Immigrants play major role in providing U.S. health care

While Filgie Jarina was still attending college in the Philippines, she was recruited to work as a physical therapist in the United States.

“A Michigan company held a job fair at the college and interviewed a lot of us,” Jarina said. “Soon after I graduated, I submitted all of my credentials to them, and they took care of all the immigration paperwork.”

As one of 23,000 foreign-born physical therapists working in the United States, Jarina illustrates a vital care-giving role that immigrants play in the nation's health-care work force.

Jarina, 40, came to the United States in 1993 and worked for several firms as a physical therapist under contract with hospitals. After stops in Indiana, Missouri, Des Moines and Manchester, she joined Health Enterprises of Cedar Rapids and works as a physical therapist under contract with Jones Regional Medical Center in Anamosa.

If immigrants are mentioned at all in the debate over health care reform, it is usually in the context of whether undocumented immigrants will, or should, be covered by the legislation.

Lost in the debate is the fact that immigrants comprised 27 percent of all physicians and surgeons (219,000) in 2006, the last year for which statistics are available. State figures are not available at all.

Foreign-born workers also accounted for 20.1 percent (409,000) of all nursing, psychiatric and home health aides and more than one-in-six (131,000) dentists, pharmacists and clinical laboratory technicians.

Jarina earned a four-year bachelor of science degree and interned for a year in the Philippines. She had to submit the courses she completed for her degree to U.S. licensing authorities before she traveled to the States and to pass the same examination as U.S.-born graduates to become a licensed physical therapist.

A December report prepared by the Immigration Policy Center in Washington noted that foreign-born health-care workers are employed in many occupations that will experience significant shortages over the next decade in many parts of the country.

“As the native-born population grows older and requires more health-care services of all kinds, and as increasing numbers of native-born health-care workers reach retirement age, the U.S. will experience serious shortages of health-care professionals,” the report concluded. “Even if more (Americans) receive the education and training needed to move into these jobs, it is highly unlikely that they will do so fast enough to fully meet the rising demand for doctors, nurses, laboratory technicians and health aides.”

A recent American Physical Therapy Association study found between 13 percent and 18 percent of physical therapy positions are already vacant, especially in nursing homes.

As of Nov. 15, Iowa was short 86 primary-care physicians, according to a study by the U.S. Department of Health and Human Services. While Linn and Johnson counties did not have a shortage, Benton County needs four additional physicians, Black Hawk County has a deficit of three doctors, Buchanan County could use two additional physicians and Cedar County needs another primary-care physician.

Dr. Nader Dahdaleh, 30, a native of Amman, Jordan, will complete his residency in neurosurgery at the University of Iowa Hospitals and Clinics in 2012. Dahdaleh said friends who have completed their residency are finding a ready market for their skills.

“There's a lot of need for neurosurgeons in the United States, especially in the Midwest,” said Dahdaleh, who graduated from medical school at the American University of Beirut. “A neurosurgery residency is longer than usual, so the dropout rate is fairly high. It requires attention to every detail, because we're dealing with life and death every second.”

Do immigrant health-care providers face discrimination from patients, or is their training questioned?

Dahdaleh said he has not, but “I think it's the right of every patient to question the background and training of the people who are treating them. The medical schools in the United States are very good, but that's not always the case for medical schools in other countries.”

Dr. Roy Venzon, 33, a native of the Philippines, completed his residency in Chicago before joining Cardiologists PC in Cedar Rapids in July 2008. Venzon has not encountered any patient resistance to his ethnicity.

“I was fortunate to have done my training in the Chicago area and then moved to Cedar Rapids, where there's enough diversity that it's not much of an issue,” he said.

While Jarina hasn't experienced any overt rejection, she has fielded some interesting inquiries.

“Some patients have asked when I'm going to graduate from high school. Others want to know if I'm still going to college. I've also been asked if I married an American man who brought me here from the Philippines,” said the single woman. “I haven't been asked to show anyone my diploma or license, but it's come pretty close.”

Since 2000, the U.S. Medical Licensure Exam has included a section for international medical graduates where individuals are measured on their ability to communicate appropriately in a clinical setting. Patients understanding doctors and other health-care providers is actually less of a problem than the reverse.

As America's foreign-born population expands, doctors, nurses and other health-care professionals are finding it increasingly more difficult to communicate with their patients.

A 45-year-old federal civil rights law requires hospitals and doctors who accept federal funds to offer language interpretation services. Federal financial assistance is available, but it requires a match from cash-strapped states.