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Vitor Melo is a postdoctoral fellow with the Open Health Project at the Mercatus Center at George Mason University and a fellow with the Initiative on Enabling Choice and Competition in Healthcare at the University of Chicago. Liam Sigaud is a postgraduate fellow with Mercatus’ Open Health Project. They wrote this for Tribune News Service.
A bipartisan group of senators recently introduced legislation to expand the Conrad 30 waiver program, which incentivizes foreign medical school graduates to work in underserved U.S. communities. These physicians help alleviate staffing shortages in rural areas and have served at least 44 million Americans since 1994.
Congress should go even further. COVID-19 was a sobering reminder that chronic understaffing risks patients’ lives. As America struggles to fill more than 1.6 million doctor, nurse and other health care staff vacancies, we need to lift the arbitrary caps on how many qualified foreigners can enter the country and help.
Even before the pandemic, a 2019 analysis predicted “significant [registered nurse] workforce shortages throughout the country in 2030,” requiring up to 1.2 million replacements. The critical need for more frontline providers has only worsened as droves of nurses have left the profession since the start of the COVID-19 crisis. And it’s not just nurses; many areas face chronic shortages of doctors, mental health therapists, dentists and other providers.
Research consistently shows that understaffing in hospitals and nursing homes is associated with more deaths and worse health outcomes. An analysis of 168 Pennsylvania hospitals found that for each additional patient over four on a registered nurse’s workload, the risk of death increased by 7 percent for those requiring surgery. In Canada, a study found that as the number of professional nursing staff fell, the number of medication errors and wound infections rose. A review of 35 academic studies concluded that higher nurse staffing levels were associated with reduced mortality, medication errors, ulcers, infections, pneumonia, and other complications.
Although there’s little dispute that the staffing crisis is harming patients, policymakers have failed to develop many solutions.
Shortages have been blamed on our aging population, increasing job stress and burnout, and a lack of college faculty to train providers — all valid concerns. Improving work-life balance, expanding the pipeline of new workers and better deploying technology to handle menial tasks can alleviate some of the strain. But we shouldn’t ignore what trained and experienced foreign-born workers can provide.
A dysfunctional immigration system prevents too many such workers from filling vacancies. The H-1B temporary work visa is the primary pathway into the country for high-skilled foreign professionals. Since 2004, the federal government has limited these visas via lottery to 85,000 per year. Back then, this number roughly coincided with the number of applicants, but much has changed. The number of applicants has exploded, reaching 483,927 last year.
The H-1B visa cap is arbitrary and increasingly disconnected from reality, particularly with health care facilities in desperate need of workers. Canada, with barely one-tenth the U.S. population, recently unveiled plans to accept 1.45 million immigrants by 2025, with most bringing skills and qualifications in health care and other high-demand industries.
Last year, a U.S. hospital seeking to hire a nurse from another country (even one educated in an American university) had to pay upwards of $10,000 in legal and processing fees, with considerable uncertainty over the lottery’s outcome. The chance of that worker winning the lottery and staying in the job was only 17.5 percent — and those odds are shrinking every year. Is it any wonder that hospitals, nursing homes, and clinics avoid hiring international applicants?
Some industries are exempt from the H-1B lottery. Higher education and nonprofit research organizations can hire foreign workers independent of the cap. Federal policymakers wisely decided that walling out workers in these fields would impede American innovation and growth. They were right. Our country has long attracted the world’s best research talent, and we’re all better off for it.
But if a think tank can hire a foreign research fellow, a hospital should be able to hire a highly skilled nurse practitioner to provide critical care to American patients. That’s especially true if the applicant already received a U.S. education.
Two decades ago, when the H-1B limit was set, tens of thousands of annual hospital deaths could already be traced to a nursing shortage. This reality has only grown worse. By allowing foreign health care workers in, thousands of American lives could be saved. In a time of political acrimony and gridlock, especially surrounding immigration policy, this should be a bipartisan no-brainer.