The baby boomer generation is composed of persons born between 1946 and 1964. They will reach retirement age between 2011 and 2029. In the coming years, there will be an unprecedented demand on our healthcare system as our country’s 76.4 million baby boomers become elderly. We are destined for a healthcare shortage, and immigration may be at the heart of it.
A study commissioned by the Association of American Medical Colleges examined the projected physician shortage between 2015 and 2030. By 2003 the demand for physicians will exceed supply by 40,800 to 104,900.
Total healthcare shortages in 2030 vary by specialty grouping and include a shortfall of between 7,300 and 43,100 primary care physicians and 33,500 and 61,800 non-primary care physicians including 1,300 to 12,000 medical specialists and 9,800 to 29,000 surgical specialists.
More than a quarter of physicians are foreign nationals. Travel bans and major immigration policy changes threaten to intensify the country’s shortage of doctors. This is especially bad news for rural areas and under-served areas where foreign national physicians often work in return for continued visa status.
Most physicians will be traveling to the U.S. on an H-1B visa. This is a lottery based visa for specialty occupations which has a cap of 85,000 visas per fiscal year. To bring in more physicians and bachelor’s or above level health care providers, the visa cap should be expanded. Instead, the current administration has proposed replacing the current H-1B cap with policies like the RAISE act which would half high skilled immigration over the next ten years. This would only exacerbate the healthcare shortage as well as shortages in all STEM professions.
In addition, recent policy changes at USCIS in accordance with the Buy-American Hire-American executive order have made it more difficult to renew all high skilled immigrant visas including the H-1B and the L-1.
Rescinding its more than 13-year-old policy, USCIS said that the burden of proof in establishing eligibility for visa renewal is on the petitioner. The agency will not be acknowledging previous adjudications when determining visa renewal eligibility. This could lead to visas which have already been granted being denied for renewal and further the shortage of high skilled professionals like doctors and nurses in our country.
In addition to physicians and degreed specialist, there will be a drastic need for home health aides to assist the ageing population. When it comes to home health care, immigrants make up almost a quarter of the workforce according to the Migration Policy Institute.
These jobs are low paid, low-skilled, and increasingly plentiful. They usually do not require a high school diploma or previous work experience. The work is laborious and included bathing and feeding the clients, cleaning their home, driving them to doctor’s appointments, and assisting them with toileting. It’s often one of the jobs many Americans do not want to do.
Curbing immigration will short circuit the supply of laborers to perform this type of work. These are not undocumented workers. Only 4% of home health aides are undocumented according to the Pew Research Center. In addition, the requirement of certification drives undocumented persons out of these positions.
Ending policies like DACA hurt the health care workforce. 113 students with DACA status applied to U.S. medical schools and 65 enrolled for the 2016-2017 matriculation. Each resident who becomes a practicing doctor is ultimately responsible for 3,000 patients. 65 doctors will treat 195,000 individuals. This does not include the hundreds of nurses, aides and technicians with DACA status.
One of the biggest issues in health care is now colliding with the biggest issue in politics. Immigrants comprise 17% of the 12.4 million people working as doctors, nurses, dentists and other health occupations. The current administration must create policies that are amicable to both high and low skilled immigration to fill the gaps and remediate the healthcare shortage.