A central principle of immigration reform should be to allow the United States to build a labor force that can compete in an increasingly complex and global environment — but this can only be achieved if American employers can manage, recruit, hire and transfer top world talent in the United States. Unfortunately, the current system works against — not for — American employers. It is plagued with uncertainty, backlogs and inefficiencies that threaten employers’ and the country’s ability to expand jobs and the economy.
Considering these factors, to say that reform of the Immigration and Nationality Act is long overdue is an understatement. In 1921, Congress first passed legislation that put numerical limits on immigrant visas of 358,000 per year. The GDP at that time was $73.5 billion. In 2012, there were just slightly over one million visas issued (143,996 were employment based immigrant visas) and the GDP was $15,851.2 billion — in short, there were 2.9 times the immigrant visas issued in 2012 versus 1921 for an economy that is 215 times larger. Also of note is the important impact that the H-1B program has had over the years, yielding substantial economic benefits to the U.S.; from 1990-2010, scientists and engineers admitted by the H1B program added $615 billion to the economy, increasing the GDP by four percent.
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With this in mind, implementing immigration reform that increases employment-based visas will have a significant and positive impact on the U.S. economy. Nationwide, immigrants are more likely to open local businesses and create local jobs; immigrants started 28 percent of all new U.S. businesses in 2011 and employed one in 10 U.S. workers. On average, among 100,000 non-business owning immigrants, 620 of these immigrants are likely to start a business each month. Comparatively, only 280 new businesses are likely to be started monthly by U.S.-born entrepreneurs.
In this discussion, it’s impossible to ignore that we are at a critical juncture in the shortage of healthcare professionals in the U.S. Given the tremendous demand for health care services in the coming years, it is not possible for America to meet those needs through purely domestic means. In general, a “shortage” normally does not last for a long time in a labor market. However, the current and projected shortages are the result of what some may call a “perfect storm” of an aging healthcare labor force (50% of physicians are 55 or older; the average age of a nurse is 47 years old; both PT and OT have similarly aging workforces), an aging population trend (10,000 Americans turn 65 every day), and an inadequate educational infrastructure to the meet demand for healthcare professionals. According to Richard “Buz” Cooper, M.D., and Linda Aiken, PhD, RN, co-chairs of the newly created Council on Physician and Nurse Supply, the U.S. might lack as many as 200,000 physicians and 800,000 nurses by the year 2020 — and these numbers do not take in account the impact of the Affordable Care Act, which will add upwards of 30 million new patients.
In addition, government actions, such as current immigration restrictions, can lead to an under-supply of specialized labor and leave employers with choices that may not be in the best interests of consumers. In other words, “shortages” of doctors and nurses in the United States will appear in the form of longer waits for appointments and subpar medical care for Americans, not empty hospital rooms or vacant medical office buildings.
If we act now, there are a couple of solutions to this problem:
1) Expand the number of employment-based green cards so that the wait times for skilled immigrants — including nurses, physicians, and physical/occupational therapists — can be measured in weeks or months, rather than in years or decades.
2) Expand temporary visa programs to allow for more access by physicians, and physical/occupational therapists and establish a temporary visa that facilitates the entry of foreign nurses.
The issue of the pathway to citizenship is both the key piece and the main point of contention in immigration reform efforts. The complexity of the issues surrounding undocumented immigrants cannot be underestimated and range from collection of back taxes to access to health care coverage. Without finding some level of consensus on undocumented immigrants, immigration reform may not be possible.
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