Healthcare Immigration in a Biden Administration

Immigration has been a hot-button issue for many years. In recent months with COVID-19 causing havoc across the healthcare system, healthcare immigration is now receiving renewed attention as a dramatic national shortage of nurses and physicians is exposed.

“We’ve got open beds, we’ve got ventilators, we’ve got all the physical aspects. Our issue has been more along the lines of having staff,” said Tim Moore, CEO of the Mississippi Hospital Association. Powerful industry groups including the American Medical Association, the American Hospital Association and the American Immigration Lawyers Association have joined in the calls for change.

In trying to keep up with the demands that the pandemic is imposing, hospitals and nursing homes are resorting to staffing measures that were previously unheard of and would never have been accepted prior to the pandemic. A national scan of how healthcare providers are responding revealed that hospitals are doing the following:

• assigning unlicensed nurse interns (students) to care for COVID-19 patients,
• trying to lure nurses and doctors who have not practiced in years out of retirement and reemploying them,
• extending job offers to nurses and others with many of the usual screening and onboarding processes being set aside.

Defining the Healthcare Crisis

The law of supply and demand dictates that when the demand for a good or service exceeds the available supply, then costs will rise. Retention of existing, permanent staff has become a high priority for all healthcare employers as competitive health systems are offering higher wage and large sign-on bonuses of upwards of $20,000 or more. Healthcare facilities in rural areas are particularly hit hard, losing staff to higher paying positions in more attractive urban locations, and with less ability to attract talent to their rural geography.

What is even more alarming is the explosive growth in the travel nursing market where contract rates for nurses are between $4,000 – 8,000/week! As of November 2020, over 31,000 travel nursing opens were being reported for a 13-week contract assignment. Medical centers are at a breaking point and facing significant financial duress to keep their system staffed at adequate levels.

While it is expected that the current staffing pressures will ease as the pandemic subsides, and they will to a degree, the reality is that:

• there was an urgent shortage of nurses and doctors before the pandemic,
• the competition for staff and resultant effect on market pay rates will remain,
• the pandemic is stressing workers to and beyond their breaking points,
• the demand for healthcare services continues to increase with an aging population,
• many COVID-19 patients will require follow up care for months,
• a new administration in Washington will likely result in more Americans having more access to the healthcare system.

All these factors will combine to confirm that the shortage of nurses and doctors will be even greater post-pandemic. As healthcare leaders consider what their staffing strategies and models will need to be in a post-pandemic world, there is a realization that innovation will be mandatory. Strategies considered to be ‘outside of the box thinking’ will have to be embraced.

Current Healthcare Immigration Policies

During all this the U.S. is now in a time of presidential transition, with the incoming administration vowing to take on a wide variety of measures to deal with the pandemic and bolster the healthcare system. One area that holds great promise is healthcare immigration.

There was already great momentum building in 2020 for healthcare workers looking for permanent residency in the US:

• Nurses and doctors were exempted from Presidential proclamations earlier in 2020 that have essentially cut off permanent resident visas and other temporary work visas.
• The impact of the pandemic to the global economy resulted in approximately 60,000 unused visas in 2020. These visas were rolled over by the USCIS to the 2021 fiscal year, making over 200,000 visas in 2021 versus the standard allotment of 140,000.
• Bi-partisan Congressional legislation introduced in March 2020 called the Healthcare Workforce Resiliency Act (HWRA) looks to reclaim an additional 40,000 unused visas from the prior 10 years for exclusive use for international healthcare workers.

The net effect of a greater supply in the number of available visas in 2021 is simple: the average visa processing time for international healthcare workers is currently running at some of the shortest cycle times seen in the last 10 years.

What Might a Biden Administration Bring?

An increasing number of healthcare leaders are urging President-elect Biden to quickly implement immigration policies that would immediately bring a reliable supply of qualified international nurses and doctors on an ongoing basis.  Hospital operators, medical associations, and powerful immigration lobbying groups want the incoming administration to issue executive orders and pass other directives like the HWRA after Inauguration Day to ease visa restrictions and accelerate processing times, particularly on the backend of the immigration process.

Approximately 15,000 nurses are already qualified and connected with a U.S. employer and could be added to the workforce early in the Biden administration, but can’t complete the final steps of the process due to consulate closures and understaffing amid the pandemic. Staffing solutions are desperately needed. U.S. embassies in many parts of the world have been closed for extended periods of time. Where they have continued to operate, they operate on a skeletal staff basis.

The new administration could address the issue by simply boosting consulate staffing and putting more priority on health worker approvals. Biden also potentially could use a power called “parole authority” to let these workers enter the U.S. and finish their final processing domestically. If either of these solutions are enacted by a Biden administration, it is entirely realistic for visa processing times to fall even further to a range of 9-12 months.

Coupled with a renewed, bi-partisan Congressional spirit to pass comprehensive immigration reform like the HWRA, the prospects for international healthcare workers to arrive faster and in larger numbers can offer much needed financial and staffing relief to forward-thinking health systems.

Long-standing Supply and Demand Problem

One thing is clear, and it is that the United States does not have and is currently incapable of producing an adequate supply of nurses and physicians. Bringing practitioners out of retirement and relying on unlicensed students to provide care is not the solution. Ultimately this challenge needs to be seen for what it is. It is not a pandemic problem. It is not a short-term issue that is fixable with tweaks to current practices. It is a pervasive long-standing supply and demand problem. Training doctors and nurses takes years, and even when they complete their training, the healthcare system cannot be staffed largely by new graduates.

U.S. healthcare employers have long had the ability to add to their supply of experienced healthcare professionals through international recruitment, but many have not considered implementing until now. Now the stark reality of healthcare staffing shortages is being exposed as never before. Real optimism is growing for a more accommodating immigration policy going forward. It is time for all healthcare employers to seriously evaluate how they can directly hire qualified and highly experienced U.S. licensed nurses and other skilled healthcare professionals from English speaking countries around the world.

With 23 years of international healthcare recruitment experience, WorldWide HealthStaff Solutions Ltd. has the experience, expertise and global footprint to connect U.S. employers with a global pool of talent.

If you are a hospital or healthcare employer interested in learning more about the benefits of international nurse recruitment, click here to download the USA Guide to Direct Hire International Recruitment.