Report Barriers to Work: Improving Access to Licensed Occupations for Immigrants With Work Authorization

Introduction 

Immigrants make up 13.6% of the U.S. population and 18.1% percent of the workforce, according to a recent report from the U.S. Bureau of Labor Statistics. Foreign-trained workers and U.S.-trained immigrants are filling key niches in the labor force, alleviating shortages in certain sectors such as health care, where immigrants make up 18.2% of all health care professionals.  

Immigrant professionals often face difficulty in obtaining recognition for foreign education or credentials. Frequently, they must obtain an occupational license in the state in which they live and wish to work. This can leave immigrant professionals under- or unemployed. The pandemic exacerbated the vulnerability of immigrant workers in the labor market. Foreign-born workers are often overrepresented in the sectors most affected by COVID-19, such as hospitality and healthcare, and generally have less stable employment conditions and low seniority in the workplace.  

The federal government sets the conditions for immigrants to live and work in the United States and issues visas for both permanent and temporary employment. Employers may sponsor immigrants with special skills for permanent residence. Foreign workers may also apply for temporary employment visas, including the H-1B visa for specialty occupations (e.g., high tech) and the J-1 physician visa. State governments establish regulations for the practice of a profession or occupation, which can include a system of licensing.   

This brief is focused on immigrant professionals who are authorized to work by the federal government and highlights innovative state approaches to overcoming employment barriers, particularly in licensing and credentialing. This is an update to a 2018 report.  

What Is an Occupational License?   

An occupational license is a credential that the government—most often states—requires a worker to hold in certain occupations. Aspiring workers must meet state-specific educational, training, testing and other requirements to practice in a licensed profession. Occupational licenses, which are mandatory in the relevant jurisdiction and time limited, are intended to set professional standards and ensure safety and quality of work. Violation of the terms of the license can result in legal action.  

Immigration to the United States: Worker Visas  

Lawful permanent residents, (aka green card holders) are granted admission for permanent residence in the U.S. based on family relation or job skill. The U.S. may grant up to 675,000 visas annually for family (480,000), employment (140,000) and diversity visas (55,000). Family visas allow lawful permanent residents to bring family members to the United States if they meet certain eligibility requirements. These family members are admitted as immediate relatives of the U.S. citizen or through the family preference system.  

Employment visas allow immigrants to live and work in the U.S. on either a temporary or a permanent basis. There are more than 20 types of temporary visas that allow employers to hire and petition for foreign nationals to perform specific jobs during limited periods of time. Permanent employment visas are available to individuals based on five preference categories determined by the skill and work experience of the worker. Each of the different categories requires a different application process.  

Finally, the diversity visa program was created by the Immigration Act of 1990 as an avenue for individuals from countries with low rates of immigration to the United States. The visas are granted through a randomized, computer-generated lottery for countries that have sent fewer than 50,000 immigrants to the U.S. in the previous five years. 

Health Care and Immigrants  

Immigrants represent a disproportionate share of health professionals.

• 26.5% of physicians and surgeons 
• 15.7% of practitioners and technicians   
• 23.1% of nursing, psychiatric and home health aides  
• 16% of registered nurses  

Nurses and nurse practitioners are projected to be among the fastest growing occupations through 2031, but nursing schools are already struggling to recruit enough students to meet the demands for care. The 2020 National Nursing Workforce Survey conducted by the National Council of State Boards of Nursing found that the median age for an RN is 52 years old, which may signal a large wave of retirements over the next 15 years. 

The Association of American Medical Colleges has predicted a shortage of 124,000 physicians by 2034. However, the association’s report, from 2021, does not include data from the pandemic, which revealed even larger gaps and vulnerabilities in the health care system and resulted in the physical and emotional burnout of many frontline workers.

The U.S. has already begun to feel these workforce gaps acutely after the influx of COVID-19 cases that have occupied workers at clinics and hospitals for the past three years. Immigrant physicians, nurses, and health-care technicians could offer a solution to some these shortages, and could contribute their own professional knowledge and linguistic and cultural skills to populations in need of service. With the complex and contrasting reaccreditation processes in the U.S. for professionals who completed their training overseas, foreign-born health care specialists may be impeded in aiding the workforce.

Impacts of Occupational Licensing  

A Migration Policy Institute analysis found that 263,000 immigrants and refugees with undergraduate degrees in health-related fields are either out of work or relegated to low-paying jobs that require significantly less education. This contributes to a phenomenon known as “brain waste,” where highly skilled immigrants with college degrees are unable to employ their credentials in the U.S.  

Access to professional licenses, in general, for people who are immigrants also varies considerably by state and even between licensing agencies within the same state. 

Immigrants may lack information about licensing requirements or have limited English language proficiency. State efforts, through licensing, credentialing, and streamlining or clarifying application processes can help immigrant professionals obtain higher income from better-paying jobs, resulting in increased spending and tax revenues.  

A survey of 4,000 college educated immigrants by IMPRINT and WES Global Talent Bridge found that the top barriers to practicing their profession were:   

• They lacked U.S. work experience (47% of respondents).   
• The employer didn’t recognize foreign work experience (40%).   
• The employer did not recognize foreign credentials (35%).

Policy Barriers to Employment  

Lack of recognition of foreign credentials  

Immigrants may face obstacles gaining recognition for foreign education and training. For example, immigrants and refugees fleeing disasters or political instability often lack access to original transcripts and documents. Other foreign-educated immigrants may have transcripts and college degrees that are not recognized or translated properly in the United States if the grading systems are vastly different or misunderstood when judged on an American scale. In many cases, immigrants face a Catch-22: Their experience is not recognized as credit toward a license, but they can’t get a job to gain U.S. experience without a license. This forces immigrants to start over in the American education system before moving into entry-level positions in a field they may have mastered in their country of origin.   

Lack of knowledge about licensing  

Immigrant professionals often lack information about the requirements to reenter their careers in the United States. Navigating state licensing can be complex, lengthy and expensive, or require training or supervision that is difficult to obtain. In addition, federally funded career centers and resettlement agencies focus on early employment and not long-term career goals.   

Skill gaps and costs   

Immigrants may have gaps in their training to meet U.S. qualifications and need to upgrade their skills to become competitive. For example, foreign-trained nurses may not meet all U.S. curricula requirements and need to complete additional coursework. Foreign-trained professionals may also face a scarcity of courses in their field. There may not be any stand-alone courses to fill gaps unavailable outside of a degree program, or supervised training may be available only to current students. Work-authorized immigrants who are unable to work in the field for which they are most qualified may be forced to accept lower paid work in non-licensed positions or repeat their degree and face the financial expense. These foreign-trained professionals may also be the sole earner in their families, making a return to school or accepting an unpaid internship impractical.   

English proficiency  

There has been an uptick in English language proficiency among immigrants compared with the early 2000’s. The Pew Research Center reported that 32% of immigrants were proficient in English in 2016, compared with 18% among the newer arrivals in 2007. However, even among those who are proficient in English, technical vocabulary in their non-native language may be unfamiliar, making it more difficult to pass licensing exams. Federal- and state-funded English language classes are not sufficiently advanced to help many immigrant professionals.  

Policy Options  

Occupational shortages across the country have spurred states to develop policies, laws, and partnerships to tap the talents of their residents, to the benefit of both native-born and foreign-trained professionals. Examples of some common state approaches that impact immigrants with work authorization include modifying licensing requirements and making licensing more transparent; addressing skills deficits and improving English language proficiency and creating task forces and offices to develop research and policy recommendations.  

Targeted Approaches  

Modifying licensing requirements 

States have passed legislation and created offices to modify the requirements for licensure. Their goal is to facilitate licensing of foreign-trained professions and/or improve accessibility of the licensing process through easily navigated channels.   

In the past five years, Colorado, New Mexico, Nevada, Oregon, Illinois have provided that no applicant shall be denied a license solely based on immigration or citizenship status. Instead of requiring the applicant’s Social Security number, these states have allowed new candidates for licensure to provide Individual Taxpayer Identification Numbers. 

Other states have created more specific licensing modifications to focus on a particular demographic or occupation. For example, Arkansas has made occupational or professional licenses available to people with work authorization, including 5,000 people under the federal Deferred Action for Childhood Arrivals program, commonly known as DACA. Alaska began allowing foreign-educated applicants for physical therapy to be eligible for licensure, provided they have met the minimum requirements for licensure in their field. Similarly, Virginia granted licensure to foreign-educated applicants for massage therapy.  

Addressing skill gaps, costs, and English language proficiency 

Federal, state, and private resources are available to assist foreign professionals in improving English proficiency and upgrading technical skills to meet state licensing requirements. These programs focus on vocational or workplace English language training, or advanced English as a second language (ESL), which is distinct from ESL for beginners or those with low literacy levels.  

For example, California passed legislation requiring the massage therapy council to assess its contact with non-English speakers and make available all written and electronic materials to certificate holders and applicants in languages other than English. In order to help immigrants upgrade job-specific skills, Colorado has developed a clinical readiness program for international medical graduates that will cover skills and proficiencies needed for in-state residency programs.  

Maine and Washington state have also established programs that provide work-based learning courses with financial assistance to improve language skills and work readiness. Maine enacted the Foreign Credentialing and Skills Recognition Revolving Loan Program to grant interest-free loans to foreign-educated or foreign-trained immigrants who need assistance while awaiting federal employment authorization. Washington appropriated more money to its workforce education investment account, which will specifically target refugees and immigrants who have arrived after July 21, 2021.  

Task forces for skilled international applicants

Maryland’s Skilled Immigrant Task Force was created in 2018 and continues to gather community leaders from large-scale employers and organizations who are focused on immigrant success. The task force has created a detailed guide to various support services available to skilled immigrants in Maryland and across the United States.  

Former Ohio Gov. John Kasich placed renewed value on immigrant success in 2018 with the signing of Executive Order 5 and the creation of the Office of Opportunities for New Americans. This office has helped new immigrants ascend the economic ladder, with a specific focus on occupational licensing, workforce training, and education.  

Illinois created a task force (Illinois H 5465) in 2022 to investigate barriers to licensure for internationally licensed healthcare professionals in the state. The task force will report to the governor and General Assembly on strategies to reduce barriers to employment for this group of licensed professionals.

Conclusion

Changing demographics, driven by retirements, the pandemic, and regional or seasonal labor shortages, are motivating states to expand opportunities and streamline licensing for foreign-trained professionals. These skilled immigrants, with legal residency through family, employment, refugee status or other federal permission, provide an opportunity for states to encourage economic development. 

States are considering models that address under- and unemployment by recognizing foreign work experience, supporting U.S. work experience, accepting foreign credentials, addressing skill deficits, and improving English language proficiency. 

States can also partner with educational institutions such as community colleges to create programs that allow immigrant professionals to obtain an American education experience that can pave a pathway for work opportunities. Initiating partnerships with employers to encourage trained immigrant professionals to re-enter their fields is another way to create job pathways. In states experiencing job shortages, this would allow immigrant workers to reestablish themselves in their fields of expertise while filling occupational shortages.

As state policymakers assess their changing demographics and local drivers of economic growth, the skills and talents of immigrant professionals residing in the U.S. can provide a piece of the workforce puzzle. Immigrant professionals are filling labor shortages and helping local businesses grow. Creative responses—targeting education and training, reducing credentialing and licensing barriers, and partnering with federal, private-sector and nonprofit groups—can improve family income, local and regional economies, and business development.