IMPRINT: Immigrant Professional Integration
Ensuring that immigrants and refugees reach their professional and educational goals in the United States is crucial to the vitality of local communities and the overall economy, especially during the current critical period of economic recovery. A robust national immigrant and refugee integration strategy will pave the way for professional advancement opportunities for immigrants and refugees, enabling them to use their valuable skills and education to their full potential.
Nearly 50 percent of recent immigrants have a bachelor’s degree or higher. Yet, about two million internationally educated immigrants are either unemployed or underemployed, resulting in a loss of $39.4 billion in foregone earnings each year and more than $10 billion in unrealized federal, state, and local taxes.
The U.S. health sector in particular is significantly impacted by the underutilization of the skills and talents of immigrants and refugees. According to the Migration Policy Institute, 263,000 immigrants and refugees with degrees in health care are underemployed or unemployed in the U.S. Of these immigrants, 165,000 were trained outside the U.S.
Immigrant physicians, researchers, nurses, health aides, and hospital workers, with their international training and linguistic and cultural assets, are uniquely poised to revitalize the U.S. health care system, but significant barriers to relicensure often stand in their way. Meanwhile, communities across the U.S. are suffering from a shortage of health care workers—a shortage that exacerbated the strain on resources and operations caused by the COVID-19 pandemic and that will continue to impact our health care system in the future.
With an effective national immigrant and refugee integration strategy, U.S. businesses struggling to fill gaps in their labor force can acquire the talent necessary to compete and grow; immigrants and their families will experience improved economic opportunities; and the U.S. economy will benefit from increased consumer spending, fiscal contributions, and improved services.
The federal government should increase federal funding for workforce development and adult education to support programs equipped to serve immigrant and refugee professionals and address gaps in services for adult English language learners with international credentials.
Over the past decade, states and local communities have taken the lead in promoting programs and policies that support the economic integration of immigrant professionals, often with the oversight of statewide or local Offices for New Americans (ONAs) and welcoming initiatives. The federal government should support these efforts by establishing a national ONA tasked with developing a framework for immigrant and refugee integration. In addition, the Administration can work with relevant federal agencies, including the U.S. Department of Labor (DOL), the Department of Commerce (DOC), the Department of Health and Human Services (HHS), and the Department of Education (ED), to expand technical assistance, grant funding, and other support to strengthen the capacity of state and local governments and community agencies that assist immigrants and refugees as they seek employment commensurate with their skills and experience.
In recent years, researchers and policymakers have focused on the potential of licensing reform to reduce barriers to in-demand licensed occupations and increase economic mobility across states. Recognizing the essential skills and experience that internationally trained health professionals offer, governors in six states exercised their emergency authority to provide temporary licenses to health care professionals licensed outside the U.S., allowing them to treat COVID-19 patients. The federal government should work with states to identify solutions to create permanent pathways to licensure for these talented professionals.
Apprenticeship programs are gaining attention as an effective means of training individuals at varying skill levels in a wide range of occupations and industry sectors. In 2019, the DOL announced $100 million in grant funding to strengthen industry-recognized apprenticeship initiatives and expand access to these opportunities to all Americans. The DOL should ensure equal access to immigrants and refugees for federally funded apprenticeship programs.
The refugee resettlement sector in the U.S. is highly focused on rapid attachment to the workforce, which often means putting refugees with international credentials in jobs that do not meet their skillsets. The Refugee Career Pathways program was established by the Office of Refugee Resettlement in 2018 to address such obstacles faced by resettled refugees in relaunching their careers in the U.S. The federal government should augment support for this program and offer comprehensive pre-arrival information on career pathways and occupational relicensure as well as access to English language learning opportunities while refugees await resettlement In addition, federal funding is needed to support training for ORR-funded case managers and job developers who assist refugees with international education and experience. Lastly, the time frame for refugee assistance should be extended.
The federal government must take the steps necessary for immigrant and refugee integration and inclusion, to ensure opportunities for immigrants and refugees to contribute their professional skills and training. The economic health of the U.S. is dependent on the strength of its workforce, and immigrants and refugees can play a powerful role in supporting our nation’s recovery and ensuring its economic stability.
On August 14, Rep. John Katko [R-NY-24] and Rep. Ben McAdams [D-UT-4] introduced H.R.8046, the Improving Opportunities for New Americans Act of 2020. This bill, if passed, would direct the U.S. Department of Labor (DOL) to conduct an interagency study on factors that impact U.S. employment opportunities for immigrants and refugees with professional credentials from other countries. The legislation is the first bipartisan proposal in Congress examining well documented barriers to employment for immigrants and refugees with international credentials. Currently, over two million people—23.4%—of college-educated immigrants and refugees in the U.S. are either under- or unemployed. In the healthcare sector alone, the Migration Policy Institute estimates that there are 165,000 immigrants and refugees with health-related degrees obtained outside the U.S. who are either unemployed or currently working in jobs that do not match their skillset. This underutilization of vital skills and experience has devastating effects on individuals, local communities, and the U.S. economy.
“The Improving Opportunities for New Americans Act of 2020 Act is an important step forward in removing the barriers that impede newcomers to the United States from fully utilizing their skills and training,” said Esther Benjamin, CEO and Executive Director of World Education Services (WES). “As an organization dedicated to ensuring that immigrants and refugees have opportunities to integrate into the workforce and economy, WES commends Representative Katko’s leadership in introducing this critical legislation and looks forward to working together to move the bill forward.”
A primary barrier to employment among immigrant and refugee community members with international credentials is the lack of recognition of their international training and professional experience. Recognizing the need to evaluate relicensing processes, H.R.8046 calls on federal leadership to develop substantive policy solutions to assist immigrants and refugees with international credentials as they seek to reenter their professions in the U.S.
Under the proposed bill, the DOL would conduct an interagency study of obstacles to adequate employment for immigrant and refugee professionals by analyzing several areas:
The bill calls on the DOL to issue recommendations to remove barriers and open pathways for immigrants and refugees to fully contribute their skills and training in the U.S. Jina Krause-Vilmar, CEO of Upwardly Global, points to the critical role immigrant and refugee professionals can play in the U.S. economy and recovery. “As we reopen our economy and rebuild our communities, we must ensure that all Americans—including new Americans—can fully contribute their skills,” she explains. “From multilingual abilities to resilience to experience in STEM fields, work-authorized immigrants and refugees bring incredible talent and potential to our workforce.” The bill calls on the DOL to issue recommendations to remove barriers and open pathways for immigrants and refugees to fully contribute their skills and training in the U.S.
The Improving Opportunities for New Americans Act of 2020 has received support from 24 organizations including Upwardly Global, WES, the National Immigration Forum, New American Economy, the National Skills Coalition, International Rescue Committee, the National Partnership for New Americans, the LIBRE Initiative, Coalition on Adult Basic Education, Church World Service, and the Presidents’ Alliance on Higher Education and Immigration. As endorsements for H.R.8046 continue to grow, WES applauds this bipartisan effort to recognize the immense contributions immigrants and refugees make to the U.S. and looks forward to advancing the bill.
The COVID-19 pandemic has exposed the existing strains on the U.S. health care system and underscored the critical need to integrate qualified immigrants and refugees into the health workforce.
Across the country, an estimated 263,000 immigrants and refugees with health care training are unable to obtain licensure in the U.S. Of these, 165,000 people earned their credentials outside the U.S. but must meet onerous, time-consuming, and costly requirements, including in some cases repeating years of training and clinical experience.*
Six governors have already taken emergency steps to address the health care needs arising from the pandemic by adapting licensing requirements to temporarily allow health care professionals licensed outside the U.S. to treat COVID-19 patients.
Read more about state emergency orders and policy updates on the IMPRINT coalition’s page Opening Pathways for Immigrant and Refugee Health Professionals
States should now work to create permanent solutions to increase health care capacity. Several states including Minnesota, Washington, and Massachusetts have established task forces to examine barriers to employment for internationally trained health workers. Some of the policies recommended by task forces include: developing standardized assessment and certification programs to determine the clinical readiness of internationally trained health care professionals, dedicated residency slots for international medical graduates, and funding for support services to help internationally trained health workers navigate the relicensing process in the U.S.
At the federal level, lawmakers have introduced several legislative proposals aimed at expanding the pool of health care professionals in the U.S. by better integrating internationally trained immigrants and refugees:
In May, U.S. Representative Debbie Mucarsel–Powell (FL-26) introduced H.R.6686, the Bringing Additional Nurses to the Fight Act, which would appropriate $30 million for U.S. nursing schools to establish or expand accelerated nursing programs for eligible applicants, including individuals with international training. While the measure makes some headway, additional steps could be taken. For example, federal funding for targeted single–course bridge programs could provide a solution for immigrants and refugees who have completed their nursing training outside the U.S. but are missing specific U.S. requirements.
The Healthcare Workforce Resilience Act (S.3599), introduced by Senators Perdue (R-GA), Young (R-IN), Cornyn (R-TX), Durbin (D-IL), Coons (D-DE), and Leahy (D-VT) in early May, would recapture 40,000 unused immigrant visas for internationally trained health care professionals. The bill recognizes that internationally trained nurses and doctors play a vital role in our healthcare system, especially in medically underserved communities, yet it fails to acknowledge the 263,000 internationally trained health care workers in the U.S. who are under- or unemployed. For these internationally trained health professionals already in the U.S., the central obstacle remains: the lack of recognition of the international education and training they already have.
In April, U.S. Representative Tony Cárdenas (CA–29) and nine co-sponsors introduced H.R. 6432, establishing a task force to study physician shortages, including identifying and examining barriers to employment for international medical graduates. H.R. 6432 demonstrates an important step the federal government could take to address the under- and unemployment of skilled immigrants and refugees ready and willing to support the response to COVID-19 and fill the projected increase in shortages of health care providers in the U.S. National leadership of this sort, focusing on the need to end under- and unemployment among talented immigrant and refugee health professionals, is urgently needed and would support states in their response to COVID-19.
The COVID-19 crisis has brought a newfound sense of urgency to addressing shortages in the U.S. health workforce. Long-term comprehensive solutions to these shortages should involve all available pools of talent, including internationally trained health workers. Despite efforts underway at both the state and federal levels to bolster the U.S. health workforce, legislation must address the obstacles faced by international medical graduates and other internationally trained health workers who are unable to re-enter their professions in the U.S. due to systemic barriers in the licensing process.
Migration Policy Institute, “As U.S. Health-Care System Buckles under Pandemic, Immigrant & Refugee Professionals Could Represent a Critical Resource,” (April 7, 2020), available at: www.migrationpolicy.org/news/us-health-care-system-coronavirus-immigrant-professionals-untapped-resource
To date, six states have issued executive orders to address health care shortages arising from the COVID-19 crisis by adjusting licensing requirements to allow internationally trained health care professionals to practice on a temporary basis.
The application process guides below provide context and guidance navigating state portals and offer additional state-specific information:
In response to urgent healthcare staffing shortages in this time of critical need, IMPRINT members have been working with governors across the country to bolster the pipeline of healthcare workers available to respond to the COVID-19 pandemic.
Data shows a robust talent pool of internationally trained healthcare professionals is poised to contribute their life-saving skills. According to the Migration Policy Institute, there are 165,000 internationally trained healthcare professionals living in the U.S. who have been unable to put their experience and skills to use because of barriers to employment. A recent Upwardly Global survey of 130 internationally trained healthcare professionals showed that nearly 95% were ready to join the frontlines in the fight against COVID-19.
Internationally trained healthcare professionals bring skills that are especially relevant to the current crisis. According to Jina Krause-Vilmar, President & CEO of Upwardly Global, “some have fought past pandemics or worked in crisis conditions—like war or natural disaster.” Krause-Vilmar added that Upwardly Global’s clients are ready and willing to serve if given an opportunity and hopes “that more governors will see the potential in this talent pool and look at options to build licensing practices that allow them to contribute their skills.”
To date, five states have taken steps to allow healthcare workers who gained experience outside the U.S. to join the frontlines against the pandemic. In Nevada, Governor Sisolak issued an executive order authorizing the waiver of licensing requirements for a wide range of medical services providers with training from another country, including doctors, nurses, and behavioral health pressionals. Similarly, in New Jersey, Governor Murphy used his emergency authority to issue an executive order allowing some doctors licensed outside the U.S. to join the fight against COVID-19, provided they have at least five years of clinical experience and have practiced within the past five years. In Colorado, Governor Polis issued an executive order creating pathways for internationally trained nurses and doctors to provide healthcare services in response to the pandemic.
Other states, including New York and Massachusetts, have permitted international medical graduates to gain an emergency licenses before completing their U.S. residencies. With support from dozens of lawmakers and leaders in the business community, Governor Baker issued an executive order allowing international medical graduates to practice in the U.S. after completing two years their three-year residency programs. New York Governor Cuomo has used his emergency authority to allow international medical graduates to care for COVID-19 patients after one year of residency.
In the face of COVID-19, the health care shortages and disparities in access to high-quality health care already challenging underserved areas of the U.S. have been exacerbated. “We now know the devastating impact COVID-19 is having on communities of color, including immigrants,” said Massachusetts Immigrant and Refugee Advocacy Coalition executive director Eva Millona. “Internationally trained medical professionals possess the linguistic skills and cultural competency to assist where help is most needed, and we must do more to ensure they can enter the healthcare workforce.”
In response to the executive order issued by Governor Polis allowing internationally trained healthcare professionals to treat COVID-19 patients, Paula Schriefer, President and CEO of the Spring Institute in Colorado praised the move, affirming that “now is the time to tap into this pool of considerable expertise we so desperately need.”
José Ramón Fernández-Peña, MD, MPA, director of the Welcome Back Initiative noted, “in addition to licensed clinical positions, internationally trained health professionals can also serve many public health roles that are critical to the fight against the spread of COVID-19, especially in underserved immigrant communities where culturally and linguistically appropriate services are essential to ensure access to timely and accurate information.”
Tapping into the talents and abilities of all healthcare workers in the U.S.—including immigrants and refugees with international training and credentials in healthcare professions—will prove decisive in tackling the monumental challenges brought on by this global pandemic.
You can view these policies and other COVID-19-related policy updates on IMPRINT’s Policy Map.