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At a time when immigration is a hot-button issue, the American health care system is highly dependent on professionals born in other countries, an analysis of U.S. census data shows.

In 2016, roughly 17 percent of professionals in 24 medical fields—from optometrists to chiropractors to veterinarians—were foreign-born, and almost 5 percent of them were not U.S. citizens, according to the analysis published this week in the Journal of the American Medical Association. The analysis could not distinguish between professionals trained in their country of origin and those trained in the United States.

The rates were even higher for the most educated providers. About one in five pharmacists, one in four dentists, and 29 percent of physicians—approaching one in three—were foreign-born.

Among one of the biggest occupational groups—psychiatric, nursing and home health aides—23 percent were foreign-born.

"We rely very heavily in health care on those who were born abroad," said lead author Anupam B. Jena, an economist and physician at Harvard Medical School. "That tells you what would happen if we had a policy that restricted skilled immigration."

Controversy has surrounded the Trump administration's policies aimed at curbing illegal immigration from Mexico, and his ban on travel from six predominantly Muslim countries. But changes that are less well known have chipped away at legal immigration, including new compliance rules, documentation requirements, and visa restrictions for skilled workers and college students.

Jena's interest in the intended and unintended consequences of immigration policy is partly personal. He was born in Chicago, but his parents—a physician and a physicist—emigrated from India.

"People like my mom who are able to make it to this country and perform professionally, these are generally very skilled, very motivated people," Jena said.

Yet doctors trained outside the U.S. are so often perceived as less qualified or less competent that Jena and his colleagues did a study to evaluate the quality of the care they provide. The study found that hospitalized Medicare patients who were treated by international medical school graduates had lower mortality rates than patients treated by U.S. medical graduates.

For another study, Jena looked at the scientific contributions of foreign medical graduates by counting their journal publications, federal research grants, and clinical trials. The conclusion: Physicians educated abroad but working in the U.S. account for nearly a fifth of U.S. biomedical research scholarship.

Jena led the new analysis—which used data from an annual household survey conducted by the Census Bureau—to look broadly at the health care workforce. While studies over the past decade have reported that about a quarter of doctors working in the U.S. were born abroad, most other health care professions haven't been examined.

The fields with the smallest percentages of foreign-born professionals were audiologists (5.9 percent), veterinarians (7.3), nurse-anesthetists (8.4) and psychologists (9.5).

About 16 percent of nurses, optometrists, dietitians and dental assistants were born abroad. Asia was the most common region of birth, accounting for 6.4 percent of all U.S. health care professionals. Mexico and the Caribbean were next, accounting for nearly 5 percent.

"As the U.S. population ages, there will be an increased need for many health care professionals, particularly those who provide personal care like home health care aides, a large proportion of whom are currently non-U.S. born," the researchers concluded.

Jena speculated that current anti-immigration policies and sentiment may discourage skilled workers from coming here, even if a move would mean better economic prospects.

"Skilled immigration isn't going to stop," he said. "But at the margins, there are always people on the fence. That's true for anything in life. Do we want them on the fence when they are contributing to the American health system?"

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