Essential Workers: Immigrant Health Care and Social Assistance Workers in the Washington, DC and Baltimore, MD Metro Areas
Even before the COVID-19 pandemic began, the United States faced a shortage of healthcare workers. In 2018, there were 27 open healthcare practitioner jobs—such as doctors, surgeons, registered nurses—for every available unemployed healthcare practitioner. As the coronavirus outbreak affected more states, there was an increasing demand for doctors, nurses, and other critical healthcare workers.
In the Washington, DC and Baltimore, MD metro areas, there are approximately 584,500 workers in the essential Healthcare and Social Assistance industry. Immigrants constitute 26 percent of the workforce in this industry (approximately 152,000 workers). It is important to note that industries are the types of businesses a firm is involved in and occupations are the tasks or functions performed by individual workers within a business. Workers within an industry can work in any occupation. Within the essential Healthcare and Social assistance industry, the top five occupations with the highest total counts of immigrant workers are: registered nurses (approximately 23,000), nursing assistants (15,300), physicians (10,800), personal care aides (10,000), and licensed practical and licensed vocational nurses (7,300).
Immigrant workers are long-term and integral members of communities and have contributed significantly during the battle with the COVID-19 pandemic. Many of them speak multiple languages, which makes them valuable assets to reach communities who may not be proficient in English. At the same time, immigrant healthcare workers have faced certain immigration related challenges. For instance, foreign-born physicians are often restricted to work within one specific healthcare facility and cannot work at more than one hospital. Furthermore, visa terms limit the scope of their clinical practices to particular specialties. Thus, foreign-born physicians are not able to fully utilize their knowledge and skills in ways that would greatly benefit patients.
This analysis will focus on key socio-demographic information about immigrant workers in the Healthcare and Social Assistance industry as well as on immigrant registered nurses and nursing assistants who make up 25 percent of all foreign-born workers in the Healthcare and Social Assistance industry.
Country of Origin, Race and Ethnicity, and Gender Distribution
Nigeria is the top country of origin for immigrants in the Healthcare and Social Assistance industry. Seven percent of foreign-born workers are from Nigeria. Other countries in Africa such as Ethiopia (6 percent) and Cameroon (5 percent) also fall in the top 5 countries of birth. When looking at the top two occupations, Philippines is the top country of origin for immigrant registered nurses (16 percent) and Ethiopia for immigrant nursing assistants (11 percent). Immigrant registered nurses are more likely to come from Nigeria (13 percent) compared to foreign-born nursing assistants who are more likely to come from Sierra Leone (11 percent), Cameroon (11 percent), and Jamaica (8 percent).
In terms of race, 44 percent of immigrant workers in the Healthcare and Social Assistance industry are Black and 27 percent are Asian. When looking at the top two occupations, the vast majority of both registered nurses and nursing assistants are Black. Fifty-three percent of immigrant nurses are Black and 78 percent of foreign-born nursing assistants are Black, which is consistent with their countries of origin.
With respect to ethnicity, only 15 percent of immigrant workers in the Healthcare and Social Assistance industry identify as Hispanic (who can be of any race). Only six percent of immigrant nurses and nine percent of immigrant nursing assistants identify as Hispanic.
The vast majority of foreign- and native-born workers in the Healthcare and Social Assistance industry are female. Native-born workers are slightly more likely to be female compared to foreign-born workers in this industry. Seventy-three percent of foreign-born workers are female compared to 77 percent of their native-born counterparts. There is a similar trend in the top two occupations within the industry. Eighty-four percent of immigrant nurses are female compared to 93 percent of native-born nurses. Similarly, 84 percent of foreign-born nursing assistants are female compared to 88 percent of their native-born counterparts.
Year of Immigration, Citizenship Status, and English Proficiency
More than half of the foreign-born workers in the Healthcare and Social Assistance industry have lived in the United States for a long time. Fifty-three of immigrant workers in the Healthcare and Social Assistance industry arrived in the United States prior to 2000, while only approximately 13 percent of them arrived since 2010. Immigrant nurses have been in the United States longer than immigrant nursing assistants; specifically, 56 percent of them arrived in the United States before 2000 compared to 36 percent of immigrant nursing assistants. Immigrant nursing assistants are more likely to have arrived in the U.S. after 2000 (65 percent) compared to nurses (44 percent).
Sixty-seven percent of immigrant workers in the Healthcare and Social Assistance industry are naturalized U.S. citizens, which is consistent with how long they have been in the United States. With respect to the top two occupations, immigrant nurses are much more likely to be naturalized citizens (78 percent) compared to immigrant nursing assistants (57 percent). One of the reasons for this difference might be the fact that immigrant nursing assistants tend to have arrived in the United States more recently than nurses.
The vast majority of immigrants in the Healthcare and Social Assistance industry are proficient in English (speak English well or very well). Seventy-eight percent of immigrant workers in the Healthcare and Social Assistance industry are proficient in English. Immigrant nurses are more likely to be proficient in English (88 percent) compared to immigrant nursing assistants (72 percent).
Foreign-born workers in the Healthcare and Social Assistance industry are slightly less likely to earn $40,000 or less (47 percent) compared to their native-born counterparts (45 percent). Native-born workers are more likely to earn between $40,000 to $74,999 per year (31 percent) compared to immigrant workers (29 percent). Foreign-born nurses are more likely to earn above $75,000 per year (43 percent) compared to native born who are more likely to earn between $40,000 to $74,999. Alarmingly, eight out of ten of both foreign-born and native-born nursing assistants earn less than $40,000 per year.
 New American Economy. 2020. Immigrant Healthcare Workers Are Critical in the Fight Against Covid-19. Retrieved May 11, 2021 (https://research.newamericaneconomy.org/report/covid-19-immigrant-healthcare-workers/).
 The IIR defines the following the essential retail industry as: offices of physicians, offices of dentists, offices of chiropractors, offices of optometrists, offices of other health practitioners, outpatient care centers, home health care services, other health care services, general medical and surgical hospitals, and specialty (except psychiatric and substance abuse) hospitals, psychiatric and substance abuse hospitals, nursing care facilities (skilled nursing facilities), residential care facilities, except skilled nursing facilities, individual and family services , community food and housing, and emergency services , vocational rehabilitation services.
 Kochenderfer, Aaron. 2021. “Immigrant healthcare workers are essential to the U.S. comeback.” Think Immigration, May 11, 2021 (https://thinkimmigration.org/blog/2021/02/11/immigrant-healthcare-workers-are-essential-to-the-u-s-comeback/)