July 13, 2024
essential pillars of the U.S. health system

In a recent study by The Baker Institute for Public Policy, Prof. Shishir Shakya of the Appalachian State University and a Visiting Research Fellow from West Virginia University investigated trends in immigrant healthcare professionals, stressing their contribution to the United States (U.S.) health system. He studied legal avenues for medical experts, such as the J-1 Visa Exchange Visitor Program and the Conrad 30 Waiver Program, addressing health worker shortages.

essential pillars of the U.S. health systemStudy: Understanding the Role of Immigrants in the US Health Sector: Employment Trends From 2007–21. Image Credit: PeopleImages.com – Yuri A / Shutterstock

Healthcare professionals in the U.S. confront obstacles such as an aging population, labor shortages, and underrepresentation of minorities, which limit their capacity to respond to future health concerns and deliver crucial treatment. Policymakers must balance increasing healthcare access, enhancing quality, and lowering prices without sacrificing compassionate treatment. Immigrants may offer a viable answer to these difficulties.

About the study

In the present study, the researcher provided long-term trends in healthcare subindustries using annual estimates from population usage microdata acquired from the United States Census Bureau’s American Community Survey (ACS).

The researcher examined patterns in the United States population expansion and immigrant proportions. Individuals who were born in Guam, Puerto Rico, the North Marianas, and the Virgin Islands were natives and non-US residents, including legally authorized refugees, immigrants, undocumented immigrant populations, and temporary residing individuals who were foreign-born.

The native and foreign population definitions align with those put forth by the ACS and the Bureau of Labor Statistics (BLS). The researcher calculated the overall number of employed civilian U.S. residents aged ≥16 years and the immigrant proportion. This demographic comprises civilians who are employed, civilians who are working, and civilians who are employed but on temporary leave at the time of collecting survey data.

The researcher excluded unemployed individuals, those in the U.S. armed forces (including those on temporary leave), and those not a part of the labor forces from the number of civilians working in the United States aged 16 years and above. The North American Industry Classification System and the Bureau of Labor Statistics classify workers in the healthcare industry as ambulatory healthcare services, hospitals, residential and nursing facilities, and social support.

Nursing and residential care facilities provide medical and nursing care to patients who need more than in-home care. The social assistance subsector comprises institutions that give social help directly to people and families in need. Healthcare technicians and practitioners, such as registered nurses, doctors, surgeons, and licensed practical and vocational nurses, play a variety of tasks and duties in the healthcare profession. Nursing, psychiatry, home health, and medical assistance are all examples of healthcare support employment.


In 2021, the United States population was 331 million, with approximately 45 million immigrants. The immigrant proportion in the entire population is reaching an all-time high, with 15% being the highest percentage reported among Americans in 1890. From the initial period until the late 1800s, the United States witnessed a tremendous increase in its proportion of foreign-born individuals, predominantly those from North Europe. However, there was a significant inflow of immigrants in the initial 1900 period, mainly from Poland, Italy, and other Eastern and Southern European regions.

Between 2007 and 2018, the immigrant proportion in the worker group aged ≥16 increased from 16% to 17%. Between 2007 and 2021, the proportion of immigrants in the U.S. population rose from 13% to 14%. Five of the 20 industrial categories expected to develop rapidly from 2019 to 2029 are in the healthcare and social support sector, which comprises businesses providing medical treatment in clinics, hospitals, doctors’ offices, residential and nursing care, and social support.

The worker counts increased from 15 million to 19 million between 2007 and 2021, while the proportion of immigrants working in health care climbed from 14% to 17%. The worker count in nursing care institutions rose from 1.7 million (2007), with a 15.5% immigrant proportion, to 1.9 million (2013), with a 16% immigrant share. This trend, however, is reversing, with 1.50 million jobs in the sub-sector by 2021, with an 18% immigrant proportion.

The count of registered nurses in the United States rose from 2.7 million in 2010 to 3.4 million in 2021, while the percentage of immigrant registered nurses increased relatively marginally between 2007 and 2021. By 2034, the U.S. may experience a physician shortfall ranging from 37,800 to 124,000, with general and specialty care gaps. The demand for home health aides has expanded dramatically due to the aging baby boomer generation and Medicare’s extension of coverage for home health services in 2017. The typical annual wage for home health and personal care aides was $29,430 in 2021, representing a 25% increase between 2021 and 2031.


The findings showed that immigrants are crucial to the U.S. healthcare industry, with an increasing share of foreign-born individuals in the civilian workforce. Despite witnessing decreases in specific industries, they occupy several healthcare and social support occupations. Programs such as the Conrad 30 Waiver Program and legislation such as Tennessee H.B. 1312 attempt to minimize labor shortages and enhance access to care in rural and neglected regions. However, visa processing times are too long and too expensive to meet the needs of international healthcare practitioners. Addressing these hurdles and integrating immigrant healthcare professionals should be part of a comprehensive strategy to address the United States healthcare system’s difficulties.

Article Revisions

  • Jan 8 2024 – Position of the main article image raised up the page and active hyperlink to research paper added.

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