Immigrants Make Up the Bulk of High- and Low-skill Health Care Jobs

The Immigrant Learning Center in Malden, Mass., released a new study on May 6, 2008, about the presence and need for foreign-born workers in the health care industry in Massachusetts.

Called "Immigrant Workers in the Massachusetts Health Care Industry," the study was prepared by various divisions of the University of Massachusetts Boston, Tufts University and the University of California at Berkeley.

Marcia Drew Hohn, the director of public education for the Immigrant Learning Center (ILC), talked to EthnicNewz.org by telephone about the report, on May 8, 2008.

Following is the edited and condensed interview.

The ILC study is attached below (scroll down to the bottom and click on the attachment).

Why is it important to have a culturally-diversified health care workforce?

It better reflects the patient population. You have an enrichment of understanding of (how) different cultural beliefs and practices may come into play that would directly affect somebody's care.

The immigrant population in Massachusetts is 14.4 percent, maybe even a little higher now.

That doesn't mean that every (non-Caucasian) person needs to be served by someone from (his or her) own ethnic group - that's not what anyone is saying.

(Those who make up a) diversified workforce can help educate other practitioners when cultural factors may be an important issue in caring for somebody.

The ILC report confirms that immigrants make up major proportions of workers in health-related jobs, from high-skill to low-skill occupations. What would be the fallout economically or otherwise without these foreign-born workers?

That's a very complex question (which the study didn't directly answer). We collected data, looking at 2000 and 2005.

Immigrants have very high percentages (of the heath-related professions that they're in, in Massachusetts, compared to their native-born counterparts) at the higher-end occupations, such as physicians, surgeons, pharmacists and physician assistants.

They also have substantial representation at the lower end, such as nurse aides, CNAs (certified nurse assistants), home health aides and psychiatric aides.

What about in the mid-level range of health occupations? Are there many foreign-born persons who hold these jobs?

There isn't a huge presence (of foreign-born workers) in that middle level of occupations - radiologic technicians, respiratory therapists, even nurses. (Their) presence is quite low.

It's (about) 10 percent (for nurses in Massachusetts), and it's remained steady between 2000 and 2005, whereas all the (high-skill and low-skill) occupations showed significant increases.

(For) respiratory therapists in 2000, immigrant workers were 10 percent (of all respiratory therapists in Massachusetts). In 2005, (the percentage) went down to 5 percent.

I don't have a figure for (foreign-born) radiologic technicians because they are so few.

Why are these mid-level health professions – nurses, radiologic technicians, respiratory therapists – filled by relatively few foreign-born workers?

If you try to bring people through the ranks from the lower level into the mid-level (jobs) that require at least an associate's degree, there aren't a whole lot of educational and training programs that can take people through those levels.

It's a big jump from being a CNA to even being an LPN (licensed practical nurse, which requires a 10-month training program). It requires strong English-language skills and reading and writing skills.

Making the leap from LPN to RN (registered nurse) requires a lot of supportive education, and we really haven't figured out how to do this very well.

What about educational institutions? Can they somehow help fill the gap for the mid-level health occupations?

A panelist at (an ILC presentation) who's from a community college, she pointed out that (the college is) very inhibited by regulations. In other words, (the college) can open up only so many slots for certain programs based on resources that (the college has).

For instance, (the college) might be given 90 slots (for which the college has) 400 applications.

Also, (the college) is judged for ultimately how many people pass the state exams.

So you're saying that colleges that funnel the future healthcare workers into the workforce, they're restricted by how many students they can take?

Yes. Also, they're suffering from the fact that their nursing faculty is retiring, and they don't have replacements.

Even if they wanted to expand their programs, they might not be able to because they can't get the faculty that they need to oversee the programs.

Massachusetts – the whole country – is experiencing a shortage of nurses. The ILC report suggests that an effective strategy to fill the nurse shortage would be to focus on immigrant and minority health care workers who are already in the country – specifically, giving them educational and professional opportunities. What's wrong with recruiting nurses from abroad?

That's a stop-gap measure, to bring in labor from abroad. (Those in) the nurse profession are primarily in their 50s. They're going to retire soon.

There aren't replacement workers coming from the pipeline because of the restrictions on the numbers (of students who can be accepted into programs of educational) institutions.

There's also a lack of nurse faculty.

Just relying on recruiting people from abroad or "stealing" them from another state, with salary incentives, isn't a good long-term solution.

Do you see in Massachusetts any successful recruitment or training efforts that have resulted in more middle-level healthcare workers?

Nursing homes have had some good success in doing in-house training programs and collaborations with community colleges. We need more of these kinds of programs.

These training programs of nursing homes are having success for what kinds or levels of jobs?

Just to bring people through the ranks, so they come up from being a nurse's aide to maybe becoming an LPN (which involves) a 10-month training program. It's not as rigorous as an RN (registered nurse) program.

We certainly need more publicly-supported programs that provide transition from positions such as CNA or psychiatric aide, into (providing workers) enough preparation to be successful for an associate-degree program that would be required, for example, (to become) a nurse or radiologic technician.

Do you see any models that are working in Massachusetts for recruitment and retention of nurses?

This (is) just (one) example:

There's the "Boston Welcome Back Center," (which is) a collaboration of Bunker Hill Community College, MassBay Community College, the Massachusetts Board of Higher Education, and the University of Massachusetts Boston (and Roxbury Community College).

(They incorporate) cultural competency, credentialing, linguistic and healthcare competency building.

What about outside of the Greater Boston area? The ILC report shows that regions outside of Greater Boston have many immigrants and healthcare institutions, such as in Essex County and Bristol County. Do you see any successful training programs or models there?

There's a program at Northern Essex Community College (NECC) in Lawrence. That's the Merrimack Valley (region).

There are others, but Northern Essex is the only one that I have information on (right now).

Editor's note: NECC offers a two-year associate degree in nursing, as well as a certificate program in critical care nursing for those who are already RNs.

The ILC report suggests that to strengthen the health care workforce, collaborations among federal, state, regional and urban sectors must exist in the implementation of programs. If Massachusetts doesn't initiate or foster such collaborations, what do you think could be the potential loss to the workforce?

You don't want to have people stuck in the lower levels (that many healthcare occupations are in, such as CNAs and HHAs), with few opportunities to advance.

You want an experienced workforce that has been supported with education and training that can provide culturally competent care and fill critical vacancies, which are projected for almost all healthcare occupations.

Given that the state's population is aging and the working-age population is somewhat declining, do you foresee that Massachusetts might have a shortage of mid-level healthcare workers in the future?

Clearly, all the healthcare occupations are growing. In fact, they're the only segment of the labor market that's really growing.

The ILC report talks about the importance of ESOL (English for Speakers of Other Languages) training for low-skill and lower-paying health care jobs. One could argue that such jobs should go to those born here in the U.S. What's your response to that?

Well, I, you know, I-- (laughter). (The) native-born population doesn't seem to be coming into these occupations.

It isn't like foreign-born workers are trying to snatch these jobs away from people who were born in this country. There's a shortage overall (of people to hire for unfilled health care jobs) - and not enough people to fill them.

I wouldn't say that there's competition for these jobs.

Is most of this ESOL training for certified nurse assistants and home health aides? Or who else might benefit?

Yes (for CNAs and HHAs), but it might even be (beneficial) for people who are in housekeeping or dietary (jobs) in a hospital who really want to get into the healthcare professions.

A lot of jobs go around healthcare as opposed to just jobs that are directly with patients.

The Immigrant Learning Center is devoted to English-language instruction for the foreign-born. Why is the ILC engaged also in carrying out research, such as this latest report on immigrants in the healthcare industry?

In 2003, the organization adopted a second mission: to promote immigrants as assets to America.

That mission is in response to the ever-escalating hostility that our students were experiencing personally and (what we were) reading about in the papers and documented by the Southern Law Poverty Center, (which) tracks hate crimes.

We wanted to provide concrete evidence that, in fact, immigrants do make very significant economic and social contributions to this country.

Is there anything else you'd like to add?

This report is the first in our (ongoing) report about immigrant workers.

We're about to release a study on economic participation of immigrants in Massachusetts - meaning taxes paid, homeownership, wages, consumer spending, et cetera. It will be ready in the summer.

We have three other studies that look at immigrant entrepreneurship.

We've also done a study on immigrant home buyers.

source: EthnicNewz.org

Copyright 2008 New England Ethnic News, EthnicNewz.org. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without the express permission of the news source. Contact Newz for more information.

SEE ALSO:
Can Immigrants Save Massachusetts' Shrinking Workforce?

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