Ohio healthcare shortages cannot be ignored.

Current statistics report that by 2025, Ohio will be short of 1,200 primary care physicians, 70% of nurses are seriously considering leaving the profession, and the United States is expected to have a deficit of 139,000 physicians by 2023.

With approximately 102 million people living in a primary care health provider shortage area (HPSA), 167 million people living in a mental health HPSA, and 77 million people living in a dental health HPSA, this local problem is reflected by ongoing workforce shortages across the nation, spelling bad news for Ohio if a solution is not found quickly.

Counties across Ohio are impacted, with a lack of workers increasing consumer health costs, decreasing the quantity of care, and making care less accessible. During the pandemic, when the healthcare workforce shortage became especially apparent, hospitals and clinics resorted to calling physicians out of retirement, waiving out-of-state practice requirements, and expanding the capabilities of many practices. However, these solutions are simply unsustainable for the long term.

International medical graduates, or IMGs, as well as international newcomers, are the key to fixing a Cleveland’s lack of physicians, nurses, nurse practitioners, EMTs, phlebotomists, pharmacists, dentists, nursing home staff, home care workers, dental hygienists, technicians, and mental health providers.

IMGs can hit the ground running, considering their previous training, rather than require local governments to allocate additional time and resources searching for new talent.

In addition, international newcomers who lack extensive career training and professional experience in the United States should be encouraged to pursue healthcare professions—careers with high demand and strong benefits—and barriers should be reduced for these individuals seeking training opportunities.

IMGs are already being utilized to fill gaps in the healthcare workforce, proving their clear competency in assuming these positions. The National Institute of Health found that IMGs constitute 25% of the current healthcare workforce in the United States. Between 2010 and 2021 the number of IMGs increased by 18%, while the number of U.S. medical graduates only increased by 15%. According to the Annals of Internal Medicine, 18% of academic physicians are IMGs.

Despite their undeniable impact on the field, IMGs are unfortunately severely underutilized in the United States with current estimates stating that “brain waste” is impacting over 250,000 individuals, meaning refugees and immigrants are working jobs far below their skill level. It is further estimated that 225,000 doctors, nurses, and home health aides lack lawful immigration status and 190,000 individuals working in custodial and administrative healthcare roles lack lawful immigration status, meaning thousands of individuals within the field are at risk of deportation.

Policies reducing barriers to entry for these individuals are a necessity to ensure that workers providing necessary services to their local communities have proper paths to citizenship and long-term residency. With the Ohio healthcare shortage, ensuring that international medical graduates can work jobs indicative of their training and professional success is essential.

A recent summary published by the Economic Innovation Group shares that 75% of American voters support increasing immigration levels for the benefit of highly skilled innovation. With 71% of Trump voters and 86% of Biden voters in support, this issue is inarguably bipartisan.

Further, reducing the barriers to education for short-term training positions within the health workforce (phlebotomy, emergency health services, technician work, home care aids, custodial work, etc.) will allow international newcomers to attain much-needed jobs with strong benefits, opportunities for career growth, and the ability to support their families. The United States, particularly Ohio, must pull from a large employee market to fill these positions, and with fewer and fewer natural-born citizens choosing this line of work, international individuals must be considered in the healthcare professional applicant pool.

International newcomers want the ability to work and study within the United States and are both capable and willing to fill these positions when given the chance. Funding education programs at local community colleges that push these certifications, offering services to help international newcomers navigate the bureaucracy of applying for these positions, and educating healthcare providers on the importance of hiring international talent is imperative.

If the Ohio healthcare shortage remains unaddressed, disastrous effects will ripple across Northeast Ohio and the greater Cleveland area in the near future. Thousands of Ohioans are already suffering from acute workforce shortages within healthcare. Medical professionals across Northeast Ohio continue to provide quality care, but growing gaps in the workforce impact their ability to perform their jobs to the highest extent, due to an overburdened system that needs more labor.

The solution is here: public health workforce policy that provides provisional licensure to international medical graduates and increased opportunities for training within the job market.

Cleveland may be renowned around the world for our exceptional healthcare providers and hospitals, but it is no secret that Ohio is experiencing a demand for physicians.

In fact, the data shows that workforce shortages in healthcare aren’t unique to Northeast Ohio; they are affecting the entirety of the U.S. Because of the absolute necessity of accessible, quality healthcare for each and every person, addressing this situation isn’t just important, it’s crucial.

In Northeast Ohio, our population and workforce continues to dwindle, falling to keep pace with our region’s growing needs. The report, Aligning Opportunities in the Northeast Ohio Region, found that from 2001-2019, the region’s population dropped by 173,000 people. In that same time frame, Northeast Ohio’s labor force dropped by 156,000.

While shortages exist in a variety of our industries, including manufacturing and IT, healthcare leads the region in demand. According to Aligning Opportunities in the Northeast Ohio Region, approximately 7,842 entry-level healthcare positions went unfilled in 2019. In order to align our state’s demand for healthcare workers with our population growth, our workforce must expand 8% by 2030.

The longer life expectancy for the population, as well as the trend of an aging population, will cause an even greater demand for healthcare practitioners. In fact, he Population Reference Bureau projects that from 2022-2050, the number of Americans ages 65 and older will increase by 47%, making their share of the total population rise from 17% to 23%. They also reported that, based on the median age across the country, the U.S. population is older today than it has ever been.

The projected demand for healthcare workers by the U.S. Bureau of Labor Statistics can also be explained by healthcare professionals leaving the profession due to retirement. The Migration Policy Institute reports that “18 percent of physicians, surgeons, and registered nurses are within ten years of expected retirement (meaning they were between ages 55 and 64) as of 2021.”

As the need for healthcare workers continues to escalate, people are beginning to ask, “how do we fill this gap?” Data shows that new births in our country will not be enough to fill our needs. The Centers for Disease Control and Prevention reports that the birth rate in the U.S. has reached a historic low, decreasing by 3% from 2022. They report that from 2014-2022, the birth rate has consistently decreased by 2% every year.

Where is our solution to the healthcare shortage? It lies in International Medical Graduates (IMGs).

An IMG is an individual who completed their medical schooling outside of the United States or Canada. This categorization of healthcare professionals can include native-born Americans that received medical training outside of the country, but it most often describes individuals who were both born and educated outside of the U.S. The National Institutes of Health (NIH) reported that nearly 90% of IMGs are non-U.S. born, and over 75% of that population come from low-resource, developing nations.

The United States is failing to prioritize the attraction of new IMGs, and with the aging trend of our population and the low birthrate, seeking to grow our population with international newcomers is essential. While foreign-born workers in healthcare can enter the United States via a variety of visas, one of the most common temporary visas for an IMG to obtain is called an H-1B. The H1-B visa is designated for those who work in specialty occupations.

IMGs are being underutilized. While we face a staffing shortage in healthcare, approximately 270,000 immigrants with a college degree in healthcare faced skill underutilization (working in a lower-skilled job) or unemployment, reports the Migration Policy Institute.

Once in the U.S., many IMGs face another challenge: obtaining a medical residency.

For medical graduates seeking to become physicians, they need to complete a medical residency. In the U.S., the process of pairing a medical graduate with a residency is called The Match, or matching, short for the National Matching Program.

A study in the Journal of General Internal Medicine found that IMGs were three times as likely to be selected into community programs instead of university programs for residency, citing that departmental pressure, concerns surrounding reputation, and priority given to certain institutes were some of the reasons that IMGs were not chosen for university programs.

IMGs can also face a delay in joining the healthcare field in the U.S. depending on the level of medicine they seek to practice and the licensure it requires.

States are varied in their approach to IMGs. Many have taken to submitting new legislation to get IMGs working in our healthcare system faster, while still maintaining quality of care.

Washington state passed legislation in 2021 that gives IMGs a temporary license to practice.

Requirements include:

• Working under an already licensed doctor
• Have passed the USMLE exam
• English proficient

This license can be renewed.

Washington passed an IMG bill in 2019, and significantly expanded it in 2021. They are already seeing positive results from their IMG legislation.

A Republican standalone bill for IMGs was passed in Alabama in 2023. This bill:

• Allows IMGs to apply for a temporary renewable license one year earlier during their training
• Eliminates the Special Purpose Exam (SPEX), an additional test
• Creates a program for grads who were not Matched into a residency program to train under a licensed Alabama physician

In 2023, Illinois signed into legislation two bills that will help break down barriers for IMGs to practice in the U.S. As Upwardly Global reports, the legislature created an alternative, permanent pathway for IMGs to obtain full licensure. They also created an ombudsman position, that will help IMGs navigate relicensing. Illinois will be able to “issue limited licenses to international medical graduates (IMGs) who are fully licensed physicians in their country of origin. These IMGs will be able to practice in the state under the direct supervision of an Illinois licensed physician,” according to the Illinois State Medical Society.

Furthermore, the Illinois House Health Care Licenses Committee passed a bill in April 2024 creating a clinical readiness program. This will help IMGs find a residency program in Illinois, which will help IMGs get working, and also increase the likelihood that the IMG will practice in the state after their residency.

Tennessee signed into law in 2023 a bill that will allow IMGs skip residency by instead getting a 2-year provisional license at a healthcare facility with an accredited residency program.

The IMGs can bypass residency if:

• They receive an offer of employment from a residency hospital
• They have obtained certification by the Educational Commission for Foreign Medical Graduates (ECFMG)
• They pass the U.S. Medical Licensing Exam (USMLE) Step 1 and 2 CK
• They have completed a 3-year residency at an accredited international program

IMGs will then receive a full-license after two years.

The New England Journal of Medicine released an article claiming that Tennessee law “…offers a model for attracting IMGs to practice in the United States.” In Tennessee Leads the Way in Removing Barriers to Foreign Doctors on the CATO Institute, the author said that Tennessee’s bill “…breaks down barriers that prevent foreign doctors from helping address the worsening physician shortage.”

The legislation being adopted in states across the country comes from both sides of the political aisle, showing that this is not a partisan issue. The states also alter the legislation to best fit their needs, whether it be getting IMGs in the workforce faster, or supplying rural, understaffed areas with much needed medical care.

To put it simply, each state that has adopted IMG legislature for easier integration into their healthcare system has seen a success that we should try to emulate. If Ohio wants to maintain our industry-leading, competitive healthcare sector, it’s important that we keep pace with other states and their adoption of IMG legislation.

While actively advocating for IMG legislation, Global Cleveland continues to support the pursuits additional healthcare positions for international newcomers.

Our workforce team will make referrals to partners for healthcare careers in the following programs:

• Phlebotomy
• STNA
• Community Health Worker
• Medical Coding
• Medical Assistant
• Sterile Processing Tech

We also have strong relationships with resettlement partners who can connect international newcomers with entry-level jobs at University Hospital and Sodexo, including:

• Nutrition Services
  • Meal Delivery
  • Dishwashing
  • Meal Dispatching
• Facilities Management

Global Cleveland is aware of other sector workforce issues and different solutions could be advanced through partnership, including:

• Nursing (re-credentialing and exchange)
• Medical Innovation
• Healthcare Workforce Resilience Act

Cleveland’s strongest sector is our healthcare, and we lead in this sector because of our ability to innovate, as well as attract talent from around the world.

If you’re committed to expanding our healthcare sector and filling the gaps in our workforce, we ask that you join us in voicing support for consideration of IMGs in our legislature and sharing this article and information about IMGs with your friends and colleagues.

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If you are an organization or international newcomer interested in learning more, send us an email to connect with our team.