Every healthcare organization has two essential requirements: (1) continuous access to qualified talent; and (2) continuous access to significant numbers of that talent. Hospitals clearly need a lot of employees. To meet these demands, today, more than ever, hospitals and other healthcare providers call on international medical graduates, international students educated in medicine in the United States, global researchers in every practice of medicine, and world-renowned specialists in countless professions.
In the Lehigh Valley, 6 of the top twenty-five employers in the Lehigh Valley are hospitals, medical, nursing, or rehabilitation facilities. These 6-employers collectively employ over 26,000 employees in the Lehigh Valley alone. In New Jersey, 9 of the top twenty statewide employers are hospitals, healthcare providers, pharmaceutical, or rehabilitation groups. Over 70,000 jobs—in the top 9.
In both regions, international medical employees, such as physicians, researchers, surgeons, technicians, nurses, medical aides, therapists, and administrators, are a significant portion of those employed in the healthcare industry. For example, a 2016 Association of American Medical Colleges (ACMC) Report found that New Jersey “tops the nation in the percentage of active physicians educated overseas,” with “more than 38 percent of New Jersey’s 25,930 doctors” who “went to medical school outside the United States.” The ACMC report notes that this is more than double the percentage in nearly every other state. This number takes only the 10,000 physicians in New Jersey who went to overseas medical schools (trained in their home countries and immigrated to practice medicine). Tens of thousands more are international medical students who graduated from medical schools in the United States and take healthcare positions.
As noted, core to many of each organization is incredible talent and consistent access to a significant number of individuals with that talent. The global workforce has become a critical element of public and private healthcare organization staffing projections and requirements. The world’s workforce is now a necessary means for healthcare organizations to effectively meet these projections without compromising financial integrity and quality of care. New York Times Reporter Aaron E. Carroll wrote in an October article that the American system
relies to a surprising extent on foreign medical graduates, most of whom are citizens of other countries when they arrive. By any objective standard, the United States trains far too few physicians to care for all the patients who need them. [The United States] rank[s] toward the bottom of developed nations with respect to medical graduates per population.
Carroll reported “that almost a quarter of residents across all fields, and more than a third of residents in subspecialist programs, were foreign medical graduates.” Additionally, Carroll writes, “foreign medical graduates are also responsible for a considerable share of physicians practicing independently today.” Overall, a quarter of all doctors in the United States are foreign medical graduates alone.
For years, healthcare organizations enjoyed ease when filing applications with the Department of Homeland Security (DHS), the Department of State (DOS), or, even the Department of Labor (DOL). Processing times were short. The Immigration & Nationality Act (INA) was all too often ignored, whether deliberate or inadvertent. Things were, for lack of a better word, lax. Those days are over.
The current Administration has promised increased immigration enforcement on every industry, leaving none, including healthcare, behind. Across the United States, hospitals, physicians, healthcare human resources management, and corporate leadership have already reported DHS’ implementation of the policy. The overall focus is actual enforcement of every letter of the INA by, first, enhanced limitations and restrictions to the world’s workforce, and, second, auditing and inspecting the employers of hundreds of thousands, for complete employment immigration compliance on every employee, both foreign and domestic.
This has led to longer processing times, demanding requests for evidence, random application audits and secondary reviews, significant increases in the number of DOL audits, document requests, and detailed verification demands of institutions who now employ or are seeking sponsorship of international talent. Applications for immigrant and non-immigrant visas and employer petitions for all those sponsored are now subject to review by two, three, or four immigration officials, and months of administrative processing, interviews, requests for evidence, and other delays and followed by unnecessary, or, better put, avoidable (with the correct representation) denials.
Only complicating the entire international employee situation is DHS’ reinstatement of the random worksite immigration verification compliance and inspection. Every employer is required to verify the eligibility of every new employee to work in the United States, with complete perfection–the Form I-9, Employment Eligibility Verification. Errors are unacceptable, and inspections are random. There is, however, a shift from random inspections to a focus on employers of sponsored, international employees.
To task immigration to Human Resources, general counsel, outside counsel not experienced in immigration law, or, even, immigration counsel far away and unable to immediately appear for a random audit, is a decision that may require reconsideration in light of the current political climate on immigration.