Objective: This study provides a national snapshot comparing immigrants to the U.S. with native-born citizens who work in healthcare occupations, including their sociodemographic characteristics and the jobs they fill.
Data/Setting: We used a three-year pooled sample (2011 to 2013) of the American Community Survey, an annual household survey conducted by the U.S. Census, selecting a sample of noninstitutionalized individuals age 18 to 75 years in the U.S. labor force.
Design/Methods: We compared native-born U.S. citizens with immigrants, which include naturalized citizens and noncitizens. We examined sociodemographic characteristics including birthplace, gender, age, marital status, metropolitan or non-metropolitan residence, highest level of educational attainment, and state of residence. Among immigrants, we also examined the number of years they had lived in the U.S. and age of immigration, and among naturalized citizens, age at naturalization. We compared the sociodemographic characteristics of healthcare workers having less than a bachelor’s degree with those having a bachelor’s degree and higher by immigrant and citizenship status.
Results: Immigrants constituted 15.7% of the healthcare labor force. There were about twice as many naturalized citizen (10.5%) as noncitizen (5.3%) immigrants in healthcare. Unemployment in healthcare was lower for naturalized citizens (3.5%) compared with native born citizens (4.8%) and noncitizens (6.0%). Most common birthplaces for naturalized citizens were Asia, the Caribbean, Europe, and Africa. For noncitizens, most common birthplaces were Asia, the Caribbean, Mexico, and Africa. Naturalized citizens were older than native-born citizens and noncitizens; noncitizens were the youngest. Naturalized citizens had immigrated into the U.S. at a younger age and had lived in the U.S. about 10 years longer than noncitizens. Immigrants were more likely than native-born citizens to be married. Over 97% of immigrants lived in metropolitan counties. More naturalized citizens (53.2%) had a bachelor’s degree or higher than native-born citizens (44.4%) and noncitizens (41.1%). Unemployment rates were higher for individuals with less than a bachelor’s degree versus those with a bachelor’s degree or higher, regardless of immigration or citizenship status. Most common healthcare jobs of naturalized citizens included registered nurse (19.8%); nursing/psychiatric/home health aide (18.4%); and physician/surgeon (11.4%). The most common healthcare jobs of noncitizens included allied health occupations such as nursing/psychiatric/home health aide (27.3%) and personal/home care aide (17.6%), as well as registered nurse (12.7%).
Conclusions: Our study suggests that noncitizens in the healthcare labor force are likely to experience greater social and labor market vulnerability than either naturalized citizens or native born citizens. Further research to understand these patterns, the causes of health worker migration, and its consequences. Given shortages of healthcare professionals in underserved communities in the U.S., and the loss of healthcare talent in immigrants’ home countries, the extent of the mismatch between immigrants’ skills and the jobs they occupy is an issue of great concern. Policymakers in the U.S. and other nations need a more thorough understanding of these dynamics of healthcare worker migration and occupational outcomes to make more rational use of scarce and valuable human resources for health.
This study resulted in a full report and a 2-page policy brief that can be found in the publications section of our website.
Lead Researcher: Davis Patterson, PhD
Contact Info: email@example.com
Funder:HRSA: HWRC Allied Health