Resource Center

Abstract
We examine the confluence of three policy streams—immigration, occupational licensing, and healthcare—with a focus on physicians and direct care workers (nursing assistants, home health aides, and personal care aides). We attempt to determine the impact of occupational licensing requirements for both foreign-born international medical graduates and direct care workers on immigrant employment levels, as well as the impact of immigrants in these occupations on both the quality and accessibility of healthcare services. The methods employed included a literature review, a qualitative analysis based on interviews with immigrants and healthcare administrators, and quantitative analyses of the physician and direct care workforces. Foreign-born international medical graduates and immigrant direct care workers account nationally for roughly twenty percent of both the physician and direct care workforces. International medical graduates (IMGs) comprise a disproportionately high percentage of primary care physicians and are more likely to practice in rural high poverty areas and underserved areas relative to U.S. medical graduates (USMGs). However, different residency length requirements for IMGs and USMGs to attain state licensure and the limited number of available medical residencies restrict the ability of foreign-born IMGs to practice in the U.S. For immigrant direct care workers, training costs, language barriers, and cultural competency are the largest obstacles to entry into the occupation. Our research also indicates that foreign-born IMGs and immigrant direct care workers provide medical care of equal or higher quality than their native counterparts. However, the potential of immigrants to help fill the projected future demand for physicians and direct care workers will be limited without appropriate changes to immigration policy and the residency match system.

Keywords: occupational licensing, immigration, physicians, international medical graduates, direct care workers