Following the demands of the coronavirus pandemic, there’s more pressure than ever on the world’s healthcare systems—and in the United States, this is only projected to get worse during the next 10 years.
 
The Bureau of Labor Statistics (BLS) recently released figures predicting that the nation will struggle to meet its healthcare demands by 2031, facing a shortage of 195,000 registered nurses.[1] Furthermore, The Association of American Medical Colleges estimates that the US will see a shortage of up to 124,000 physicians by 2034.[2]
 
The Migration Policy Institute states that immigrants make up just over 18% of healthcare professionals in the US [3], which is slightly above the 17% national average across all industries. However, the proportion of immigrant healthcare workers in each state varies, and with the demand for a skilled healthcare workforce already being felt across the country, there is an opportunity for immigrants to bridge the gap further.
 
Immigrants contribute meaningfully to the nation’s economy by paying taxes and, often, through remittances, also support the communities and economies they’ve moved from.
 
We want to celebrate the diligent care existing immigrant healthcare workers provide to this country. To do so, we’ve created the Immigrant Healthcare Index, which examines the percentage of existing immigrant healthcare workers in each state, alongside the global Google search demand for healthcare jobs across the country. We’ve also analyzed the most common healthcare roles for immigrants and the top states for each of these too, to provide further insight into immigrant healthcare worker trends.

• New York tops the Immigrant Healthcare Index, as it is the state with the highest percentage of immigrant healthcare workers and the highest number of Google searches for healthcare jobs.
• Immigrant healthcare workers in the country are most likely to be physicians and surgeons, making up 15% of both professions.
• The most popular state for immigrant physicians and surgeons is New Jersey (37% are immigrants), while for home health aides, it is New York (74%) and for registered nurses, it is California (37%).

The US shortage of healthcare professionals is longstanding and well-documented. From doctors to personal health assistants, the system that provides vital diagnoses and treatment to the ever-aging population is under significant strain.
 
There are a myriad of factors causing the shortage, all of which have been exacerbated by the coronavirus pandemic. The American Medical Association (AMA) found that two in three doctors reported burnout during the pandemic, and one in five physicians said they would leave medicine in the next two years following the outbreak of COVID-19.[4]
 
The AMA estimates that more than 83 million American citizens currently lack access to a primary care physician. For those who do have access, the physician demographic is aging; almost 50% of practicing physicians in America are aged 55 years or above, meaning that this issue will only continue to worsen over time.
 
The ramifications of this are concerning, the most obvious being reduced access to care, either to diagnose or treat sometimes life-threatening medical conditions. This impacts the US economy, with the country’s workforce taking time off sick due to a lack of prevention or treatment of health issues.
 
In addition, understaffing means that those who are providing care may be experiencing burnout, which affects how able they are to perform their jobs to the best of their ability and, in some cases, causes them to leave the medical profession, resulting in even more shortages.
 
Healthcare systems may need to recruit temporary workers and pay overtime, resulting in greater financial costs and inefficiencies within the healthcare workplace.

Various bills have been brought in to address staff shortages, some of which endeavor to increase the appeal of working as an immigrant healthcare professional.
 
  "Immigrants make up 18% of America's practicing healthcare professionals"
 
The Resident Physician Shortage Reduction Act of 2023 aims to offer 14,000 more medical residency positions by 2030, allowing international doctors to remain and work in the country under the condition that they take up roles where there are current physician shortages.[5]
 
Immigrants make up 18% of America’s practicing healthcare professionals. With the country sometimes affording greater career and wage opportunities than other parts of the world, recruiting even more immigrants to bridge the gap could be one way to help reduce shortages.
 
But first, the current immigrant healthcare trends and landscape must be explored. Read below to find out more.

While the US faces an overarching shortage of healthcare professionals, specific professions are set to experience greater shortages than others, according to the Bureau of Labor Statistics.[6]
 
With this in mind, we wanted to find out which professions currently have the highest percentage of immigrant workers, to help identify where immigrant workers have successfully secured roles in the past and helped to fulfill increasing demands.

*The BLS classifies these jobs as one category labeled ‘Home Health and Personal Care Aides’. Estimated workforce refers to joint total jobs available.
 
According to the data, a staggering one in six (15%) physicians and surgeons in the US are immigrants, making this the top healthcare profession for foreign workers in the country. With America set to see a 124,000-physician shortage in the next decade, this trend of a strong immigrant workforce may need to continue and grow.
 
Immigrants are also playing their part as registered nurses and home health aides, making up 8% and 6% of these workforces respectively. Meanwhile, there tend to be fewer immigrants working as nursing assistants and personal care aides, making up less than 5% of both of these professions.

Following our analysis of which professions immigrants are most likely to inhabit, we wanted to look at the states in which immigrants are seeing the most success in securing healthcare-related roles.

Nationwide, immigrants make up the highest percentage of physicians and surgeons compared to the other roles analyzed (15%), but the numbers within individual states are more balanced. The top five range from 37% immigrant physicians and surgeons in New Jersey ( or close to two in five) - to 32% (nearly one in three) in California and Maryland.
 
The demand for a greater number of qualified physicians is ongoing, even in states like New Jersey, where immigrant physicians are most common. A recent report from the New Jersey Health Care Quality Institute found that there is indeed a lack of adequate primary care physicians for the state population’s needs.[7]
 
Physicians are some of the most highly trained healthcare professionals in the country. They undergo a four-year undergraduate degree, four years of medical school, and a residency program ranging from three to seven years, depending on their area of expertise.
 
According to the Bureau of Labor Statistics, those who work as physicians are paid well for their efforts: the median annual wage for the profession in 2022 was $229,300 - nearly five times more than the national average.[8]
 

With almost two in five (37%) registered nurses being immigrants in California, the state has the highest percentage of immigrants in this role across the entire country.
 
Nevada makes its only entry in the top states for a range of immigrant healthcare roles here, with immigrants making up over a third of registered nurses in the state.
 
New Jersey ranks closely behind, with a 32% immigrant registered nurse workforce, while Florida and the District of Columbia rank joint fourth, both reporting just under three in ten (29%) registered nurses as immigrants.
 
Registered nurses typically complete an associate degree or bachelor of science in nursing, taking two to four years to finish, depending on the course chosen.
 
According to the American Association of Colleges of Nursing, nurses make up the largest proportion of all healthcare professions in the US - nearly 4.7 million are currently licensed. Despite this, more than 25% of nurses report plans to exit the profession in the upcoming five years.[9]
 
Furthermore, the US Chamber recently reported that while the US projects 193,100 job openings for registered nurses per year for the next eight years, the expected number of nurses that will enter the workforce is just 177,400. This will fill the registered nurse openings for less than one year, indicating even more need for immigrants to fill these roles in the near future.[10]

Immigrants make up 60% of Hawaii’s nursing assistants, 15% higher than in the other leading states. The majority of immigrants in Hawaii hail from the Philippines (44.6%), followed by China (8%), Japan (7.5%), and Korea (5.9%).[11]
 
Massachusetts, New York, Florida and Connecticut also rank in the top five, growing immigrant nursing assistant populations to the 40-45% mark.
 
Nursing assistants tend to work in hospitals, nursing homes, assisted living hubs and for home healthcare agencies. Shift work is common in the profession, and the role may involve basic patient care, taking vital signs, helping patients to move around safely, and assisting with simple medical procedures. Assistant nursing requires a diploma or state-approved program certifications, and the profession earns an annual average of $38,200 in the US, according to the BLS in 2023.[12]

With immigrants constituting more than half of New Jersey's personal care aides, the state appears to rely on those from overseas to support this section of its healthcare offering.
 
Maryland and the District of Columbia are not far behind, with just under half of personal care aides being immigrants, while New York and Florida wrap up the top five states, with 43% and 40%, respectively.
 
Home health aides provide basic care and medical services, usually working alongside another more qualified medical professional. The role involves some admin (e.g. keeping a record of ongoing care and medication) and education - for example, teaching nutrition, basic healthcare and how and when to take medication relating to patients.
 
The role requires a high school diploma and, in some cases, formal healthcare programs, resulting in an average median salary of $33,530 per year.[13]

New York has more immigrant home health aides than any other state, with a higher percentage than the national average (59%) by quite some margin.
 
Florida follows behind by some 15%, but still reports six in 10 of its home health aides as immigrants (60%), while Maryland and New Jersey-based immigrant home health aides make up more than half of the profession, with 55% and 54%, respectively.
 
Home health aids differ from personal health aids in that their jobs mainly consist of non-medical routine tasks such as helping patients with personal hygiene, mental support, and household maintenance. Those looking to enter the profession will need a high school diploma (or equivalent) and typically a state-approved training program certificate.
 
The number of people aged 60 onwards in the US is predicted to increase by 30% by 2050, and current trends suggest that more people are choosing to stay at home, opting for home health aide care rather than entering a care home.14 As such, home health aides will be in high demand, making the need for immigrants more essential than ever.[15]

We combined the government employment data for immigrants in healthcare jobs with Google search data to reveal how demand for these jobs matches actual workforce data. From this, we were able to show not only which states have the most existing immigrant healthcare workers currently helping to support the country’s healthcare requirements but also which states have the most interest in these jobs.
 
By ranking states by Google search demand for healthcare-related phrases, such as ‘healthcare jobs in [state]’ and ‘[healthcare profession] in [state]’, we were able to rank the level of interest each state is receiving by those looking for healthcare jobs. Jobs that were included in the search analysis included nurse, doctor, physician, nursing assistant, and therapist.
 
We combined this with each state’s existing percentage of immigrant healthcare professionals, giving each state a score depending on its ranking, to create the Immigrant Healthcare Index, revealing the most popular states for immigrants as the country stands today.

1. New York

While New York has the third-highest number of immigrant professionals across all industries16, it ranks as the most popular state for immigrant healthcare professionals specifically. The iconic city that shares its name with the state is renowned for its diversity and encouragement of cultural globalization. In fact, according to the American Immigration Council [17], a fifth of the city’s inhabitants are immigrants, so it’s perhaps no surprise to see this trend reflected in the healthcare industry.
 
New York ranks as the state with the most immigrant home health aides and the state with the third highest number of immigrant nursing assistants, physicians and surgeons. And, with 60,000 global searches made annually for ‘nursing assistant jobs in New York’, it’s clear that the state truly is popular amongst immigrants and nationals alike.
 

2. California

Over one-third (35%) of health professionals in California are immigrants, and with over 36,000 healthcare-related searches made for the state each year, the state sits just two points below New York on our index.
 
California is the US’ top state for immigrant workers in general16 and is renowned for being one of the country’s most populous and economically influential states. These factors all contribute to the western state’s desirability for healthcare immigrants - particularly among registered nurses, as California has more immigrants in this role (37%) than any other state.
 

3. New Jersey

New Jersey is the second of four Northeastern states to rank in the top 10, with New York taking the top spot. The state has the third-highest number of general immigrant workers16, a trend which is reflected in the healthcare workforce too. Immigrants make up more than half (53%) of personal care aides and 37% of physicians and surgeons in the state - the highest in the country.
 
Often affectionately referred to as the Garden State, and within reach of the diverse hubbub of New York, New Jersey has become a diverse and naturally beautiful area, boasting beaches, forests and cultural hotspots.
 

4. Florida

Another coastal state, Florida, takes fourth place, with a score of 93. With 36% of its physicians, 42% of its nursing assistants, and a staggering 60% of its home health aides being immigrants, the state ranks highly for those hailing from other countries across all healthcare professions.
 
Its geographical location, bordered by the Gulf of Mexico, and its population being the third highest in the country, means that the state is a diverse melting pot of cultures.
 

5. Hawaii

Hawaii rounds up the top five most popular states for healthcare immigrants in the US. Routed in Polynesian heritage and culture, it’s renowned for its now-multicultural society, encouraging a harmony of blended and diverse cultures. Almost a quarter of Hawaii’s healthcare professionals are immigrants, and the sunny destination is particularly popular among immigrant nursing assistants, who make up nearly two-thirds (60%) of the profession there.
 
If you’re looking to broaden your opportunities and progress your healthcare career by moving to the US, and want to send money back home, then you’ll be able to transfer money securely and conveniently with Remitly. Discover more and get some tips and advice on immigration in our blog.

Global search data (searching all languages) was used to establish the annual search volume (February 23-January 24) of healthcare jobs in each state. Search terms analyzed included: ‘Healthcare jobs in {state}’, ‘Nurse jobs in {state}’, ‘Nursing Assistant jobs in {state}’, ‘Doctor jobs in {state}’, Physician jobs in {state}’ and ‘Therapist jobs in {state}. The total search volume for terms relating to each state was combined and used to create a ranking of states between 1 and 50, with a score of 50 equating to the state receiving the most combined global annual searches.
 
A separate set of Migration Policy Institute data showing the percentage of different types of immigrant healthcare practitioners in each state - from physicians and surgeons to registered nurses - was also analyzed and states were given another score from 1 to 50, with 50 equating to the highest percentage of immigrant workers.
 
Each state’s MPI data score and search data score were combined to reveal a total score out of 100 and a ranking of the most popular states for immigrant healthcare professionals.
 
MPI data was also analyzed to reveal the percentage of immigrants working in specific healthcare roles, revealing the most common healthcare jobs for immigrants, as well as the top state for each healthcare role.
 
Data correct as of March 2024.
 
Sources

• Migration Policy Institute
• Google Keyword Planner
   

References
[1] https://www.bls.gov/ooh/healthcare/registered-nurses.htm#tab-6
[2] https://www.aamc.org/news/press-releases/aamc-report-reinforces-mounting-physician-shortage
[3] https://www.migrationpolicy.org/article/immigrant-health-care-workers-united-states
[4] https://www.ama-assn.org/press-center/press-releases/ama-president-sounds-alarm-national-physician-shortage
[5] https://sewell.house.gov/2023/3/reps-sewell-fitzpatrick-introduce-bipartisan-legislation-to-combat-physician-shortage-and-improve-access-to-health-care
[6] https://projectionscentral.org/Projections/LongTerm
[7] https://www.njhcqi.org/wp-content/uploads/2024/01/Primary-Care-Report_2024_v11.pdf
[8] https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm#tab-5
[9] https://www.aacnnursing.org/news-data/fact-sheets/nursing-workforce-fact-sheet
[10] https://www.uschamber.com/workforce/nursing-workforce-data-center-a-national-nursing-crisis
[11] https://map.americanimmigrationcouncil.org/locations/hawaii/#
[12] https://www.bls.gov/ooh/healthcare/nursing-assistants.htm
[13] https://www.bls.gov/ooh/healthcare/home-health-aides-and-personal-care-aides.htm
[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749707/
[15] https://www.bls.gov/emp/tables/occupations-most-job-growth.htm
[16] https://www.usnews.com/news/best-states/slideshows/states-with-the-highest-shares-of-foreign-born-residents?slide=11
[17] https://map.americanimmigrationcouncil.org/locations/new-york/