slightly in recent years; in 2006, immigrants accounted for 15 percent (1.5 million) of the 10 million total US workers employed in health care occupations.

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The foreign born accounted for more than one in four US doctors (physicians and surgeons) in 2010.
Of the roughly 853,000 health care professionals employed as physicians and surgeons in 2010, more than one-quarter (27 percent) were foreign born. In addition, more than one in five (22 percent) nursing, psychiatric, and home health aides were foreign born (see Table 1).

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Nearly one-third of foreign-born women employed in health care occupations in 2010 worked as nursing, psychiatric, or home health aides.
In 2010, foreign-born women employed in health care occupations were most likely to work as nursing, psychiatric, or home health aides (32 percent) and as registered nurses (26 percent). In contrast, their male counterparts were most likely to work as physicians and surgeons (32 percent), and as technologists and technicians (19 percent).

Native-born women employed in health care occupations were most likely to work as registered nurses (28 percent), and technologists and technicians (23 percent). Native-born men were most likely to work as technologists and technicians (24 percent), and physicians and surgeons (22 percent). (See Table 2.)

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Foreign-born health care workers, regardless of gender, were more likely to be physicians and surgeons than their native-born peers.
Both immigrant men and women employed in health care occupations in 2010 were more likely than their native-born peers to work as physicians and surgeons: 32 percent of foreign-born men employed in health care worked in these professions (compared to 22 percent of native-born men) and 6 percent of foreign-born women (compared to 3 percent of native-born women). Regardless of nativity, however, men were still considerably more likely than women to work as physicians and surgeons (see Table 2).

Foreign-born health care workers overall were also more likely than their native-born peers to work as nursing, psychiatric, or home health aides: 32 percent of foreign-born women worked in this occupational group (compared to 20 percent of native-born women) and 13 percent of foreign-born men (compared to 11 percent of native-born men).

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In 2010, women accounted for three out of every four foreign-born health care workers.
Women accounted for 75 percent of the 1.8 million foreign-born workers employed in health care occupations in 2010. Among the native born, women accounted for 80 percent of employed health care workers.

Regardless of nativity, women accounted for the majority in each of the seven health care occupational groups except for one: physicians and surgeons. One-third of native-born physicians and surgeons (33 percent) were women compared to 37 percent of the foreign born. In contrast, women represented a substantial share of both foreign-born (87 percent) and native-born registered nurses (92 percent). Health care support professionals - including those working as nursing, psychiatric, and home health aides and in other support roles - were also particularly likely to be women.

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About 40 percent of all foreign-born health care workers residing in the United States in 2010 were born in Asia.
Among foreign-born workers employed in health care occupations in 2010, Asia was the leading region of birth (41 percent); followed by Latin America (not including the Caribbean) (18 percent); the Caribbean (17 percent); northern America (Canada and Bermuda), Europe, and Oceania (14 percent); and Africa (10 percent).

Asian-born health care workers and those from northern America, Europe, and Oceania were more likely than their counterparts from other regions to be employed as physicians and surgeons and, along with those born in Africa, were more likely to be employed as registered nurses (see Figure 1). The Caribbean born were more likely than immigrant health care workers born in other regions to work as nursing, psychiatric, or home health aides: 52 percent of the Caribbean born reported working in this profession. More than one-third of African immigrants (39 percent) and Latin American immigrants (37 percent) also reported working as nursing, psychiatric, or home health aides.

Note: The northern America, Europe, and Oceania group also includes foreign-born persons for whom birthplace information was not available.

Figure 1. Foreign-born civilian employed health care workers age 16 and older by world region of birth and occupational group, 2010

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About one-third of foreign-born workers employed as registered nurses in 2010 were born in the Philippines.
Among the foreign born employed as registered nurses in 2010, 34 percent were born in the Philippines.

Persons born in India, the Philippines, and China accounted for 34 percent of employed foreign-born physicians and surgeons. One-third (33 percent) of nursing, psychiatric, and home health aides were born in Mexico, Haiti, and Jamaica.

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Foreign-born health care workers were more likely to have a college education than their native-born counterparts in 2010.
Overall, foreign-born workers age 25 and older in health care occupations were more likely than their native-born counterparts to have obtained a college degree. This nativity gap in degree attainment was widest for health care workers employed as technologists and technicians, registered nurses, and in "other" health care support occupations (see Table 3).

Regardless of nativity, virtually all physicians and surgeons had college degrees or higher. More than 90 percent of both native and foreign-born workers in the occupational group "other health care practitioners and technical occupations" - which includes dentists and physicians assistants, among others - possessed a bachelor's degree or higher.

Among all civilian employed workers age 25 and older, 35 percent of the native born and 31 percent of the foreign born had obtained a bachelor's degree or higher educational credential.

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The majority of immigrants employed in health care occupations in 2010 had naturalized as US citizens.
In 2010, about two-thirds (66 percent) of foreign-born persons employed in health care occupations had obtained US citizenship through naturalization. The naturalization rate for all civilian foreign-born persons ages 16 and over employed in the United States - regardless of occupation - was 45 percent (see Table 4).

A majority of foreign-born workers in each of the seven health care occupational groups reported having acquired US citizenship, with naturalization rates ranging from 55 percent for those working as nursing, psychiatric, or home health aides to 78 percent for "other" health care practitioners and technical occupations. Physicians and surgeons, registered nurses, and technologists and technicians also had naturalization rates of 70 percent or higher.

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In 2010, almost three-quarters of foreign-born health care workers reported speaking English fluently.
Seventy-three percent of the foreign born employed in health care occupations in 2010 reported speaking English proficiently, meaning that they reported speaking English exclusively or "very well." The proficiency rate for civilian employed foreign-born workers - regardless of occupation - was 50 percent (see Table 4).

A majority of immigrants reported speaking English proficiently in the health care occupational groups examined in this Spotlight, with rates of English proficiency ranging from 91 percent for physicians and surgeons to 55 percent for nursing, psychiatric, and home health aides.

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In 2010, almost one-quarter of foreign-born workers employed as nursing, psychiatric, or home health aides lacked health insurance.
Regardless of health care occupational group or nativity, the majority of workers employed in health care occupations had health insurance in 2010.

Health care coverage rates were 88 percent or higher for native-born and foreign-born workers employed in most health care occupational groups, and coverage was close to universal for physicians and surgeons regardless of nativity. Nursing, psychiatric, and home health aides and other health care support professionals were the exception: almost one-quarter of foreign-born (23 percent) and native-born (24 percent) persons employed as nursing, psychiatric, or home health care aides lacked health insurance. Among other health care support professionals, 16 percent of the native born and 24 percent of the foreign born lacked health insurance.

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Sources

Association of American Medical Colleges. Visas. Available online.

American Medical Association. Immigration Information for IMGs. Available online.

______. 2010. International Medical Graduates in American Medicine: Contemporary Challenges and Opportunities. AMA-International Medical Graduate Section Governing Council. Available online.

______. International Medical Graduates: Practicing Medicine. Available online.

Bruno, Andorra, Karma Ester, Margaret Mikyung Lee, Kate M. Manuel, Marc R. Rosenblum, and Ruth Ellen Wasem. 2011. Immigration Legislation and Issues in the 112th Congress. Washington, DC: Congressional Research Service. Available online.

Lockard, C. Brett and Michael Wolf. 2012. Occupational employment projections to 2020. Monthly Labor Review, January 2012. Available online.

US Census Bureau. 2006 and 2010 American Community Surveys. Accessed from Steven Ruggles, J. Trent Alexander, Katie Genadek, Ronald Goeken, Matthew B. Schroeder, and Matthew Sobek. Integrated Public Use Microdata Series: Version 5.0 [Machine-readable database]. Minneapolis: University of Minnesota, 2010. Available online.

US Department of Homeland Security, Citizenship and Immigration Services. H-1C Registered Nurse Working in a Health Professional Shortage Area as Determined by the Department of Labor. Available online.

______. Adjudicator's Field Manual - Redacted Public Version / Chapter 31 Petitions for Temporary Workers (H Classifications). Available online.

______. Temporary (Nonimmigrant) Workers. Available online.

US Department of Labor, Bureau of Labor Statistics. Occupational Outlook Handbook (2012-13 edition), Projections Overview. Available online.

Wood, Catherine A. 2011. Employment in health care: a crutch for the ailing economy during the 2007-09 recession. Monthly Labor Review, April 2011. Available online.

For information about ACS methodology, sampling error, and nonsampling error, please click here.

For more information about BLS employment projections methodology, please click here.

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