Health systems are looking abroad to shore up the clinical workforce. But stricter immigration policies under President Donald Trump’s administration may complicate international recruiting efforts.
For years, health systems have outsourced certain administrative work such as revenue cycle management to India, China and other countries. Providers are wading into the next wave of the industry’s globalization shift by employing international nurses and physicians as well as implementing virtual support programs in radiology and other sectors, industry observers said.
Related: How Trump's immigration plans could worsen labor shortages
“Now that health systems already dipped their toe in going offshore for nonclinical functions, I do think we will see more of this look outward for virtual care or full replacement models because the current margins require much more creative thinking,” said Kate Festle, managing director at consultancy West Monroe. “We’re seeing hospitals do what they can to reduce their dependency on staffing agencies, including identifying what can be automated.”
Hackensack Meridian Health hopes that a new partnership with India-based hospital operator Apollo Hospitals will increase its supply of nurses, lead to both administrative and clinical artificial intelligence-powered technology improvements, boost research and education and improve care.
The initial phase of the strategic partnership, announced this week, includes a virtual assistant program for nurses that aims to leverage Apollo’s remote monitoring technology, said Robert Garrett, CEO of the Edison, New Jersey-based health system. A nurse in India could take on some time-consuming tasks related to the admission process, discharge planning or medication management, freeing up the bedside nurse, he said.
That program will lead to direct recruitment efforts that bolster the nursing pipeline, as well as other virtual support programs in radiology, executives said.
“The healthcare workforce shortage is a global problem,” Garrett said. “India has a good supply of nurses and New Jersey has a significant shortage.”
Apollo, which has more than a dozen nursing schools and two medical schools, could work with Hackensack to shape curricula at their respective academic institutions, he added.
Some California providers are recruiting doctors from Mexico. Los Angeles-based AltaMed, Altura Centers for Health, Clinica de Salud del Valle de Salinas and San Benito Health Foundation participate in the state-run Licensed Physicians from Mexico Pilot Program. The program, which California Gov. Gavin Newsom (D) recently expanded to 10 additional health systems, allows more than 100 physicians from Mexico to practice for three years in underserved areas of California.
Under the program, Tulare-based Altura has hired six physicians who specialize in obstetrics, family medicine and pediatrics since 2020, CEO Graciela Soto Perez said.
“They have been a blessing to us in the Central Valley, where it is difficult to recruit and retain doctors,” she said. “If it wasn’t for these physicians, thousands of patients probably would’ve ended up in the ER.”
Soto Perez is worried Trump administration policy changes could, at minimum, delay visa applications, but Hackensack executives think using a different kind of visa could facilitate the process for recruits.
Hackensack is hopeful L-1 visas, which are types of nonimmigrant visas that allow employees of international companies to work temporarily in the U.S. through intra-company transfers, will expedite the recruitment process and allow Apollo clinicians to work at Hackensack facilities. L-1 visa applications tend to have a shorter processing time than H-1B visas, executives said.
“There’s more interest in sourcing offshore [clinicians] and various dimensions of telehealth because the top priority of most CEOs is reducing labor costs,” consultant Paul Keckley said. “What each of them has concluded is they have gotten past the post-pandemic agency staffing issue, but there aren’t enough clinicians in the pipeline.”
However, Trump’s executive orders tied to immigration policy may limit international clinician recruitment strategies, experts said. In a Jan. 20 executive order, Trump said visa applications should be scrutinized more closely.
While executive orders may not survive potential legal challenges or congressional roadblocks, visa applications could take longer to process.
“If these visas come to a halt, then we are in trouble,” Soto Perez said. “The U.S. is not producing enough doctors to meet demand. I am worried foreign doctors may get discouraged or that the application process will be delayed, which means it will take longer to take care of people.”
Festle said health systems might want to consider having a backup plan, in case international recruitment is disrupted.
“There is some uncertainty around the recruitment model,” Festle said. “That’s not to say it might not be feasible, but health systems should have plans in place in case those efforts are interrupted, potentially looking to some virtual or AI models that have fewer hurdles to clear.”
Still, Garrett said Hackensack and Apollo were not discouraged by potential policy changes.
“I have no doubt that the nursing profession is a priority for the U.S. government. I’m hopeful that as time moves on, whatever restrictions there might be on nurses will be exempted because of the significant shortage,” he said. “The current administration hasn’t changed Hackensack’s or Apollo’s outlook.”
Other health systems said it’s premature to speculate on potential policies, and some scaled back on international recruitment efforts well prior to the Trump administration.
A spokesperson for Cleveland Clinic, which has an international footprint and recruits from all over the globe, said it is too early to say whether there will be any recruitment issues tied to potential Trump policies.
A spokesperson for Renton, Washington-based Providence said the health system has scaled back international hires over the past decade as they have become increasingly time-consuming and cost-prohibitive.
“In addition, the availability of international clinicians has significantly decreased compared to earlier periods when this approach was more feasible for us,” the spokesperson said.
