Speaker 1 00:00:00 It's just a great opportunity to help solve the workforce challenges that we have and have a win win from an immigration standpoint and from a health care workforce standpoint.

Speaker 2 00:00:20 Welcome to. Off the Chart: A Business of Medicine Podcast featuring lively and informative conversations with health care experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. This week's episode features a conversation between myself, medical economics assistant editor Austin Littrell and Dr. Tom Price, an orthopedic surgeon who most recently served as the 23rd Secretary of Health and Human Services. We're talking about the physician workforce shortage and how policy changes around employment based immigration might offer a solution. Dr. Price, thank you so much for for taking the time and joining me today.

Speaker 1 00:01:00 You bet. Austin, thanks so much. Good to be with you.

Speaker 2 00:01:03 We're in the middle of a serious health care workforce shortage. I mean, that's no surprise to anyone. One idea that's been getting more attention is using legal, employment based immigration to help fill the gap. So ahead of this interview, your team pointed me in the direction of a Staffing Stream piece by Ron Hoppe, who's a longtime international immigration professional who says that thousands of qualified international clinicians, that's physicians and nurses are stuck in visa backlogs even though they're ready to work.

Speaker 2 00:01:26 Considering your background, I mean, not only as the former Secretary of HHS, but even just as a physician. I mean, I'd love to get your take on this. So I guess just starting with some background. Could you talk about some of the biggest barriers that are standing in the way of of solving the shortage as it is now?

Speaker 1 00:01:42 Yeah, the shortage shortage in health care workers has been going on for a long time, decades. I was in medical school in the late 70s and and at that time, we were beginning to have challenges in certain areas of, of of health care, mostly on the acute side, but some on the chronic side as well. So this is not a new challenge. And it doesn't take a genius to figure out that that there are significant problems. When you look at whether it's in in the acute setting in a hospital where they can't, where beds can't be staffed, and so wings of hospitals are closed, or in skilled nursing facilities or nursing homes, or long term care or home health or physical therapy, all the kinds of things that people need to stay and remain healthy.

Speaker 1 00:02:30 There are challenges from a workforce standpoint. Now people say, well, why would you want to use folks who who aren't, aren't, born here in the United States and the, the, the the fact of the matter is, we're currently doing that and have been doing it for, for ever since the United States health care system, began significantly. So there are about, about one point about 15 million health care workers in the country. About 20% of those are are non US born folks. They're they're immigrants who've come here either as. As kids or, later in life. Many of them have had their education or their training here, and they fall in love with the United States and they want to stay. So about 20% of of the 15 million are, non-native U.S born workers. in addition to that, there are about a 1.5 million students, foreign students in the United States studying some sort of of, of health care, work. and what we do in the United States, sadly, is that they finish their training, they finish their education, and then we tell them to go home.

Speaker 1 00:03:35 Instead of saying, we'd love to have you stick around and and use your expertise that you've, that you've learned here. So a lot of barriers in the way some of them are immigration, some of them are just just kind of inertia of where the system has been. Some of them are across, folks who aren't native born United States, people in the health care workforce, some of them, are unique to the immigrant, immigrant population. But, it's just a great opportunity to help solve the workforce challenges that we have and have a win win from an immigration standpoint and from a health care workforce standpoint.

Speaker 3 00:04:14 Said Keith. This is all well and good, but what if someone is looking for more clinical information? Oh.

Speaker 4 00:04:20 Then they want to check out our sister site, Patient Care Online. The leading clinical resource for primary care physicians. Again, that's patient care online. Com.

Speaker 2 00:04:33 Could you talk about maybe other specific federal or state policy changes that would really effectively, you know, address this issue?

Speaker 1 00:04:40 Sure.

Speaker 1 00:04:41 If you look at, and the president has talked about this and a bipartisan group of of folks in Congress have talked about it through either the Doctors Act or other pieces of legislation that that exist in Congress for providing health care workers for rural or underserved areas. But if you talk, if you look at merit based visas so that you have folks who have have a talent, have an expertise, have an education, have a, have a a profession that would be helpful to the United States from a health care workforce standpoint. We ought to be expanding those numbers. And and many of those pieces of legislation do just that, whether they require individuals to go to those underserved areas or the rural areas, or whether they're just allowed to to to work wherever the need arises here in the United States. But a merit based visa program would be incredibly, incredibly helpful, and it would just be adding on to the current to the current system that that we already have, but expand the numbers.

Speaker 2 00:05:45 So in that piece, there's you mentioned there's thousands, tens of thousands of physicians and nurses who, even though they've passed US licensure exams and completed immigration requirements, I mean, they're they're kind of sitting in almost a queue, right? Like they're not able to enter and able to practice here.

Speaker 2 00:06:00 I mean, Why? Why is that the case?

Speaker 1 00:06:04 Well, the federal government has four years for both the foreign born individuals and for United States citizens Limited. The number of especially physicians that that are able to gain graduate medical education and training here in the United States and that that that's a holdover from the fact that the vast majority of the graduate medical education seats, positions in this country are paid for, are funded through Medicare. And so, in an effort to limit the exposure of a liability to Medicare, the number of slots, the number of residency slots are limited in this country. in other areas, it's it's simply limited by the numbers of folks who are allowed into this country on a legal basis, from from merit based or from folks who are trying to fill a need, workforce need in this area. So there are a number of different reasons for why this this challenge exists. But the truth is, the fact of the matter is that that we could solve this relatively quickly from an immigration standpoint, by moving toward a merit based visa system that would then help significantly decrease the workforce challenges that we have, and also make it so that those individuals that are allowed into this country are folks that have a talent or an expertise or a profession that is, that is drastically needed in the United States for our own citizens.

Speaker 2 00:07:28 From your perspective, I mean, why hasn't this issue of legal, skilled immigration in healthcare really received more attention and national policy conversations in general? I mean, what's missing from that debate?

Speaker 1 00:07:40 You know, there's always something that's sucking the oxygen out of the room or pushing, common sense things to to to the side. I you have likely noticed that not many things are going through Congress right now. it's hard to get bipartisan cooperation. but this is one of those. This is why. One of the reasons that I. That I've been talking about this. Because it's one of those areas that does have bipartisan support that could be able to pass through both the House and the Senate, and I believe signed by the president. And it and it solves one of those real challenges that we have. So why it doesn't happen is confounding. And I was when I was in Washington and continues to be a from the cheap seats out here in the country. But it it's important that people talk about it's important that that that our representatives and our senators know that there are specific programs that could be put in place that would help solve this challenge and just keep just keep talking about it and, and and hoping that that people will pick up the mantle and run with it.

Speaker 2 00:08:42 So you kind of touched on it there. I mean, it's important for, for people to talk about it. I mean, what role can physician groups or practices or even just individual physicians? I mean, what can they what role can they play in advocating for, for these changes?

Speaker 1 00:08:56 Well, I communicating your concern and the need for these workers is incredibly important. And so, the hospitals are doing so, medical groups are doing so. Medical organizations are doing so. State medical societies, especially societies. Are doing so, and the, the, the, the folks that, that, that organize all of this to allow these folks to, to the who are, who would be coming to our country to make certain that they they do have the highest standards, that they do meet the educational requirements that we have here in the United States, and that their training is either comparable or they're shunted into an opportunity to be able to train further here in the States before they would go to, go to work, here in either underserved or rural areas or wherever the need might, might arise.

Speaker 1 00:09:45 so mostly it's communications education. it's just it's just informing folks about the need for it. and, and again, it doesn't take doesn't take somebody in the health sphere to be able to recognize that need. If you go into any, any nursing home or long term care facility or skilled nursing facility or even hospitals. Now you will notice that there are wings of those buildings that aren't being utilized often and most often that's because of workforce. It's not because there aren't people that need a bed in that area.

Speaker 4 00:10:19 Oh, you say you're a practice leader or administrator. We've got just the thing. Our sister site, physicians practice your one stop shop for all the expert tips and tricks that will get your practice really humming again. That's physician's practice.

Speaker 2 00:10:36 Another main point, really, in that article is immigration reform isn't really about choosing between border security and workforce needs. I mean, both can coexist. Do you agree kind of with that sentiment that it can be aligned with border like broader border policy priorities? And really, how is that the case?

Speaker 1 00:10:53 Oh, absolutely.

Speaker 1 00:10:54 And in fact, it's part of the principle of what real border security is all about. And that is to make certain that folks are allowed to come into this country are ones that will be able to contribute to our society and the. And where else could somebody contribute more positively or effectively than in, in the area of, of of health care? we are an aging population. We're a population that is, that is significantly in need of health care workers. And so if we were to have a merit based visa process for health care workers, then that that solves helps to solve part of the challenges of the workforce, but also recognizes that there are principles involved from an immigration standpoint that ought to be adhered to. And, and, and merit based immigration is one of those things that I think virtually everybody can agree upon.

Speaker 2 00:11:48 Is there anything that I haven't asked you that we glossed over, maybe, or something else that you feel is important about this topic?

Speaker 1 00:11:54 Well, the only thing that I would add is that is that this isn't just in a small niche, in health care.

Speaker 1 00:11:59 It's not just physicians that that are that are in shortage. It's not just nurses that are in shortage. It's not just nurses, aides or lpns who are in shortage, or physical therapists or occupational therapists or nurses aides in long term care facilities or skilled nursing facilities or home health care folks. It's throughout the entire realm of the of our health care workforce. And so, when people say, well, there's only there really isn't a doctor shortage, there is. But some people will argue that there isn't. It's just a problem of distribution. But there's a physician shortage. There's nurses shortage, there's health, other health care worker shortages. And it runs the entire gamut of the health care workforce. And people need to appreciate that so they can again articulate to their representatives and senators and, and, and, governors and other folks at the state level, that this is incredibly important and needs to be solved.

Speaker 2 00:12:51 Absolutely. Great. Well, again. Well, Dr. Price, thank you so much for for your time today.

Speaker 1 00:12:55 Thanks, Austin. Take care. Be well.

Speaker 4 00:12:57 God bless.

Speaker 2 00:12:57 Thank you. You as well. Once again, that was a conversation between myself, medical economics assistant editor Austin Littrell and Dr. Tom Price, an orthopedic surgeon and former secretary of Health and Human Services. On behalf of the whole medical economics and physicians practice teams. I'd like to thank you for listening to the show and ask that you please subscribe on Apple Podcasts, Spotify, or wherever you get your podcasts so you don't miss the next episode. Also, if you'd like the best stories that Medical Economics and Physicians Practice publish delivered straight to your email six days of the week, subscribe to our newsletters at MedicalEconomics.com and PhysiciansPractice.com. Off the chart: A Business of Medicine Podcast is executive produced by Chris Mazzolini and Keith Reynolds and produced by Austin Littrell. Medical Economics, Physicians Practice, and Patient Care Online are all members of the MJH Life Sciences family. Thank you.