The Welcome Back InitiativeIntegrating Highly Qualified Immigrants into the US Health Workforce

José Ramón Fernández-Peña, MD, MPAInitiative Director

WES ForumNew York, November 12, 2009

®

Who We AreWho We Are

• Our mission is to build a bridge Our mission is to build a bridge between the need for more between the need for more culturally and linguistically culturally and linguistically diverse health professionals and diverse health professionals and the untapped resource of the untapped resource of immigrants trained in a field of immigrants trained in a field of health in their country of origin health in their country of origin who are living in the US. who are living in the US.

• The Welcome Back Initiative The Welcome Back Initiative currently includes centers in currently includes centers in California, Massachusetts, Rhode California, Massachusetts, Rhode Island, Washington, Maryland, Island, Washington, Maryland, Texas, and New YorkTexas, and New York

Why?Why?

““The lack of minority health The lack of minority health professionals is compounding the professionals is compounding the nation’s persistent racial and ethnic nation’s persistent racial and ethnic health disparities.”health disparities.”

(Sullivan Commission, Sept. 04)(Sullivan Commission, Sept. 04)

Composition of Selected Health Professions by Race and Ethnicity

 White

(%)Black(%)

Hispanic(%)

Asian/PI(%)

American Native

(%)

General Population * 65.6 12.2 15.4 4.5 0.8

MD 73.0 5.0 4.0 17.0 0.1

DDS 89.0 1.0 2.0 7.0 0.1

RN 82.0 9.0 3.0 6.0 0.4

PharmDS 76.0 6.0 3.0 14.0 0.3

LPN 73.0 19.0 4.0 3.0 0.8

Data Source: HRSA, US Census 2008 Population Projections

*1.5% of the population is of two or more races.

Immigration FactsImmigration Facts

• Immigrant numbers and growth rates are significant. The foreign-born population in the United States tripled in the past four decades and currently totals about 37 million, or nearly 12 percent of the total population.

• By 2010, the foreign-born population is expected to increase to 43 million, or 13.5 percent of the total population.

• In 2000, two-thirds of all the foreign-born lived in the traditional "big six" immigrant states (California, New York, Texas, Florida, Illinois, and New Jersey), down from three-quarters in the decades before 1995.

US Census Bureau

• From 1990 to 2000, the foreign-born population grew by 145 percent in 22 "new growth" states, compared to 57 percent average growth nationwide.

• The biggest growth between 1990 and 2000 occurred in the

Southeast, Mountain, and Plains states, led by North Carolina (274 percent), Georgia (233 percent), Nevada (202 percent), Arkansas (196 percent), and Utah (171 percent).

• The foreign-born averaged 25 percent of the population in central cities in 2000, with the highest percentages in Miami (60 percent), Los Angeles (40 percent), and San Francisco, San Jose, and New York (all above 35 percent).

• More immigrants now live in suburbs (12.8 million) than in central cities (9.8 million).

US Census Bureau

• In 2007, twenty-seven percent of foreign-born U.S. residents possessed at least a four year degree and 11 percent of immigrants possessed advanced degrees – a greater proportion than the 10 percent rate among native-born residents.

U.S. Census. (2009). Educational Attainment in the United States. Washington. 3.

• In February 2009, while the rest of the economy shed 681,000 jobs, the health care sectored gained 27,000 new jobs. The need for nurses is particularly acute. Nation-wide, in 2008, the vacancy rate for nurses was estimated to be approximately 8 percent, or 135,000 RNs.

American Association of Colleges of Nursing. (2009). “Nursing Shortage Fact Sheet.” Last accessed 6/7/09 at http://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htm.

Professions - All Centers

Other includes: psychologists, speech therapists, pharmacists, midwives, physical therapists, social workers. Total Participants: N= 9,346 as of 3rd Quarter. 2009

.

12.0%

10.4%

38.4%

39.2%

MD

Nurse

DDS

Other

66%

34%

Yes

No

20%

28%

28%

9%

15%

<12 months

1-3 years

4-6 years

7-9 years

10 + years

N= 9,346 as of 3rd Quarter, 2009

Working In Health? - All Centers

Time in the US

30%

70%

Male

Female

Gender

54%

15%

11%

3%

17%

Word of Mouth

TV

Newspaper

Flyer/Brochure

Other

Heard About WB?

25%

20%35%

20%

1-3

4-6

7-9

10

English Level

(Self- Reported)

Top Five Countries of OriginSan Francisco

51%

14%

7%

8%

9%

10%

Mexico

China

Philippines

El Salvador

Peru

Other

Top Five Countries of OriginLos Angeles

28%

5% 6% 9%

13%

39%

Mexico

Philippines

El Salvador

China

Peru

Other

Top Five Countries of OriginSan Diego

51%

19%

5%

21%

2%2%

Mexico

Philippines

USA

Russia

Colombia

Other

60% of Participants are Latino

44% of Participants are Latino

60% of Participants are Latino

14% of Participants are Latino

21% of Participants are Latino

62% of Participants are Latino

Top Five Countries of OriginBoston

6%

6%

4%

4%

20%

59%

Haiti

Brazil

China

Nigeria

Nepal

Other

Top Five Countries of OriginRhode Island

28%

5%5% 7%

11%

54%

DominicanRepublicColombia

Puerto Rico

Brazil

Haiti

Other

Top Five Countries of OriginPuget Sound

12%

7%

5%

6%

6%

71%

Ethiopia

Russia

India

Mexico

Ukraine

Other

Top Five Countries of OriginSuburban Maryland

54%

8%

6%

6%

12%

14%

Peru

Cameroon

El Salvador

Ghana

Ukraine

Other

Top Five Countries of OriginNew York

45%

11%

11%

11%

11%

11%

Colombia

South Korea

China

Cuba

Brazil

Other

Top Five Countries of OriginAlamo Area

62%23%

15%

Mexico

Iraq

Colombia

Individual level Barriers

• English Language Proficiency

• Time & Economic Issues

• Lack of Familiarity with US Health System

• Loss of Professional Identity

Structural Barriers

Complexity of Licensing ProcessesComplexity of Licensing Processes

Inconsistent Messages from Educational Inconsistent Messages from Educational Institutions Institutions

Complex Bureaucracies (Abroad and US)Complex Bureaucracies (Abroad and US)

Conflicting Interests of Key StakeholdersConflicting Interests of Key Stakeholders

Outcomes (through 3rd Quarter, 2009)

• 2,212 Validated their Credentials• 1,253 Passed Licensing Exams• 679 Obtained License in their Original

Professions• 533 Obtained Advancement in Health Career • 1,477 Obtained Employment in the US Health

Sector for the First Time • 82 MDs Accepted into Residency Programs

Welcome Back Initiative

San Diego WBC

Boston WBC

RhodeIslandWBC

Puget Sound

WBC (WA)

SuburbanMaryland

WBCAlamo AreaWBC (TX)

New YorkWBC

Phoenix?WBC

DenverWBC

Los Angeles WBC

San Francisco

WBC

Welcome Back CentersSan Francisco, CA Hosted by City College of San Francisco & SFSU (415) 561-1833

San Diego, CA Hosted by Grossmont College (619) 409-6417

Boston, MA Hosted by Bunker Hill Community College (617) 228-4226

Providence, RI Hosted by Dorcas Place (401) 273-8866 ext 155

Puget Sound, WA Hosted by Highline Community College (206) 878-3710 ext 33

Suburban Maryland Hosted by Montgomery County DHHS (240) 777-1004

Alamo Area, TX Hosted by Alamo Community College District (210) 485-0245

New York. NY Hosted by La Guardia Community College (718) 482-5498

www.welcomebackinitiative.org