[House Hearing, 110 Congress]
[From the U.S. Government Publishing Office]
NEED FOR GREEN CARDS FOR HIGHLY
SKILLED WORKERS
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HEARING
BEFORE THE
SUBCOMMITTEE ON IMMIGRATION,
CITIZENSHIP, REFUGEES, BORDER SECURITY,
AND INTERNATIONAL LAW
OF THE
COMMITTEE ON THE JUDICIARY
HOUSE OF REPRESENTATIVES
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
__________
JUNE 12, 2008
__________
Serial No. 110-89
__________
Printed for the use of the Committee on the Judiciary
Available via the World Wide Web: http://judiciary.house.gov
U.S. GOVERNMENT PRINTING OFFICE
42-851 PDF WASHINGTON DC: 2008
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COMMITTEE ON THE JUDICIARY
JOHN CONYERS, Jr., Michigan, Chairman
HOWARD L. BERMAN, California LAMAR SMITH, Texas
RICK BOUCHER, Virginia F. JAMES SENSENBRENNER, Jr.,
JERROLD NADLER, New York Wisconsin
ROBERT C. ``BOBBY'' SCOTT, Virginia HOWARD COBLE, North Carolina
MELVIN L. WATT, North Carolina ELTON GALLEGLY, California
ZOE LOFGREN, California BOB GOODLATTE, Virginia
SHEILA JACKSON LEE, Texas STEVE CHABOT, Ohio
MAXINE WATERS, California DANIEL E. LUNGREN, California
WILLIAM D. DELAHUNT, Massachusetts CHRIS CANNON, Utah
ROBERT WEXLER, Florida RIC KELLER, Florida
LINDA T. SANCHEZ, California DARRELL ISSA, California
STEVE COHEN, Tennessee MIKE PENCE, Indiana
HANK JOHNSON, Georgia J. RANDY FORBES, Virginia
BETTY SUTTON, Ohio STEVE KING, Iowa
LUIS V. GUTIERREZ, Illinois TOM FEENEY, Florida
BRAD SHERMAN, California TRENT FRANKS, Arizona
TAMMY BALDWIN, Wisconsin LOUIE GOHMERT, Texas
ANTHONY D. WEINER, New York JIM JORDAN, Ohio
ADAM B. SCHIFF, California
ARTUR DAVIS, Alabama
DEBBIE WASSERMAN SCHULTZ, Florida
KEITH ELLISON, Minnesota
Perry Apelbaum, Staff Director and Chief Counsel
Sean McLaughlin, Minority Chief of Staff and General Counsel
------
Subcommittee on Immigration, Citizenship, Refugees,
Border Security, and International Law
ZOE LOFGREN, California, Chairwoman
LUIS V. GUTIERREZ, Illinois STEVE KING, Iowa
HOWARD L. BERMAN, California ELTON GALLEGLY, California
SHEILA JACKSON LEE, Texas BOB GOODLATTE, Virginia
MAXINE WATERS, California DANIEL E. LUNGREN, California
WILLIAM D. DELAHUNT, Massachusetts J. RANDY FORBES, Virginia
LINDA T. SANCHEZ, California LOUIE GOHMERT, Texas
ARTUR DAVIS, Alabama
KEITH ELLISON, Minnesota
ANTHONY D. WEINER, New York
Ur Mendoza Jaddou, Chief Counsel
George Fishman, Minority Counsel
C O N T E N T S
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JUNE 12, 2008
Page
OPENING STATEMENTS
The Honorable Zoe Lofgren, a Representative in Congress from the
State of California, and Chairwoman, Subcommittee on
Immigration, Citizenship, Refugees, Border Security, and
International Law.............................................. 1
The Honorable Bob Goodlatte, a Representative in Congress from
the State of Virginia, and Member, Subcommittee on Immigration,
Citizenship, Refugees, Border Security, and International Law.. 2
The Honorable John Conyers, Jr., a Representative in Congress
from the State of Michigan, and Chairman, Committee on the
Judiciary...................................................... 3
The Honorable Lamar Smith, a Representative in Congress from the
State of Texas, and Ranking Member, Committee on the Judiciary. 4
WITNESSES
Mr. Edward Sweeney, Senior Vice President, Worldwide Human
Resources, National Semiconductor Corporation
Oral Testimony................................................. 7
Prepared Statement............................................. 9
Mr. Lee Colby, Electrical Engineer, Lee Colby & Associates, Past
Chair of The Institute of Electrical and Electronics Engineers,
Santa Clara Valley SECTION
Oral Testimony................................................. 18
Prepared Statement............................................. 19
Mr. John Pearson, Director of the Bechtel International Center,
Stanford University, Association of International Educators
Oral Testimony................................................. 22
Prepared Statement............................................. 24
Mr. Yongjie Yang, Legal Immigrant Association
Oral Testimony................................................. 38
Prepared Statement............................................. 39
Mr. Mark Krikorian, Executive Director, Center for Immigration
Studies
Oral Testimony................................................. 40
Prepared Statement............................................. 42
Ms. Jana Stonestreet, Chief Nursing Executive, Baptist Health
System
Oral Testimony................................................. 51
Prepared Statement............................................. 54
Ms. Cheryl A. Peterson, Senior Policy Fellow, American Nurses
Association
Oral Testimony................................................. 61
Prepared Statement............................................. 62
Mr. Steven Francy, Executive Director, RNS Working Together, AFL-
CIO
Oral Testimony................................................. 66
Prepared Statement............................................. 68
APPENDIX
Material Submitted for the Hearing Record
Prepared Statement of the Honorable Zoe Lofgren, a Representative
in Congress from the State of California, and Chairwoman,
Subcommittee on Immigration, Citizenship, Refugees, Border
Security, and International Law................................ 79
Prepared Statement of the Honorable John Conyers, Jr., a
Representative in Congress from the State of Michigan, and
Chairman, Committee on the Judiciary........................... 79
Prepared Statement of the Honorable Sheila Jackson Lee, a
Representative in Congress from the State of Texas, and Member,
Subcommittee on Immigration, Citizenship, Refugees, Border
Security, and International Law................................ 81
Prepared Statement of the Honorable Earl Pomeroy, a
Representative in Congress from the State of North Dakota...... 82
Prepared Statement of Mary Amundson, M.A., Center for Rural
Health, University of North Dakota School of Medicine and
Health Sciences................................................ 83
Prepared Statement of Jack Krumholtz, Managing Director Federal
Government Affairs, Microsoft.................................. 85
Letter from Darrell G. Kirch, M.D., the Association of American
Medical Colleges (AAMC)........................................ 86
Letter from Rick Pollack, Executive Vice President, the American
Hospital Association........................................... 88
Letter from Roger Cochetti, Director--U.S. Public Policy, CompTIA 90
Letter from Immigration Voice, the National Cooperative of Health
Networks Association, the National Health Care Access
Coalition, the National Organization of State Offices of Rural
Health, the National Rural Health Association, the National
Rural Recruitment and Retention Network (3RNet), and the North
Dakota Hospital Association.................................... 92
Letter from Michael D. Maves, MD, MBA, Executive Vice President,
CEO, the American Medical Association.......................... 94
Letter from Nancy McClure, Senior Vice President, HealthPartners
Medical Group and Clinics...................................... 95
OFFICIAL HEARING RECORD
Material Submitted for the Hearing Record but not Reprinted
Report entitled Educating Tomorrow's Workforce, April 2008, submitted
by Edward Sweeney, Senior Vice President, Worldwide Human
Resources, National Semiconductor Corporation This report is
available at the Subcommittee and can also be accessed at:
http://www.sia-online.org/downloads/K12_Catalog_2007-2008.pdf
NEED FOR GREEN CARDS FOR HIGHLY SKILLED WORKERS
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THURSDAY, JUNE 12, 2008
House of Representatives,
Subcommittee on Immigration, Citizenship,
Refugees, Border Security, and International Law
Committee on the Judiciary,
Washington, DC.
The Subcommittee met, pursuant to notice, at 11:05 a.m., in
Room 2237, Rayburn House Office Building, the Honorable Zoe
Lofgren(Cchairwoman of the Subcommittee) presiding.
Present: Representatives Conyers, Lofgren, Gutierrez,
Waters, Smith, King, Goodlatte, and Lungren.
Staff present: Blake Chisam, Majority Counsel; George
Fishman, Minority Counsel; and Andres Jimenez, Majority
Professional Staff Member.
Ms. Lofgren. I understand that Mr. Goodlatte is on his way.
So maybe we will begin just the opening portion of this
hearing.
Oh, here he is right now. Very good.
Chairman Conyers. Speak of the devil.
Ms. Lofgren. This hearing of the Subcommittee on
Immigration, Citizenship, Refugees, Border Security, and
International Law will come to order.
I would like to welcome the Subcommittee Members, our
witnesses, and members of the public to the Subcommittee's
hearing to explore the need for green cards for highly educated
employees in the field of science, technology, engineering, and
mathematics, otherwise known as STEM, as well as the situation
in nursing.
There is a recognized shortage of U.S. employees available
to fill jobs requiring the highest educational levels,
particularly in the field of STEM. According to the National
Foundation for American Policy, major U.S. technology companies
today average more than 470 U.S.-based job openings for skilled
positions, while defense companies have more than 1,265 each,
indicating U.S. businesses continue to experience difficulty in
filling positions in the United States at the highest
educational levels.
At the same time our country is experiencing shortage in
U.S. employees at the highest educational levels, employers
from Europe, Australia, Canada, and even China and India are
increasingly attracting to their shores the highly educated,
high-achieving scientists, engineers, mathematicians, and
researchers that are the foundation for innovation. In 2000,
for example, 75 percent of the world's engineers were hired by
U.S. employers. Just 6 years later, in 2006, that percentage
had dropped to 63 percent.
Today, more than half of the graduates from U.S.
universities in master's and Ph.D. programs in science and
engineering are foreign born. To ensure that America remains
the greatest source of innovation in the world, we must not
only educate more U.S. students in STEM. We must retain the
best and brightest innovators among our graduates so that they
can work with us rather than compete against us in other
countries.
In addition, at the same time that nursing schools are
unable to produce enough nurses to meet existing health care
needs around the country, the demand for nurses is projected to
continue increasing at high rates as the baby boom generation
hits retirement and birth rates plunge. Currently, 12.4 percent
of the U.S. population is aged 65 and older. That percentage is
projected to increase to 16.3 percent in 2020 and 20 percent in
2030.
I look forward to hearing from our witnesses today on how
the current immigration system has failed to respond
effectively to these economic and health care challenges and
what might be done to address the situation in the near and
long term.
I would now like to recognize Mr. Goodlatte for his opening
statement.
Mr. Goodlatte. Well, thank you, Madam Chairman.
It is important to note at the outset that this hearing is
about legal immigration, not illegal immigration or amnesty. I
have long believed that legal immigration has blessed our
Nation with talent, diversity, and a commitment to freedom and
the rule of law. In fact, those who have come to the country
through the legal channels are often some of the most vocal
opponents of the illegal immigration and amnesty. It is my hope
that as we move forward, we can keep these issues distinct.
I would also be one of the first to point out that our
Nation's legal immigration system is flawed in many ways. For
example, I am a strong opponent of the visa lottery program
through which 50,000 aliens are chosen at random to come and
live permanently in the United States based on pure luck. This
program threatens national security, results in the unfair
administration of our Nation's immigration laws, and encourages
a cottage industry for fraudulent opportunists.
In addition, it seems clear that our immigration laws do
not sufficiently address the Nation's needs in the area of
highly skilled workers. I believe that U.S. businesses should
have access to the best and brightest workers in the world.
U.S. workers have consistently been the best and brightest, and
we are working to ensure that the U.S. continues to produce the
most talented high-tech and STEM graduates. However, highly
skilled talent is not limited to the U.S., and our immigration
laws should help U.S. businesses attract and retain the best
and brightest global talent.
Unfortunately, we have backlogs for processing green cards
that are simply unacceptable. In addition, the laws have not
seemed to keep up with the demand for highly skilled workers in
our dynamic economy. When faced with the prospect of waiting
for many, many years to get their green cards approved, it is
ever more attractive for H-1B workers to leave the U.S. and go
to other countries with more stable and predictable immigration
laws.
To address these problems, I have introduced legislation
with Chairman Lofgren to relieve the backlog of green card
issuance for current H-1B employees. Our legislation eliminates
the per-country caps for highly skilled immigrants which will
reduce the waiting time for those workers who have been waiting
in line the longest.
In addition, from this year on, our bill would recapture
any unused green cards for highly skilled immigrants each year
and add them to the cap for the next fiscal year. This
provision will help ensure that Government red tape and
bureaucratic delay do not prevent legal immigrants in the high-
tech sector from obtaining their green cards, which will help
to make America a more attractive place to come live and work.
There are other proposals which have been introduced about
which I have concerns. Instead of recapturing visas from this
point forward, one proposal would reach far back into the past
to recapture hundreds of thousands of visas. Such a proposal
would surely bring with it new procedural problems as the
Administration would likely struggle to handle the overwhelming
new workload. We need to carefully consider the ramifications
of such proposals.
In addition, another piece of legislation would create a
limitless number of green cards for foreign students who come
to the U.S. and receive advanced degrees in math, science, and
related fields. While granting U.S. businesses better access to
this pool of applicants seems like a good idea, such a
broadscale change needs careful consideration and review,
including considering the effects that such a policy would have
on the native U.S. labor pool. We would certainly not want to
create a policy that has the effect of displacing our own
talented U.S. workers at a time when our economy is struggling.
Furthermore, most Members on my side of the aisle would
like to couple any increase in legal immigration that benefits
our economy and country with policy changes that would decrease
the number of random green cards that are handed out through
programs like the visa lottery which experts believe poses a
national security threat.
In summary, I would reiterate my strong desire for the
majority to keep legal immigration issues separate from the
issues of illegal immigration and amnesty. If we work together
in a bipartisan fashion, I believe that we can achieve success
in addressing many of our Nation's legal immigration problems
this Congress.
I look forward to hearing from our witnesses.
Thank you, Madam Chair.
Ms. Lofgren. Thank you, Mr. Goodlatte.
I now would invite the Chairman of the full Judiciary
Committee, Mr. Conyers, to give any opening statement he may
have.
Chairman Conyers. Thank you, Chairwoman Lofgren, and to all
of my fellow Members of the Judiciary Committee.
This is very important. It is also so fundamental. It is
almost a little shocking that we have now figured out that we
are going to give green cards to our graduates so that we can
fill up this horrible vacuum that is going on, and I guess, you
know, better late than never. I do not see what took so long to
get here.
I talk irregularly with the heads of the engineering
departments and the school of nursing at Wayne State
University, and we have a horrendous problem developing. First
of all, in nursing, the young ones are not staying. The
experienced ones are retiring, quitting. We have a tremendous
problem.
And at least a half-dozen Members of this Committee are on
H.R. 676, the Universal Single-Payer Health Care bill, that we
have been working on, and that anticipates that we will need
lots more nurses and lots more schools and lots more people
trained and able to teach nursing.
Now that is the crisis right now. So we figured out that
you have to start looking at dealing with that now, and I am
proud of what SEIU is doing with the nurses, but this is just a
mere beginning. This is just starting off with this problem. We
have to look at this with a far more urgent attitude because we
have to deal with these and deal with it fast.
So I want to commend Chairwoman Lofgren and our Ranking
Member Goodlatte and all of us here for working on this
problem. It is a big one, and so I am just hopeful that we will
begin to look at what is the holdup. We have to build more
nursing schools and get more experts in to train, to teach in
those skills, and we have to do it fast.
So I am proud to be in on this modest STEM step forward,
but there is a whole deeper layer of complex issues to be
resolved, and I am glad it is here that we are looking at them
in the Immigration Committee.
I thank you.
Ms. Lofgren. Thank you, Mr. Conyers.
I would recognize the Ranking Member of the full Committee,
Mr. Smith, for any statement he may have.
Mr. Smith. Thank you, Madam Chair.
I do have an opening statement.
Is this mic on?
Ms. Lofgren. Yes. They are all live all the time.
Mr. Smith. Okay. Thank you.
Madam Chair, the first thing I want to say is I am always
impressed by Chairman Conyers' knowledge of so many subjects,
and he just finished mentioning nurses, and I happen to agree
with what he said about the nursing shortage and the need for
additional nurses, and, of course, that also emphasizes again
the need to admit people who have the skills and the education
we need, and nurses are a prime example of that.
While the U.S. grants permanent residence to over one
million legal immigrants each year, only 5 percent are actually
chosen based upon the skills and education they bring to the
American economy. The vast majority of immigrants are selected
because of their family relationships with U.S. citizens and
permanent residents or even at random, as Mr. Goodlatte
described a minute ago. This does not make sense in today's
economy.
First, the economy's thirst for highly skilled and educated
workers has increased dramatically, yet the economy's
preference for the more highly educated and skilled is ignored
by our immigration system. Second, the much anticipated
retirement of the baby boom generation is now upon us. In order
to sustain a strong economy, we must replace these workers.
So what type of immigrant should we be looking to attract?
As the Congressional Research Service notes, industries such as
leisure and hospitality that are known for having young low-
skilled workforces will not need to fill many jobs as a result
of the baby boom retirements. Rather, other occupations and
industries will need large numbers of skilled and educated
workers. Suitable replacements are more likely to come from
immigrants selected for their skills and education than from
ones selected at random or through family relationships, yet
this fact is ignored by our immigration system.
To borrow a line from Harvard economist George Borjas,
``Skilled immigrants earn more, pay higher taxes, and require
fewer social services than less skilled immigrants.'' This is
verified by the National Research Council which found that each
immigrant with more than a high school education provides a net
fiscal benefit to American taxpayers of $105,000 over their
lifetime. On the other hand, each immigrant with less than a
high school education imposes a net fiscal burden of $89,000 on
taxpayers. It is clear that American taxpayers benefit from
highly skilled and educated immigrants, but not from low-
skilled and uneducated immigrants, yet this is ignored again by
our immigration system.
Despite these facts, 95 percent of legal immigrants to the
United States are not admitted based on their skills and
education. So what is the result? Hundreds of thousands of new
immigrants without a high school education arrive each year.
This has a devastating impact on the wages and job
opportunities of disadvantaged, native-born Americans.
In 2003, there were 8.8 million unemployed native-born
adults without a high school diploma--1.3 million who were
unemployed and 6.8 million no longer even in the labor force.
Native-born Americans comprise 68 percent of all workers
employed in occupations requiring no more than a high school
education. These are some of the Americans competing with low-
skilled and uneducated immigrants for jobs.
Immigration is already having a depressing effect on the
standard of living of vulnerable American workers. Steve
Camarota at the Center for Immigration Studies has estimated
that immigration has reduced the wages of an average native-
born worker in a low-skilled occupation by 12 percent a year,
or almost $2,000. Mr. Borjas estimates that immigration in
recent decades has reduced the wages of native-born workers
without a high school degree by 7.4 percent.
Congress should have revised our immigration policy long
ago. Given the current state of the economy and the ever-
increasing retirement of baby boomers, we can no longer wait
any longer. Congress has a responsibility to promote
immigration policies that protect the American worker and
promote a strong American economy. To do that, we must
prioritize the immigration of high-skilled and educated
individuals.
I thank you, Madam Chair, and I will yield back.
Ms. Lofgren. Thank you, Mr. Smith.
And in the interest of proceeding to our witnesses and
mindful of the schedule, other Members' opening statements will
be made a part of the record, without objection.
Today, we will hear from two panels of witnesses to help us
consider the important issues before us.
It is my pleasure first to introduce Edward Sweeney. Mr.
Sweeney is a senior vice president in worldwide human resources
at National Semiconductor Corporation, and he is the Chair of
the Semiconductor Industry Association's semiconductor
workforce strategy committee. He returned to National
Semiconductor in May of 2002 after serving as vice president of
worldwide human resources at Vitria Technology, Incorporated.
Prior to that, Mr. Sweeney was vice president of human
resources at Candescent Technologies Corporation, a
manufacturer of flat-panel displays. From 1983 to 1998, Mr.
Sweeney served as a vice president of human resources for
National Semiconductor's central manufacturing technology group
and also for the company's analog products group. He also
directly supported National's worldwide sales and marketing
organization and the company's manufacturing facility in
Greenock, Scotland.
Mr. Sweeney has a bachelor's degree in organization
behavior and a master's degree in human resources and
organization development both from the University of San
Francisco, and he is from my neck of the woods.
So glad to have you here today.
Next, I would like to introduce Lee Colby. Mr. Colby is an
electrical engineer who has 50 years of experience in the high-
tech field. After a 36-year career with Hewlett-Packard, Mr.
Colby helped found his own technology company, O'LE
Communications, and now runs his own consulting firm, Lee Colby
& Associates.
As the past chair of the Santa Clara Valley Section of the
Institute of Electrical and Electronics Engineers, Mr. Colby
represented over 13,000 technology engineers in the Silicon
Valley area, my home. He is speaking to us today as an
engineer, a business owner, and a manager with decades of
experience with the high-tech world.
Next, I am pleased to welcome John Pearson. Mr. Pearson was
born in Manchester, England, and first came to the United
States in the summer of 1969. Beginning in the early 1960's
after completing degrees in American studies at the University
of Wales and University of London, Mr. Pearson studied and then
worked at the University of Tennessee from 1971 to 1985.
He has been working at Stanford University, again my neck
of the woods, since 1985 and has been director of the Bechtel
International Center since 1988. His work at Stanford focuses
both on services to foreign students and scholars and to U.S.
students applying for such scholarships as Fulbright, Rhodes,
Marshall, Mitchell, Gates, and Luce.
Next, I would like to introduce Dr. Yongjie Yang who is a
current post-doctoral research fellow in the neurology
department of Johns Hopkins University. Dr. Yang came to the
United States for graduate study in 2000 and was awarded his
Ph.D. in neuroscience and genetics from Iowa State University
in 2005.
Dr. Yang's current studies focus on the interaction of
neuron and astrocyte interaction and their dysfunction in
neurodegenerative diseases, including Alzheimer's disease,
Parkinson's disease, and in particular ALS, known as Lou
Gehrig's disease. He has personal experience with the U.S.
immigration system.
And, finally, I would like to introduce Mark Krikorian. Mr.
Krikorian is the executive director of the Center for
Immigration Studies, a research organization here in
Washington, DC, that examines the impact of immigration on the
United States. Mr. Krikorian has published articles in The
Washington Post, The New York Times, and the National Review,
among other publications. He holds a master's degree from the
Fletcher School of Law and Diplomacy and a bachelor's degree
from Georgetown University and is the minority's witness at
today's hearing.
Your written testimony will be made part of our official
record. We would ask that your oral testimony consume about 5
minutes, and that little light on the table will tell you when
your time is up. When the yellow light goes on, it means you
have just 1 minute to go. When the red light goes on, it means
you have actually been speaking for 5 minutes. It always
surprises me. We do not have a heavy gavel here, but, at that
point, we would like you to wrap up so that we can have an
opportunity to hear the second panel and also to ask questions.
So, Mr. Sweeney, if we could begin with you.
TESTIMONY OF EDWARD SWEENEY, SENIOR VICE PRESIDENT, WORLDWIDE
HUMAN RESOURCES, NATIONAL SEMICONDUCTOR CORPORATION
Mr. Sweeney. Good morning. My name is Eddie Sweeney, and I
am the Senior Vice President, Worldwide Human Resources, at
National Semiconductor Corporation and the Chair of the
Semiconductor Industry Association workforce strategy
committee. Today, I am pleased to testify on behalf of the
Semiconductor Industry Association. The SIA represents the
semiconductor U.S. industry, which employs 216,000 U.S.
employees and is America's second largest exporter.
Today, I would like to cover three key points: the
important role the foreign nationals play in the success of our
companies, the problems created by the current U.S. immigration
policy, and the joint positions that the SIA has taken with the
Institute of Electrical and Electronic Engineers USA.
Let me first note that the SIA believes that high-skilled
immigration reform is part of a broader set of policies needed
to promote innovation in America. We believe that we must also
increase Federal support for basic research, enact true
innovation tax policies, such as a permanent R&D tax credit,
and improve science, engineering, and math education at the K-
12 level.
With this context in my mind, let me cover my first key
point, the importance of foreign nationals to our companies.
Semiconductor components are the most complex products
manufactured on the planet with millions, and in some cases
billions, of circuits integrated on slivers of silicon the size
of your fingernail. To design these devices, we need to hire
the brightest minds from our Nation's universities.
Each year, about half of our total recruitment activity
comes from university hiring. However, when we go on campus, we
find that 51 percent of the engineering master's graduates and
71 percent of the engineering Ph.D. graduates are foreign
nationals.
Let me repeat these numbers because this is the crux of our
issue. More than one in two of every master's engineering
graduate in a U.S. school is a foreign national, and almost
three out of every four Ph.D. graduates are foreign nationals.
This brings me to my second point: the problem that is
created by our U.S. immigration policy. As the Committee well
knows, the annual allotment of H-1B visas is filled within
days, if not hours, after the DHS accepts applications and then
decides by lottery who can best contribute to our economy. What
is not so well known are the problems created by the caps on
permanent resident visas or green cards.
SIA companies seek green cards for almost all of our H-1B
hires, so the caps are a major problem for us. We are not
talking about large numbers. In 2007, the entire semiconductor
industry sought green cards for less than 4,000 employees.
Although relatively few in number, these employees are
nonetheless critical to the design of our new products, to
helping customers adopt semiconductors in their end systems,
and to researching the next generation of semiconductor
technology, and these are all tasks that create additional
jobs, high-paying jobs, in other parts of our companies, such
as in sales, production, and administration.
The green card quota cap has forced employees to wait for
years for permanent residency during which time their ability
to move within their company or to be promoted is restricted.
Furthermore, during this period, their spouses may not work,
and their home life is essentially put on hold. Needless to
say, many individuals become frustrated and frequently seek
alternatives, either with another employer or with the same
employer overseas.
Many U.S. companies are finding workaround solutions that
often involve creating R&D locations in overseas locations,
meaning that the downstream benefits of our U.S. higher
education system are not accruing to the U.S. Rather than
sending these scientists home into the arms of our foreign
competitors, our employees are often finding themselves
creating jobs for these people in their foreign subsidiaries
when they could otherwise be employed in the U.S.
Addressing this challenge brings me to my third point: the
SIA's work with the IEEE-USA. Our organizations' differences on
H-1B issues have been widely publicized, but we both agree that
the current immigration system is broken. Last October, we
arrived at a common position which is detailed in our written
testimony. It includes raising the green card cap with an
exemption for master's and Ph.D.s in science and engineering
and allowing science and engineering graduates to transition
directly from student visas to green cards.
In May, the SIA and IEEE-USA followed up its letter on
long-term reforms with specific support for H.R. 5882, 5921,
and 6039. These three bills will help talented foreign
nationals create jobs in America and help our industry to
export products and not jobs.
The SIA and IEEE-USA worked hard to find common ground, and
we urge Congress to similarly work in a bipartisan basis to
pass these important bills this year. This matter is of urgent
and critical importance to our industry.
Thank you.
[The prepared statement of Mr. Sweeney follows:]
Prepared Statement of Edward Sweeney
Ms. Lofgren. Thank you.
All the bells are telling us that we have actually five
votes on the floor of the House, so that is going to interrupt
our hearing. But perhaps we can get one more witness statement
in before we adjourn to the floor. We will be gone probably for
about 40 minutes, is my guess, with apologies, but we have to
go.
So, Mr. Colby, if we could hear from you now, and then we
will come back and hear from the others.
STATEMENT OF LEE COLBY, ELECTRICAL ENGINEER, LEE COLBY &
ASSOCIATES, PAST CHAIR OF THE INSTITUTE OF ELECTRICAL AND
ELECTRONICS ENGINEERS, SANTA CLARA VALLEY SECTION
Mr. Colby.0 Good morning, Congressman Lofgren.
My name is Lee Colby, and I am testifying today on behalf
of IEEE-USA, which represents a group of engineers 215,000
strong in the United States, of which 22 percent are foreign-
born Americans.
I have been a professional electrical engineer for over 50
years in Santa Clara Valley. In fact, I was in the Valley when
it was called the Valley of Hearts Delight. For my first 36
years of my career, I worked at Hewlett-Packard as an
electrical engineer.
I left HP in 1997 and started Lee Colby and Associates
which consults on circuit and system designs for some of the
world's leading technology firms. In 2000, I decided to try my
hand in a technology startup, O'LE Communications, as chief
technical officer.
It was at O'LE that I had my most direct experience with
our immigration system. We employed about 24 employees, half in
Taiwan and half in the United States. During the dot.com boom,
we had trouble finding American workers, so we turned to the H-
1B program. When the dot.com boom burst, those workers were
unable to transfer to another company and so had to leave. H-1B
workers are effectively tied to their employer, creating a
dependency that is both unjust and harmful.
In 2005, I chaired, as Chairwoman Lofgren said, the IEEE
Santa Clara Valley section, representing over 13,000 electrical
and electronics engineers in the San Jose area. I also, though,
volunteer as a math and science teacher assistant at the
Sunnyvale Middle School and teach a class in fuel cells and
solar cells for advanced high school children at San Jose State
University.
In other words, I know both ends of the technology sector
inside and out. For almost 50 years, I have been deeply
involved with cutting-edge technology and the men and women who
developed it. I understand the problems faced by engineers and
employers, and I believe the approach to high-skill immigration
reform being offered by Chairman Lofgren is a good one for all
parties.
Earlier this year, the House Immigration Subcommittee,
Chair Zoe Lofgren, and a bipartisan team of legislators
introduced three important proposals. We support all three
bills, as noted in the record. I am especially pleased to see
that H.R. 6039 would allow graduate students to move quickly
from a student visa to a green card.
Remember it is not a question of whether the talented
graduates of our schools get jobs but only where those jobs
would be located, and if we force them to leave, the jobs
created by the world's most talented people will not be in our
country, but rather in whatever nation had the foresight to
accept them.
Today, my neighborhood is filled with workers on H-1B
visas. In the evening, while walking Heidi, my miniature
schnauzer, they tell me what they will do once they become
American citizens. They plan to start their own companies,
create exciting and profitable new products--entirely new
industries, in some cases. Why are we making them leave?
On the plane coming over, I met James Stubbs, chief science
officer of Cianna, a small 35-person medical company. They make
a cutting-edge device for treating breast cancer. They employ
two H-1Bs. One is from Costa Rica and is in their advanced
research R&D. The other is from India and does field research.
Both of these H-1Bs are integral to the success of their
company. Do you want the company to be successful for 6 years
or 30 years?
Temporary visas like H-1B do nothing to enhance America's
long-term competitiveness. They are a short-term fix that will
weaken us in the long run. The H-1B visa is a great way to
train our overseas competition but is an awful way to build our
workforce.
Innovative companies do not need innovative people for 6
years. They need them for 30. Moreover, H-1B visa engineers are
easy to exploit, harming both American and foreign engineers.
America does not need skilled temporary workers. We need
skilled Americans, and citizenship requires at least an EB
visa.
In conclusion, IEEE-USA members share the belief that
making foreign nationals with the knowledge, skills, and
determination citizens has always served America's best
interests. We urge Congress to reform the Nation's permanent
employment-based admissions system. An integration policy based
on the concept of green cards, not guest workers, will help
America create jobs, maintain its technological
competitiveness, and ensure our success.
The goal of U.S. immigration policy should be to facilitate
the entry of talented people, including potential inventors,
innovators, and entrepreneurs from other countries. Congress
should grant them legal permanent resident status and put them
on a path to full-fledged American citizenship.
Thanks, Congresswoman Lofgren and fellow Committee Members,
for the opportunity to speak to you about the future of the
United States of America. Congress, please pass the Lofgren
bill.
Thank you.
[The prepared statement of Mr. Colby follows:]
Prepared Statement of Lee Colby
Thank you for inviting me to speak today. My name is Lee Colby and
I am testifying today as a member of the Institute of Electrical and
Electronics Engineers-United States of America (IEEE-USA). The
Institute of Electrical and Electronics Engineers (IEEE) is a multi-
national professional/technical society made up of more than 375,000
individual electrical, electronics, computer and software engineers in
150 countries. IEEE-USA promotes the professional careers and
technology policy interests of IEEE's 215,000 U.S. members, 22% of whom
were born in other countries.
I have been a professional electrical engineer in Silicon Valley
for almost fifty years. In fact, I was in Silicon Valley when it was
still known as the Valley of Hearts Delight. For the first 36 years of
my career I worked as an electrical engineer for Hewlett-Packard. I
left HP in 1997 and started Lee Colby and Associates which consults on
circuit designs for some of the world's leading technology firms. In
2000 I decided to try my hand in a technology start-up, O'LE
Communications.
It was at O'LE that I had my most direct experience with our
immigration system. We employed about 24 employees, half in Taiwan and
half in the U.S. During the dot.com boom, we had trouble finding
American workers, so we turned to the H-1B program. When the dot.com
boom burst, those workers were unable to transfer to another company
and so had to leave. This is not uncommon. H-1B workers are,
effectively, tied to their employer, creating a dependency that is both
unjust and harmful. It would have been better if we could have hired
all of our workers as permanent residents, but that is simply not a
practical option, especially for small firms.
In 2005, I served as Chair of IEEE's Santa Clara Valley Section,
representing over 13,000 electrical, electronics and computer engineers
in the San Jose area. I also volunteer as a math and science teacher's
assistant at the Sunnyvale Middle School and teach a class on fuel and
solar cells for advanced high school students at San Jose State during
the summer.
In other words, I know the technology sector inside and out. For
almost 50 years I have been deeply involved with cutting edge
technology and the men and women who developed it. I understand the
problems faced by engineers and employers. And I believe the approach
to high-skill immigration reform being offered by Chairwoman Lofgren is
a good one for all of the parties involved.
importance of education, infrastructure and immigration for us economic
and technological competitiveness
Continuing US economic and technological leadership in the 21st
Century will depend in no small part on the nation's ability to marshal
the resources and the will to:
1) increase high quality educational opportunities for US
students at all levels, especially in critical disciplines like
math and science;
2) improve America's high tech infrastructure, including its
basic and applied research and development capabilities; and
3) enact immigration reforms that will give priority to the
legal permanent admission of persons with the knowledge, skills
and talents needed to sustain America's unparalleled tradition
of invention, innovation and entrepreneurship.
Balanced reforms in the nation's legal permanent and temporary
admissions programs are particularly important if U.S. employers and
U.S. workers are to compete and succeed in an increasingly knowledge-
based, technology-driven global economy. Instead of becoming more
dependent on temporary non-immigrant visa programs, like the H-1B,
IEEE-USA recommends that Congress make permanent immigrant admissions
programs the preferred option for adding skilled and educated workers
to our economy.
To this end, IEEE-USA urges Congress to put aside longstanding
partisan differences and take immediate steps to:
1) Increase the availability of permanent, employment-based
(EB) visas and streamline the immigrant admissions (Green Card)
process in order to make these visas the preferred path to
legal permanent resident status and full citizenship for
foreign professionals in STEM fields,
2) Allow foreign students who earn advanced degrees in STEM
fields from U.S. colleges and universities to transition
directly from temporary student visas to legal permanent
resident (Green Card) status,
3) Reform the H-1B temporary work visa program to ensure that
U.S. and foreign workers are treated fairly by requiring all
participating employers to make good faith efforts to recruit
U.S. workers, to use the H-1B program to augment, not replace
American workers and to pay H-1B workers fair, market-based
wages, and
4) Expedite visa processing for trusted short-term visitors,
including foreign professionals who come periodically to attend
conferences and meetings, to teach, or to conduct research in
the United States.
two lofgren bills address permanent employment-based admissions
Earlier this year, House Immigration Subcommittee Chair Zoe Lofgren
and a bipartisan team of like-minded legislators introduced three
important permanent immigrant admissions reform proposals. Two of these
bills make simple, easy to implement reforms that will reduce the
waiting times that talented people--and their prospective employers--
must currently endure before they can be admitted permanently to live
and work in the United States.
HR 5882 will help to reduce the backlog for highly
skilled admissions by recapturing an estimated 220,000
employment-based Green Cards that were not issued between 1992
and 2007 due to bureaucratic inefficiencies.
HR 5921 will further reduce administrative backlogs
and waiting times by eliminating per country limits on
employment-based admissions from high demand countries like
India, the Philippines and Mexico. If the U.S. needs to add
skilled workers to our economy, and I think we do, why do we
care which countries they come from?
I believe there are at least two additional reforms that Congress
should consider to further increase the availability of immigrant visas
for foreign-born high tech professionals.
One would be to raise the statutory admissions ceiling on permanent
employment-based visas. The current 140,000 annual limit is unduly
restrictive and should be expanded.
Another would be to exclude spouses and minor children from the
annual cap. Such a step would free up as many as 60,000 additional
employment-based visas per year for the exclusive use of principals,
including high tech professionals.
third lofgren bill addresses high tech talent retention problems
Representative Lofgren's third proposal--and an identical bill, S.
3084, recently introduced by Senators Barbara Boxer (D-CA) and Judd
Gregg (R-NH)--addresses a growing high tech talent retention problem
that adversely affects many U.S. businesses, educational institutions
and government agencies.
HR 6039 will exempt foreign nationals with advanced degrees in STEM
fields from U.S. educational institutions from the limits on permanent
employment-based admissions. If enacted, this reform will enable
foreign students with U.S. graduate degrees in technology-based
disciplines to get Green Cards upon completion of their studies rather
than having to return to their home countries or remain here for as
long as a decade on a temporary (non-immigrant) visa until a Green Card
becomes available.
Graduates from American schools are among the most sought after
employees in the world. This is especially true of students who receive
Masters and PhD degrees in STEM fields. America has already invested in
these students' education. The students speak English, have lived here
for several years and, to qualify for an employment-based visa, have a
job. It is in America's interest and Americans' interest that we allow
them to put their talents and education to work here.
Remember, it is not a question of whether the talented graduates of
our schools will get jobs, only of where these jobs will be located. If
we force them to leave, the jobs they create will not be in this
country, but rather in whatever nation had the foresight to accept
them.
IEEE-USA and the Semiconductor Industry Association (SIA)--two
groups that have long been on opposite sides of the table on temporary
work visa issues--have joined forces to promote prompt enactment of all
three Lofgren proposals. Our two organizations are very encouraged by
the possibility that Chairwoman Lofgren's reform bills will help to
shift the focus of the debate about high tech immigration away from the
controversial H-1B program to immigration reform proposals on which
America's business organizations, educational institutions, labor
unions and professional societies are more likely to agree.
why immigration is better than temporary visas
My beliefs on this subject have been informed by my 50 years as an
electrical engineer and my deep involvement with the engineering
community. During my service as Chair of IEEE's Solid State Circuits
Society Chapter in San Jose, 15% of our members, all highly trained
engineers, were without jobs. I have had friends replaced by H-1B visa
holders and had friends have their jobs moved overseas. I have seen
companies, including my own, lose business opportunities because they
could not find the right skilled people. I have also lost some of my
best employees and friends when their H-1B visas expired, forcing them
to leave the country.
Today, my neighborhood is filled with workers on H-1B visas. While
walking my miniature schnauzer in the evening, they tell me what they
will do once they become American citizens. They plan to start their
own companies, create wondrous (and profitable) new products, entirely
new industries in some cases. What I would like to know is: Why are we
making them wait, and making our country wait, before letting them
fully contribute to our society? How is this in our country's interest?
The United States needs more skilled engineers and scientists. We
need to educate more of our own students in these fields, but the
United States does not have a monopoly on talent. There are hard
working, innovative and smart people all over this planet, many of whom
would apply their skills here, if given a chance. Congress needs to
give them that chance.
But how that opportunity is offered counts more than the offer
itself. Temporary visas, like the H-1B, do little to enhance America's
long-term competitiveness. They are a short-term fix that will weaken
us in the long-run.
The H-1B visa is a great way to train our overseas competition, but
it is an awful way to build our workforce. Innovative companies do not
need innovative people for six years--they need them for thirty.
Moreover, the subservient position H-1B visa place workers in makes
them easy to exploit, harming both American and foreign engineers.
America does not need skilled temporary workers. We need skilled
Americans. And American citizenship requires an EB visa.
conclusion
IEEE-USA is convinced that welcoming foreign nationals with the
knowledge, skills and determination needed to succeed and making them
citizens has always served America's best interests. Accordingly, we
urge Congress to make needed reforms in the nation's permanent,
employment-based admissions system rather than simply raising the H-1B
visa cap. We firmly believe that an immigration policy based on the
concept of ``Green Cards, Not Guest-workers'' will do far more to help
America create jobs, maintain its technological competitiveness, and
ensure its economic and military security than continuing to rely on
temporary admissions programs.
The goal of U.S. immigration policy should be to facilitate the
entry of talented people--including potential inventors, innovators and
entrepreneurs from other countries. Congress should grant them legal
permanent resident status and put them on a path to full-fledged
American citizenship.
Congress should pass the Lofgren EB reform bills.
Ms. Lofgren. Thank you very much, Mr. Colby.
We are now going to adjourn to vote on the floor of the
House. We will recess, and I think we will not be back before
12:15. Let's say we will be back at 12:25, if at all possible.
There is a cafeteria and coffee shop in the basement, if people
want to get a cup of coffee, and we will see you, we hope,
about 25 minutes after 12.
[Recess.]
Ms. Lofgren. So the Subcommittee will come back to order,
with apologies to all for the interruption.
We are eager, however, to hear the rest of our witnesses as
well as the second panel. I think we have a window of about an
hour and a half before the next set of votes.
So we will proceed promptly to Mr. Pearson.
STATEMENT OF JOHN PEARSON, DIRECTOR OF THE BECHTEL
INTERNATIONAL CENTER, STANFORD UNIVERSITY, ASSOCIATION OF
INTERNATIONAL EDUCATORS
Mr. Pearson. Madam Chairwoman and distinguished Members of
the Subcommittee, thank you very much for the opportunity to
testify this morning in support of H.R. 6039.
My name is John Pearson, and I am director of the Bechtel
International Center at Stanford University. I am testifying
today on behalf of my professional association, NAFSA, the
Association of International Educators. NAFSA is the world's
largest professional association dedicated to the promotion and
advancement of international education and exchange. I am also
testifying with support from Stanford.
My remarks today will focus on the broad challenges the
United States now faces in attracting and retaining
international students. Of specific interest, of course, is the
current law capping the number of green cards issued annually,
even to those who graduate from U.S. colleges and universities
with higher degrees.
The United States is in a global competition for
international students and scholars. That may seem like an
unremarkable statement, but often U.S. law and policy does not
always reflect an understanding of this reality.
Though the U.S. is renowned and still renowned for being
home to the majority of the top colleges and universities in
the world, the international student market is being
transformed in this century. There are many new players in the
game, acting much more purposefully and strategically than ever
before.
Competitor countries have implemented strategies for
capturing a greater share of this market. Their governments are
acting to create more streamlined visa and entry processes and
more welcoming environments and are setting goals for
international student recruitment.
Our neighbor, Canada, recently changed its employment
policy to allow international graduates to work for up to 3
years after graduation, and, in fact, Canada does recruit
international students on our own campuses, including my own.
They have visited Stanford three times in the last few years to
talk to students about opportunities in Canada.
At Stanford, we have been recently dealing with the
homeland security extension on practical training for STEM
students. A broader context is that France, Germany, the United
Kingdom, and Canada have all made similar changes to the
possibilities for international students remaining in those
countries and working after graduation.
New competitors will also enter the market for
international students. Primary among them is the European
higher education area which compromises the signatories to the
Bologna Declaration. This goal is to create a seamless higher
education system in Europe by 2010 with credits entirely
transferrable among their higher education institutions and
often instruction in English. The European Union is also
considering a blue card, similar to our green card, to be more
competitive for non-European talent.
Other countries are recognizing the value of educating the
next generation of leaders and attracting the world's
scientific, technological, and intellectual elite. U.S.
immigration law and policy has not yet effectively been adapted
to this era of globalization. My own institution has been
witness to this, as we also offer services to hire foreign-born
faculty and researchers.
But even so, many of the best and the brightest around the
world still wish to come here and study. We should welcome them
by creating a clearer path to green card status for them that
is not tied to these low caps on the green cards available
annually.
In a global job market, employers look for the talent they
need wherever they can find it, and students and highly
talented workers look for the places to study and work that
offer them the most opportunity. This means the options for
employment after graduation are integral to attracting bright
and talented international students.
Employment prospects are often a part of their calculus in
deciding where to study, work, and live. Not all students who
arrive in the U.S. wish to remain. Some have commitments to
their home country. But others discover their potential in the
environment of U.S. higher education and their career and life
goals are changed. Google, Hotmail, Yahoo are some examples in
Stanford's own backyard of former students who have remained in
the United States.
I do not think it is a secret that U.S. immigration law
often makes it difficult for international students to work
after graduating, even from the most prestigious U.S. higher
education institutions. The annual H-1B cap lottery is reported
internationally, highlighting that the entire annual allotment
is depleted in a day or two.
In conclusion, what better way to capture the world's best
and brightest who want to become part of our Nation than to
make it easier for them to remain to contribute to American
economic and scientific leadership after they graduate from
U.S. universities? It is with these comments that I am
delighted to support H.R. 6039.
Thank you very much.
[The prepared statement of Mr. Pearson follows:]
Prepared Statement of John Pearson
Madam Chairwoman and distinguished Members of the subcommittee,
thank you very much for the opportunity to testify this morning in
support of H.R. 6039. My name is John Pearson and I am the Director of
the Bechtel International Center at Stanford University. I am
testifying today on behalf of my professional association, NAFSA:
Association of International Educators. NAFSA is the world's largest
professional association dedicated to the promotion and advancement of
international education and exchange, with over 10,000 members. Last
month NAFSA had its 60th annual conference in Washington, DC, with over
9,000 attendees. I also testifying with support from my own institution
My remarks today will focus on the challenges the United States now
faces in attracting and retaining international students. Of specific
interest today is the current law capping the number of green cards
issued annually, even to those who graduate from U.S. colleges and
universities with degrees. This limitation on the talent in high demand
by our knowledge- and innovation-based economy will make it
increasingly difficult to attract and retain these bright and talented
students with every passing semester.
i. a global competition for international students
The United States is in a global competition for international
students and scholars. That may seem like an unremarkable statement,
but U.S. law and policy do not always reflect an understanding of this
new reality. Though the United States is renowned for being home to the
majority of the top colleges and universities in the world, the
international student market is being transformed in this century.
There are many new players in the game, acting much more purposively
and strategically than ever before. Consequently, the best and
brightest from around the globe are now aggressively recruited, and are
able to choose from more options than ever before.
Competitor countries have implemented strategies for capturing a
greater share of the market. The UK and Australia are the classic
examples. Their governments are acting to create more streamlined visa
and entry processes and more welcoming environments, and are setting
increasingly aggressive goals for international student enrollment. Our
neighbor, Canada, recently changed its employment policy to allow
international graduates to work for up to three years after graduation.
Canada recruits our international students on our campuses, including
my own, highlighting Canada's more liberal employment policies. That is
not to say that our competitors don't have their own problems--they do.
But we are not acting as strategically to take advantage of their
weaknesses as they are to take advantage of ours.
New competitors have entered the market. Primary among them is the
European Higher Education Area, which comprises the signatories to the
Bologna Declaration, including the European Union and other European
states. The goal is create a seamless higher education system by 2010,
with credits entirely transferable among their higher education
institutions. Potentially, all the European higher education systems
will work together with free movement of students among them as a
counterpart to the United States. The EU is also considering a ``Blue
Card'' similar to our green card to be more competitive for non-
European talent.
Furthermore, countries once thought of as ``sending countries'' are
building their indigenous higher education capacity and are encouraging
students to stay home for their education so as not to lose them to the
United States. China is engaged in a dramatic expansion and opening of
its higher education system, and India is also emphasizing keeping its
students home.
ii. green cards for u.s. graduates
Other countries are recognizing the value of educating the next
generation of world leaders and attracting the world's scientific,
technological, and intellectual elite. U.S. immigration law and policy
have not yet effectively been adapted to the era of globalization. My
own institution is witness to this, but it is not alone. Even so, the
best and the brightest still want to come here. We should welcome them
by creating a clearer path to green card status for them that is not
tied to unnecessarily low caps on the green cards available annually.
In a global job market, employers look for the talent they need
wherever they can find it, and students and highly talented workers
look for the places to study and work that offer them the most
opportunity. This means that options for employment after graduation
are integral to attracting bright and talented international students.
Employment prospects are now a part of their calculus in deciding of
where to study, work, and live. Not all students who arrive to study in
the U.S. wish to remain; some have commitments to their home country.
But others discover their potential in the environment of U.S. higher
education and their career and life goals are changed.
It is no secret that U.S. immigration law makes it difficult for
international students to work after graduating, even from the most
prestigious U.S. higher education institutions. The annual H-1B cap
lottery is reported internationally, highlighting that the entire
annual allotment is depleted in a day or two. But the truth behind the
overwhelming demand for H-1Bs is that many if not most of the
applicants would rather be applying for a green card, but are unable to
do so because of backlogs and delays. It is fair to say that many
employers would also like to be able to make some of these students
permanent employees sooner, rather than later.
It does not make sense that in a global competition for highly
educated and talented workers, we turn away the graduates from our
colleges and universities. This is doubly true for those graduating
with Master's degrees and Ph.Ds. When they leave the United States,
they go to work in other countries for companies that often directly
compete with American companies.
What better way to capture the world's best and brightest who want
to become part of our nation than to make it easier for them to remain
to contribute to American economic and scientific leadership after they
graduate from U.S. universities? Our ability to remain competitive and
build our innovation- and knowledge-based economy requires that our
laws reflect the reality of the global market for talent for
international students and highly educated workers. Creating a clearer
path to green card status for graduates from U.S. colleges and
universities, in STEM subjects, would be a serious step in showing that
we have a commitment to continuing to be the leader in international
education and in industry.
Madam Chairman, appended to my testimony is NAFSA's 2006 report,
Restoring U.S. Competitiveness for International Students and Scholars,
which I ask to be included in the record.
Thank you again for the opportunity to testify. I will be pleased
to respond to questions.
ATTACHMENT
Ms. Lofgren. Thank you very much, Mr. Pearson.
Dr. Yang, we would be delighted to hear from you.
STATEMENT OF YONGJIE YANG,
LEGAL IMMIGRANT ASSOCIATION
Mr. Yang. Good afternoon, Madam Chairwoman and Congressman
King and Members of the Committee.
I want to first thank the representative, Congresswoman Zoe
Lofgren, for giving this opportunity for me to testify here,
and I would like to share my personal experience on permanent
residence application with this panel, and along with other
people's testimony, I would like to draw attention for the
America's need to change the laws regarding the highly skilled
immigrants.
My name is Yongjie Yang. I was born in China and came here
in 2000 when I was admitted to the neuroscience center genetics
program in Iowa State University, and there I basically focused
on the mechanisms for environmental toxin-induced nerve-cell
degeneration, which is highly relevant to the Parkinson disease
research. I was awarded Ph.D. degree in genetics and the
neuroscience in 2005. That same year, my wife also was awarded
the master degree from also Iowa State University.
Currently, I am now a research scientist in the department
of neurology at Johns Hopkins University, and my current work
also focuses on the pathogenic mechanisms in neurodegenerative
diseases, including Alzheimer disease, Parkinson's disease, and
amyotrophic lateral sclerosis, also known as Lou Gehrig's
disease.
Our lab is one of the best leading labs in the research of
this disease in the world. By better understanding the
pathogenic mechanism for the disease, we hope to develop an
effective neuroprotective strategy to cure or delay the
progression of this disease. We hope to find the cure here.
On a personal note, I married my wife while we were both at
Iowa State University, and my wife also works at Johns Hopkins
University as a specialist in Parkinson's disease research. We
have a U.S. citizen daughter who is about 4 year old, and we
recently just bought a house in Ellicott City, Maryland. So we
do plan to stay here long.
I currently have an H-1B visa status, which will expire
next year. Although I have filed my immigrant visa petition in
May, 2006, and got approved last year, February, but I have not
received my green card yet because of the severe backlog of the
employment-based visa numbers, and I do not know now because of
the situation how long I have to wait before I can become the
permanent resident and also become the U.S. citizen.
I would like to emphasize the three major obstacles that
the immigration status poses on my situation as well as other
people's.
The first one is because of the unavailability of the green
card, I am not available to apply for many Federal grants from
National Institute of Sciences or from National Institute of
Health or National Science Foundation and from other Federal
agencies, although my research is very promising to identify
the direct target to cure or delay the ALS.
The second obstacle is because of the situation, not me,
but some other people who share the similar background as me
cannot work for the Federal agencies, such as FDA, NIH, or
other Federal agencies, although they possess specialized skill
that is very much needed for these agencies.
The third obstacle, obviously, is the travel inconvenience.
For example, last year, I had opportunity to go to London for
international conference, which is very important in my field,
but I could not go because if I go, I have to go back to China
to re-apply for my H-1B stamp and then come back to Baltimore
which will take months. So opportunity like this got wasted,
and for my specific research, it is vital to have discussion to
meet with colleagues to talk about the latest research
progress, and that is also a problem to establish the long-term
collaboration with your international colleagues.
So, as I understand it, the whole point of the employment-
based immigration system is to keep the brightest, the best of
the foreign minds, people in this land, in this land of
opportunities. However, we cannot become the U.S. citizen
before we got the green card, the permanent residence. Because
of all these problems, we cannot travel freely, we cannot apply
for some Federal grants, we cannot apply jobs for the Federal
agencies, even though we are doing very cutting-edge researches
and developing important technologies and which might create
new job opportunities for the U.S.
The Legal Immigrant Association I represent was formed by
scientists, engineers, and other professionals in the United
States. Most of us received advanced degrees from United States
academic institutions, and most of us are also from China, and
we are doing the petitioning to let the Government know and the
Congress know what we need to let our voice be heard.
So, on behalf of the LIA, I want to thank the Congress, the
Subcommittee, for giving this opportunity, and I urge you to
pass the legislation that would benefit eventually America by
recognizing that putting highly skilled, highly educated people
like us directly on the path to U.S. citizenship, and this will
eventually benefit the best interests of the United States.
Thank you.
[The prepared statement of Mr. Yang follows:]
Prepared Statement of Yongjie Yang
Madam Chairwoman, Congressman King, Members of the Committee. Good
morning. I am honored and grateful to share my experiences with this
panel, and I hope that these will highlight America's need to change
the laws regarding high-skilled immigrants.
My name is Yongjie Yang. I was born in China and have lived in the
United States since 2000 when I entered the graduate program in
neuroscience and genetics at Iowa State University. I was awarded a
Ph.D. in 2005, the same year my wife got her Master's, also from Iowa
State, which is known throughout the world as a leading institution in
my field.
I am now a research scientist at Johns Hopkins University in
Baltimore. I investigate pathogenic mechanisms in neurodegenerative
diseases. That is, I am helping to advance human knowledge about how
certain kinds of diseases develop, including Alzheimer's , Parkinson's,
and ALS, which is also known as Lou Gehrig's disease. Our lab is one of
the leading labs in the research of Lou Gehrig's disease in the world.
All of these cruel and often fatal diseases have certain
characteristics in common. Scientists all over the world work on
understanding these common characteristics, noting similarities and
differences, seeking to find effective therapies.
We all hope to find a cure.
On a personal note, I married my wife while we were both at Iowa
State University. She is also a specialist in neurodegenerative
diseases. We have a US citizen daughter and just bought a house in
Ellicott City, Maryland.
I have H-1B status, which will expire next year. My immigrant visa
petition was approved more than a year ago, in February 2007. That
means that the U.S. government formally recognized that my skills are
needed in this country--but there will not be an immigration visa
available for me until at least 2009, if not much later. In fact, no
one knows when I will finally be allowed to get on the path to US
citizenship.
I need to emphasize the unnecessary obstacles my immigration status
poses for the kind of vital research that I do. Let me explain--
scientific research is collaborative. It thrives on free inquiry,
debate and accountability. It doesn't matter whether the field is
chemistry or physics or medical, like mine: we scientists need to work
with and respond to each other's work to move forward. We need to talk
and travel freely. And our work benefits humanity--we really can cure
diseases now, provide effective therapies to relieve pain and
suffering, in ways that weren't possible just a few years ago. And
there is always something better, even more effective, just beyond the
edge of our knowledge. We seek that.
As I understand it, the whole point of the employment-based
immigration system is to turn highly-skilled foreigners into Americans,
to keep talent in the land of opportunity. To do that, the system needs
to keep us here. We cannot become US citizens until we have been legal
permanent residents. We cannot travel freely; we cannot take many
government jobs or receive many Federal grants, without the green
card--even though we are often doing very promising research or
developing cutting edge technologies which can have significant
economic job-creating potential. It's discouraging.
Johns Hopkins wanted to pay for me to go to an international
conference in London last year, the 8th European meeting to discuss
glial cells in health and disease. These are a particular kind of cells
in nervous systems vital to normal brain function. But in order to get
the new visa that I would need to re-enter in H-1B status after
traveling from Baltimore to Britain, on the way back I would have first
had to travel to China and wait for my new visa to be issued. My work
for a cutting edge American research facility regarding new discoveries
in pathogenic mechanism's research would have sent me to Europe, but
the visa process required that I re-enter from China. The paperwork
alone would have taken so long, I didn't go.
The Legal Immigrant Association was formed by scientists, engineers
and other professionals in the United States. Most of Us are from
China. We are learning how to be Americans. My story is not unique. One
member of LIA is the database manager for clinical trials seeking a
cure for cancer. He has also been approved for permanent residency--yet
he still has only temporary permission to work in the US. Do we really
want him to go back to China? He wants to stay here. Another member, in
Texas, is an entrepreneur unable to raise money for a nano-technology
business he would like to start, because even though he is eligible for
a green card, there are none available. Do we want him to go back to
China, to create those jobs there, when he wants to stay and create
them here?
LIA members with advanced degrees from American universities do
cutting edge research in high-tech fields that can help cure diseases
and solve problems, creating jobs for Americans in America--but the
immigration system simply does not work in America's interest.
We know this from the inside.
On behalf of LIA, I want to thank the Subcommittee for inviting me
to testify, and I urge you to pass legislation that can benefit America
by recognizing that putting highly skilled, highly educated people like
us directly on the path to US citizenship is in America's best
interest.
Thank you.
Ms. Lofgren. Thank you very much, Dr. Yang.
And we will end with Mr. Krikorian.
STATEMENT OF MARK KRIKORIAN, EXECUTIVE DIRECTOR, CENTER FOR
IMMIGRATION STUDIES
Mr. Krikorian. Thank you, Madam Chairwoman, for the
opportunity to be the skunk at the garden party.
The public is assured that employment-based immigration
categories in our law is Einstein immigration. Even many of
those concerned about the harmful impacts of low-skilled
immigration often take for granted that higher skilled workers
are needed.
But like everything else in immigration policy, skills-
based immigration is not what it seems. Once we peel away the
misconceptions, we find that the highly skilled workers in
question often really are not that highly skilled, and the need
for them is really more an employer need for cheaper labor.
First, a couple of numbers. Last year, 162,000 or so
foreigners were granted legal permanent residence in the five
employment-based categories. More than half of them were in the
third category, EB-3, which is for skilled workers and
professionals, though a majority of those were really for
family members, and this is the category that is at the center
of the discussion about the supposed need for high-skilled
workers.
Research shows that, contrary to the claims of lobbyists,
these workers are not necessarily the best and brightest. Dr.
Norman Matloff, professor of computer science at UC-Davis, has
found that there is no premium paid to foreign workers in
science, technology, engineering, and mathematics whose
employers are petitioning for green cards. In a market economy,
if these foreign workers were indeed the outstanding talents we
are told they are, they would be paid accordingly with wages
far above the prevailing wage, and they are not.
What is more, Dr. Matloff has found that the large majority
of these foreign workers are hired in the two lowest levels of
ability, according to the Labor Department's classifications
and thus unlikely to be contributing much to innovation. In
fact, most of the large tech firms had only a handful of
workers in the highest skill level category where the
innovations are most likely to be found. As he summed up, ``the
vast majority of the foreign workers, including those at most
major tech firms, are people of just ordinary talent doing
ordinary work. They are not the innovators the industry
lobbyists portray them to be,''
And we see a similar situation looking at H-1B visas that
are the supposedly temporary visas that serve as a stepping
stone to much of employment-based immigration, with software
expert John Miano finding the overwhelming majority of them are
not highly skilled for their occupations and are paid well
below the median for comparable American workers.
So what should our skills-based immigration program look
like? The first thing to keep in mind is that in today's
America ``skilled'' does not mean what it did a century ago in
the Ellis Island era. Then a high school graduate anywhere in
the United States was unusual and a college graduate was rare
indeed.
Today, with Americans having attained dramatically higher
levels of education, any foreigner asking to be admitted based
on exceptional skills would need to demonstrate even greater
levels of accomplishment acquired abroad without subsidies from
the American taxpayer, and every foreign student is subsidized
to the tune of thousands of dollars by the taxpayer to justify
admission.
And another very important point is that the admission of
large numbers of technical workers or other skilled workers
would have a perverse long-term effect by decoupling American
business from the fate of the American educational system,
since companies could simply import their workers from abroad.
Business is the country's single most important interest group,
and if it is true that American students are not being
adequately trained for the technical jobs of tomorrow, mass
skilled immigration actually frees American firms from the need
to pressure lawmakers and schools for whatever educational
reforms might be needed to address the problem.
For instance, if hospitals and other firms had easy access
to foreign nurses, for instance, then the incentive to build
those new nursing skills and the other things that Congressman
Conyers referred to is simply not there or is dramatically
reduced.
There is really no reason any employer should be permitted
to make an end-run around our flexible dynamic labor force of
150 million people unless the prospective immigrant in question
has unique, remarkable abilities. One way to do that would be
simply to give green cards to anybody who scores 140 on an
English language IQ test. It certainly would be preferable than
this H-1B business that Dr. Yang rightly criticized.
Another way to do that, maybe a more practical way, would
be to use the current system but limit it to the genuinely best
and brightest category, EB1-1 and EB1-2. Those are the aliens
of extraordinary ability and outstanding professors and
researchers.
Congress, in fact, in the legislative history of the
immigration law specifically said, ``that that visa is intended
for the small percentage of individuals who have risen to the
very top of their field of endeavor.''. That is Einstein
immigration, if you will, and those are the only foreign
citizens who should be granted special immigration rights based
on their skills.
Last year, we gave about 11,000 green cards to people in
that category, including family members, and, you know, we
could easily cap that at 15,000 or not have any cap at all if
the standards were high enough because, after all, if we are
talking about the immigration of geniuses, how many geniuses
really are there in the world?
Thank you.
[The prepared statement of Mr. Krikorian follows:]
Prepared Statement of Mark Krikorian
``Einstein immigration.''
This is what Americans imagine our employment-based immigration
categories to be. Even many of those concerned about the harmful
impacts of low-skilled immigration into a modern society still often
take for granted that higher-skilled workers are beneficial--hence the
title of this oversight hearing, ``The Need for Green Cards for Highly
Skilled Workers.''
But like everything else in immigration policy, skills- and
employment-based immigration is not what it seems. Once we peel away
the misconceptions, we find that the ``highly skilled'' workers in
question aren't really that highly skilled, and the ``need'' for them
has little to do with the national interest and much to do with firms
seeking cheaper and more compliant workers. In fact, the employment-
based immigration category with the highest standards, the category
that really does select for the best and brightest around the world, is
never fully used, precisely because there are so few people in the
world who have such extraordinary abilities.
First a few numbers. In FY 2007, 162,176 foreigners were granted
legal permanent residence in the United States in the five employment-
based categories. More than half of these--85,030--are in the third
employment-based category, or EB-3, for skilled workers, professionals,
and others, though a majority (48,275) of those green cards are
actually for the spouses and children of such workers. It's this
category that is at the center of the discussion about the ``need'' for
``highly skilled'' workers.
Research shows that, contrary to the claims of tech-industry
lobbyists, these workers are not the best and brightest, the cream of
the crop, the global elite of talent. Dr. Norman Matloff, a professor
of computer science at the University of California, Davis, recently
calculated the premium paid to foreign workers in science, technology,
engineering, and mathematics whose employers are petitioning for green
cards. He did this by computing the ratio of their salaries to the
prevailing wage for that occupation. In a market economy, if these
foreign workers were indeed outstanding talents they would be paid
accordingly, with wages far above the prevailing wage.
They're not. In his report (``H-1Bs: Still Not the Best and the
Brightest,'' May 2008, http://www.cis.org/articles/2008/back508.html),
Dr. Matloff called the ratio the ``Talent Measure''--the higher the
number, the greater the premium employers were paying for the worker's
talents compared to the wage paid to other workers in the same field
with comparable experience. Dr. Matloff found that the Talent Measure
was at or near 1.0 for virtually all the professions and tech firms he
studied--i.e., they are average workers in their fields. (By
definition, the ratio cannot be lower than 1.0, since employers are
barred law from paying below the prevailing wage.) He concluded that
``the vast majority of the foreign workers--including those at most
major tech firms--are people of just ordinary talent, doing ordinary
work. They are not the innovators the industry lobbyists portray them
to be.''
What's more, Dr. Matloff found that the large majority of these
foreign workers are hired at the two lowest levels of ability,
according to the Labor Department's classification, and thus unlikely
to be contributing much to innovation. In fact, most of the large tech
firms had virtually no workers in the highest skill level, where
innovators are most likely to be found, despite the fact that it is
these very firms which argue that innovation depends on their ability
to import foreign workers.
And looking at H-1B visas, the ``temporary'' visas that serve as a
stepping-stone to employment-based immigration, paints the same
picture. Software expert John Miano has looked at the employer
applications for H-1B workers, and found that the overwhelming majority
are not highly skilled for their occupations and are paid well below
the median for comparable American workers. And he concluded in ``Low
Salaries for Low Skills: Wages and Skill Levels for H-1B Computer
Workers,'' April 2007, http://www.cis.org/articles/2007/back407.html:
The newly available data on skills suggest one of two things is
happening, neither of which is consistent with the claims of
employers pushing for the expansion of the program. Either the
H-1B program is used primarily to import relatively less-
skilled, entry-level, or trainee workers (and thus is of
dubious value to the American economy), or employers are lying
about these workers' skills in order to suppress their wages.
In other words, unless tech companies are engaged in a massive
conspiracy to lie to the government, the current skilled immigration
flow is not made up mainly of Einsteins, but rather ordinary workers
for their fields.
So what should our skills-based immigration program look like? The
first thing to keep in mind is that in today's America ``skilled''
doesn't mean what it did a century ago. Then, a high-school graduate
was unusual, and a college graduate was rare indeed; in 1910, only 13
percent of American adults had graduated high school and fully one-
quarter had no more than five years of schooling. At the same time,
only 2.7 percent of Americans had college degrees. Today, with
Americans having attainted dramatically higher levels of education, any
foreigner asking to be admitted based on high skills would need to
demonstrate even greater levels of accomplishment--acquired abroad,
without subsidy from the American taxpayer--to justify admission.
Also, the admission of large numbers of technical workers would
have a perverse long-term effect--it would decouple American business
from the American educational system, since companies could simply
import workers from abroad. Business is the single most important
lobbying group at the federal, state, and local level, and if it's true
that American students are not being adequately trained for the
technical jobs of tomorrow, mass skilled immigration frees American
firms from the need to pressure lawmakers and schools for whatever
educational reforms might be needed to address this problem.
Thus there's no reason any employer should be permitted to make an
end run around our vast continental labor force of more than 150
million people unless the prospective immigrant in question has unique,
remarkable abilities, and would make an enormous contribution to the
productive capacity of the nation.
Perhaps the simplest way to approach this would be to admit anyone
who scores above 140 on an English-language IQ test. A more likely
approach would be to keep part of the current system, but limit skilled
immigration to a portion of the first employment-based category (EB-
1)--specifically, ``aliens of extraordinary ability'' and outstanding
professors and researchers. Congress intended this to be the real
cream-of-the-crop category, intended ``for the small percentage of
individuals who have risen to the very top of their field of
endeavor.''
(The EB-1 category also gives green cards to multinational
executives or managers, people who are not necessarily, as anyone who
reads the business pages knows, the best and the brightest.)
These two groups--``aliens of extraordinary ability'' and
outstanding professors and researchers - accounted for about 11,000
green cards last year (including spouses and children). This is the
real Einstein immigration, and these are the only foreigners who should
be granted permanent residence based on skills or employment. We could
do without a numerical cap altogether, so long as standards for
admission are set sufficiently high, but to prevent ``bracket creep,''
as it were, it might be best to cap such immigration at 15,000 per
year. After all, how many geniuses are there in the world?
Ms. Lofgren. Thank you, Mr. Krikorian.
And thank you to all of the witnesses.
Now is the time when Members of the Committee can pose
questions to our witnesses, and I will begin.
First, let me thank all of you for this testimony. I am
mindful that Mr. King mentioned that we have smart people who
are here from Iowa, we have smart people here from Santa Clara
County, and I am interested in exploring the role that highly
educated individuals in the STEM field play in job development
here in the United States.
I talked to Mr. Lungren on the floor and he had a conflict
because he thought we would be here just in the morning--hoping
that I would explore the situation of Microsoft opening up a
new research center in Vancouver and the whole issue of whether
the individuals we are talking about, really Ph.D. and master
levels, create new jobs as sort of team leaders and innovators
or not.
Can anyone address that? Maybe Mr. Sweeney. I mean, you
have experience--substantial experience--in the technology
industry.
Mr. Sweeney. I think that is a particularly important
point. In the semiconductor industry where we have about 80,000
U.S. engineers, we apply for green cards for typically up to
4,000 per year, 5 percent of our population. These people,
although small in number, are crucial to manufacturing process
research.
These individuals create jobs by coming up with the next
innovations of semiconductor technologies for products going
into everything from cell phones, your Blackberry, to medical
instrumentation, automotive instrumentation. In fact, it is
well documented that semiconductor engineers' productivity
gains for the United States was one of the greatest factors
over the last decade.
Most of these scientists that we hire, these master's and
Ph.D. scientists that we hire, are not the cheap labor that my
colleague referred to just a few minutes ago. These are
master's and Ph.D. students coming out of the best universities
in the U.S. They are making north of $100,000 per year, and
these are job-creating scientists.
I will give you one particular example of a scientist that
we had in our Texas factory. He was an Indian national with a
master's degree from the University of Texas-Arlington. He had
been waiting for his green card for a period of about 6 years,
and, of course, during that period, he is not permitted to be
promoted or transferred.
Most recently, we had a need in a research center, a
corporate research center, in Santa Clara to work on some new
manufacturing processes that would create jobs in our factories
in Maine and Texas. That individual selflessly gave up his
place in the green card in the queue to come and work at our
corporate headquarters, knowing that he would have to restart
his whole permanent residency application.
But he was so important to our company that we endorsed
that and we supported him because he is going to create more
jobs for us in our factories.
Ms. Lofgren. Mr. Colby, I wonder if I could ask you. As you
pointed out, the IEEE and SIA have not always agreed, but you
have come to an agreement on this. Can you tell me what brought
you to this point?
Mr. Colby. I think that what brings us to this point is
that we do need top talent from overseas. At this point, it is
difficult to get enough engineers in the United States at this
point to satisfactorily staff our R&D labs. It is somewhat
pitiful that that is the case, but that is the way it has
fallen out, and that is the reason that a lot of these
companies, including my own when I was involved with the
startup, we just could not get people come in the door for a
good salary, again over $100K--this was in 2001--and it is just
difficult to get people to be thinking along the lines of being
an engineer or something like that in the United States.
In my school, when I work in the volunteer school, the
children will come up to me and say, ``Why would you want to be
an engineer?'' and I do not really understand what has happened
in the United States, but somehow we have to correct that. In
this interim period, we definitely need talent from overseas so
we can correct this situation.
Ms. Lofgren. Can I ask maybe Mr. Pearson? You are at
Stanford, my alma mater. Certainly, I know the Bechtel Center
well. I really felt that if you have someone like Dr. Yang who
is maybe going to find a cure to Alzheimer's--I hope so--it is
not an alternative. You want to educate more American students,
but you also do not want to send Dr. Yang someplace else. You
know, we want to invent the stuff here. Do you see those in
conflict, that if we could educate more American students, then
you would want to send Dr. Yang home?
Mr. Pearson. No, I do not. I do not see that in conflict.
If you would look at the data, I think it has been from the
late 1970's that about 40 percent of all master's and doctoral
students in the STEM fields have been from overseas. I think
you can do both. Graduate programs at Stanford and at many
institutions--Iowa State I do not think would be any
exception--tend to invite people to those programs who they
consider are the best, and if they are from Napa Valley or
China, I actually do not think they look at that.
We have had at Stanford in the last few years a number of
people like Dr. Yang who have had similar struggles in waiting
for green cards. We did a few years ago lose one person who
moved back to Europe because of that. The others did work out
but after many years of frustration and consultation with
immigration attorneys.
Higher education also made the claim a number of years ago
with the H-1 changes when we were not charged the training fee
that, in fact, universities are trainers of young talent, and I
would suspect that Dr. Yang would be a classic example of
somebody from overseas who would not only contribute to better
understanding with diseases, but would also be a good teacher
and a good educator.
Ms. Lofgren. Thank you.
I can see that my time has expired.
So I am going to turn to Mr. Gutierrez for whatever
questions that he may have.
Mr. Gutierrez. Thank you. Thank you, Chairwoman.
Fifty-one percent of the master's degree students are
foreign nationals; 71 percent of Ph.D.s, electrical engineers.
They are called urgent and critical and important to the
industry, and I just have a comment on the testimony.
One could come away from this hearing and decide that if
you are educated and you have a master's degree, you are
welcome and the Congress will act to bring you and your family
together and give you permanent residency, and if you want to
remain here after you get your Ph.D. and your doctorate's
degree, then stay. There is a way for you.
If you are a farm worker who comes here under our current
system, the H-2A program, then you come only temporarily
without family, with the only expectation that after a few
years to return to your home and never stay in the United
States of America.
I think that is part of the dilemma that I have with all of
this, is should the Congress be acting for those who have
Ph.D.s and master's degrees who come here on student visas to
our country to become educated, to have their master's and
probably have a relatively good future somewhere else, but who
I would love to have them stay here.
For the record, I think we should fix the system. I think
we should give the high-tech industry the innovators that they
need and that they should be able to remain here. My point is
not that, not that I am against you. I am for you.
Expand on it then to say how do we do that at the same time
we have farm workers in pesticide-ridden fields earning low
wages and say to them, ``You are not really smart. You are not
really very educated,'' but who I could state are just as
critical and relevant to the innovation of that industry as the
Ph.D. and master degree students are to the high-tech industry.
So, yes, let's work on this, but I think let's work on it
on a holistic approach so that we can truly be proud from a
historical point of view about what we do to reform our
immigration system so that the most vulnerable among us, the
most vulnerable immigrant among us, is not somehow stigmatized
by actions of the Congress to say, ``These will go forward.''
I think there are people who are going to be against
increasing because they do not care what kind of immigrant it
is. You know, one immigrant is one immigrant too many in this
country. And so we are going to have to deal with that, but I
think the vast majority of the American people understand that
immigration is good for our country, that we need the high-tech
industry, that we need people in all kinds of industry where
maybe there are not the relevant workers and the relevant
skills as we work as Americans to create those opportunities
for our own children.
So I guess that is just my basic point. If someone would
like to comment, I would be happy to yield the time to any one
of the participants.
Mr. Sweeney. Congressman Gutierrez, thank you for your
comments.
I would say that the Semiconductor Industry Association has
been supportive generally of an overhaul of our entire
immigration process because we see many flaws, but I would also
say that our industry association is dealing with the day-to-
day criticalities of the loss of job-creating talent in our
country.
Every day that passes, we see more and more people who have
been waiting in a permanent residency queue leaving our shores
to go back to their own location where they are creating jobs
to compete against us. This is just a travesty after we have
invested so much effort in theses scientists, these highly
talented individuals in our country.
I would say that one of the other things the semiconductor
industry feels is that despite the need for a comprehensive
view of this, we feel that there is an urgent requirement to
address this high-skilled immigration problem immediately. I
will say, however----
Mr. Gutierrez. That clock is on yellow.
I agree with you. I want to address it. Try to put what you
just said in the context of someone who is an American citizen,
and there are millions of American citizen children whose
parents are on the threat of deportation today, whose parents
have already been deported and have been separated from them.
Put yourself in a meat-packing plant in Pottsville, Iowa,
where you have been indicted for working with false
documentation, basically working undocumented, and the
prosecutor asks for a 5-year sentence. When you put that in
juxtaposition to your critical area, that is--I am just trying
to stress to you, you know, we are all in this together. I want
to help, but the most--how would I say it--vulnerable among us
must be responded to, I think, if we are going to be of justice
and of fairness.
I thank you, Mr. Sweeney, and I hope to work with you and
all of you.
Ms. Lofgren. Thank you, Mr. Gutierrez.
I now turn to Mr. King for his 5 minutes of questions.
Mr. King. Thank you, Madam Chair.
I want to thank all the witnesses.
Just with regard to the Pottsville, Iowa, raids, there were
383 that were arrested for document fraud, and 300 pled guilty.
They received 5-month sentences and 3 years of supervisory
release. There were 83 that were released for humanitarian
reasons because they had dependent children or one reason or
another. So I do not accept the idea that ICE is insensitive to
families and their needs.
I think, though, that what we are dealing with here is that
we want bright people to come into the United States legally,
and I have for a long time said my mantra on immigration has
been and will remain we need to craft an immigration policy
that is designed to enhance the economic, the cultural, and the
social wellbeing of the United States of America. Call it
selfish, if you will, but any nation would set that kind of a
policy.
And so when we get to the point of what type of people does
this country need, we are not in great disagreement, myself and
Madam Chair from California, on the merit of highly skilled
immigrations. But where I draw a line in a disagreement is that
I do not believe we can have unlimited immigration. I do not
think we can have unlimited immigration in any of our
categories. I think a smart nation will set that policy and set
a cap, an overall cap, and a cap in each of the visa
categories.
At this point, I am not going to call it a partisan
position because we have people on both sides of all these
issues across the aisle, but it is predominantly over on my
side of the aisle that there has to be an overall limit and a
hard cap.
Now we legally brought in about 1.3 million last year, and
I continually hear the complaints that the lines are long. That
is because this is a good place to come, and we can have short
lines if we broaden them out and bring more people in. If we
would bring them in as fast as they had applied, we would not
have any lines. We have them because there are more people that
want to come to the United States than we actually process and
get here under the laws that we have today.
So my view is this, that between 89 and 93 percent of the
legal immigration in the United States is not based upon merit.
It is based upon familial, family reunification policies, and
so if we are only in real control of merit of 7 to 11 percent
of our legal immigration, that is not much control to try to
build a brain trust in the United States.
I appreciate especially it has to be Dr. Yang, if I read
the memo correctly, instead of Mr. Yang, and the education that
you received in the path that you are following. I have another
concern, and that is if we continue to educate in the United
States bright people and send them out of America, at some
point, they have created the universities in the other
countries and taken our brain trust and exported it. They will
not need us to educate their young people anymore, they will be
educating them there, and they will have surpassed our brain
trust here.
So I am interested in keeping the brains here. I appreciate
Mr. Krikorian's testimony, though, because I think it lends a
balance to this. And we left you out of the brain trust
compliments of the other four witnesses, so I want to add they
come from other places as well, bright people, Mr. Krikorian.
So I think I will go first to Mr. Krikorian. The statement
that you made that the wages are at 1.0, which is the statutory
wage applied for those skills, if there is not deviation from
that, then statistically the exceptions would simply be
anomalies then, and I would like to ask you to expand upon that
a little bit. If 1.0 is the pay scale, that is what the law
says, you cannot pay less. If you pay more, that would be an
indicator of highly skilled. The study says no.
Mr. Krikorian. Yes. I mean, it would essentially be the
premium above the prevailing wage that is being paid, and so it
cannot be any less, and it is essentially, you know, a slight
amount more. There are variations. The report on our Web site
is variations between firms and industries, but, basically, for
most firms, most industries, it is only the slightest bit above
the floor, basically.
You know, a premium, as far as I would understand it, would
be a significantly higher wage. I mean, I am just picking 20
percent out of the air, but something like that or more would
be the kind of thing that you would pay to somebody who was an
outstanding talent that you were attempting to draw in and pay,
you know, accordingly.
Mr. King. Let me also say also that I have had the
privilege of seatmates flying back and forth of some of the
young immigrant doctors that are doing research work for us,
being paid about $50,000 a year and, it occurs to me, trapped
in a green card or in a non-green card avenue, you are not in a
position to negotiate for a higher wage.
The longer we can drag out your slow walk toward
citizenship, Dr. Yang, the less we would be paying you for the
work you are doing. Would that be a fair analysis?
Mr. Yang. Well----
Mr. King. I am not saying that is the right thing. I just
simply ask if it is the real thing.
Mr. Yang. You mean people like me get a lower payment?
Mr. King. Yes.
Mr. Yang. Well, I think that is probably not the truth. My
own case is, for example, my salary probably is the highest in
our department because the salary basically goes by your merit,
like your excellence. If you are good at it, then basically
your department will like to pay more to keep you there to
conduct the nice research.
Of course, it is relevant to how much money you can bring
into the department, how many grants you can get for the
department. So there are a lot of practical issues, too, but,
basically, I think in my own case is that being the highest
payment, not the lowest payment, I think.
Mr. King. Just as a follow up on that, Dr. Yang, but where
you are doing research now, if you got a better offer from,
say, Stanford, are you free to travel and take that job? Are
you limited?
Mr. Yang. No, I am somewhat limited. For example, I have to
get letter Stanford to apply for a new H-1 for me, and after I
receive that H-1, then I can transfer from Johns Hopkins to
Stanford. But before I get that, I cannot really move to
anywhere else.
Mr. King. Okay. Then just to conclude that point, say if
Mr. Krikorian were doing research right next to you and he is
an American citizen and you are not, if he gets the call from
Stanford and you are of equal skills, then isn't it a lot
easier for Mr. Krikorian to negotiate for a higher salary and
show up the next day and go to work for Stanford?
Mr. Yang. Well----
Mr. King. You are worth more if you can travel. That is my
point.
Mr. Yang. Right. Well, I think the point is basically for
the employer to consider his skills. If, for example, Mr.
Krikorian has the same skill as what I have, then probably go
to him because he is a U.S. citizen, I think, but if I have a
better skill, especially some special skills that I possess,
but he does not, probably the employer will prefer me rather
than him, I think.
In the scientific field, it is not purely 100 percent, but
majority will base on the skill or your background, your
expertise, not by, you know, who you are which comes----
Mr. King. The red light indicates you are still a Cyclone
fan. I yield back to the Chair.
Mr. Yang. Yes, I am.
Ms. Lofgren. Thank you, Mr. King.
And I will just--we do have another panel--thank you for
your testimony today.
I would just note that, you know, sometimes I think there
is a false distinction made. Well, maybe that is an
overstatement, but I look at Silicon Valley, and Jerry Yang
grew up in East San Jose, but he was not admitted because of
his Ph.D., because of his mind. He came as a child. Sergey Brin
who founded Google--he was not admitted because of his
education. He was admitted as a child. His parents were
professors. Andy Grove, I mean, founded Intel. He was not
admitted because of his education. He was a refugee.
So, you know, you never know where the talent is going to
come. Certainly, somebody like you, Dr. Yang, we want to keep,
and I am hopeful that we can move forward on some of these
measures, the Lofgren-Sensenbrenner bill would recapture the
visas that were meant to have been issued, the Lofgren-
Goodlatte bill would eliminate the per-country limits on the
employment side, and the Lofgren-Cannon bill which would
address the STEM issue that we have talked about today.
I hope that we can move forward in a collegial and
hopefully bipartisan way to do some variation of those bills in
this Congress, and I know Mr. Gutierrez had another commitment,
but he is absolutely right. We have to do something about the
other elements of our flawed immigration system. What is
happening, in my judgment, to individuals--I mean, when we have
our salad, we have to thank the people who are and really
living in a state of fear today--is not acceptable and has to
be changed.
With that, I will thank you all and invite the next panel
to come forward.
We have our second panel, and I will introduce them as they
are coming forward so we are not interrupted by our votes.
I am pleased to welcome Dr. Jana Stonestreet. Dr.
Stonestreet has been a registered nurse for 32 years and a
nursing executive for over 17 years exclusively with an acute
care hospital. She has worked as a health system chief nurse at
the University of Texas Medical Branch at Galveston, Methodist
Health Care System in San Antonio, and she is currently chief
nursing executive for the Baptist Health System in San Antonio,
Texas.
Dr. Stonestreet received a bachelor's degree in nursing
from Kent Street University, a master's degree in nursing from
the University of Texas, and her Ph.D. in nursing from Texas
Women's University. She has been certified in critical care
nursing and administration. She has published articles on the
subjects of leadership, strategic planning, and retention of
staff nurses and nurse managers.
Next, I would like to introduce Cheryl Peterson. Ms.
Peterson is a senior policy fellow in the department of nursing
practice and policy at the American Nurses Association. She is
responsible for policy development on issues relating to the
nursing workforce and nursing workforce planning for the
future.
Since coming to the ANA in 1990, Ms. Peterson has developed
expertise in several areas, including issues related to labor,
employment, trade and immigration, and policy development on
the supply of and demand for nursing services. She has a
bachelor's of science in nursing from the University of
Cincinnati and a master's of science degree in nursing from
Georgetown University.
And, finally, I would like to introduce Steve Francy, who
is the executive director of RNs Working Together. RNs Working
Together is a coalition of 10 AFL-CIO unions representing over
200,000 registered nurses and is America's largest organization
of working registered nurses. Mr. Francy received his BS and
his MS in political economy from the Colorado State University
and his juris doctorate from the University of Denver.
As with our first panel, your complete written statements
will be made part of our official record. We would ask that
your oral testimony take about 5 minutes, and when the red
light is on, it means your time is up.
So if we can go to you first, Ms. Stonestreet.
TESTIMONY OF JANA STONESTREET, CHIEF NURSING EXECUTIVE, BAPTIST
HEALTH SYSTEM
Ms. Stonestreet. Thank you very much.
Madam Chair Lofgren and Committee Members, I thank you for
the opportunity to appear today to discuss the nursing
shortage, particularly as it relates to green cards and the
recruitment of foreign-educated nurses.
My name is Jana Stonestreet. I am chief nursing executive
for the Baptist Health Care System in San Antonio, Texas.
Baptist is the leading provider of health care in San Antonio
and South Texas, and I welcome the opportunity really to tell
you our story.
Our hospital has more than 1,700 licensed beds and serves
patients through five facilities, six emergency departments,
and outpatient services. We also operate a school of health
professions with a history of educating nurses and allied
health professionals for more than 100 years.
As chief nursing executive for Baptist, I have
responsibility for providing quality nursing care to all of the
patients who come to us. This requires the recruitment and
retention of an adequate number of qualified nurses.
Currently, our hospitals have 236 unfilled RN positions. We
anticipate needing 136 more RNs in the next 12 months. This
vacancy rate exists in spite of a 6.1 percent improvement in
our nurse turnover for a rate of just under 20 percent for our
nursing turnover.
The inability to fill RN positions has an adverse effect on
our ability to care for patients, and it prevents us from
expanding needed services to our community. It also forces our
hospitals to divert EMS and at times cancel elective
procedures.
The nursing shortage is at a critical level and is expected
to get worse. The U.S. Department of Labor says that 1.2
million new and replacement nurses will be needed by 2016. The
Department of Health and Human Services expects the national
nursing shortage to grow to more than one million nurses by
2020.
The causes of the nursing shortage are complex. They
include a shortage of nurse educators, including lack of
clinical sites and classrooms for educating our nurses, an
aging workforce, and an increased demand for RNs both inside
and outside of the hospital setting.
Baptist's overall strategy is to keep all RN pipelines
flowing to our hospitals. We have a school of nursing that has
graduated over 3,300 RNs since its inception in 1903, and since
2004, we have been able to triple our graduates to 126 in 2007.
The recruitment strategies we use run the spectrum of those
reported in the literature and reported as best practices,
including job fairs, direct mailings, community events, and
continuing education programs for our nurses. We have developed
and maintained a reputation for excellence in nursing practice,
which is vital to recruitment.
The development of a positive work environment through
implementation of shared governance enables staff nurses to
truly share in decision making related to professional practice
in the work environment. Our own staff have become our best
recruiters.
To help us fill our patient needs, Baptist has recruited
well-qualified foreign-educated nurses. Two-and-a-half years
ago, we interviewed and selected 88 qualified nurses from the
Philippines. Most have met the requirements for admission to
the United States, including passage of the licensing exam and
visa screen. A lack of green cards has resulted in at least a
1-year additional delay for 80 of these nurses who otherwise
could be available to our patients today. But even with these
80 nurses, our hospitals would still have 150 vacancies.
Foreign graduates account for about 15 percent of new
nurses that are licensed to practice in the United States each
year. Any interruption of their availability has an immediate
and detrimental effect on health care, making an already
difficult situation worse. I understand that foreign nurses
face delays of more than 2 years in gaining entry into this
country.
As of July 1, their waiting time will grow even longer
because no green cards will be available. Over the past 3
years, the delay has reached as high as 5 years. Without
congressional action, this situation will only get worse.
Although significant nurse recruitment initiatives have
been adopted at the local, regional, State, and national
levels, they cannot overcome a shortage of this magnitude.
America's hospitals must be able to take advantage of all
available options to meet this critical need.
When local solutions fail to address the workforce
challenges, hospitals must be able to have the option to
recruit qualified foreign nurses to provide care to our
patients. On this point, legislation recently introduced by
Representative Robert Wexler, H.R. 5924, the Emergency Nurse
Supply Relief Act, will help us address our immediate need for
nurses. The bill would set aside 20,000 green cards per year
for highly qualified foreign-educated nurses for 3 years. It
would also help bolster our domestic supply by establishing a
program to help U.S. nursing education programs.
Immigration is not the permanent solution to our nursing
shortage, increased domestic supply is, but dramatically
increasing our domestic training and retention takes time, and
our patients need nurses now. So we must keep a reasonable
supply of qualified immigrant nurses in the meantime.
As a person who has spent my entire professional life
caring for patients, much of it in roles responsible for
staffing, my goal has always been to give our patients the very
best possible care, but we cannot accomplish that goal without
nurses. Please help us meet our patients' needs and that of our
communities by passing H.R. 5924.
Thank you.
[The prepared statement of Ms. Stonestreet follows:]
Prepared Statement of Jana Stonestreet
Ms. Lofgren. Thank you, Dr. Stonestreet.
Ms. Peterson?
STATEMENT OF CHERYL A. PETERSON, SENIOR POLICY FELLOW, AMERICAN
NURSES ASSOCIATION
Ms. Peterson. Good afternoon, Madam Chair and Members of
the Subcommittee.
I am Cheryl Peterson, a registered nurse and senior policy
fellow at the American Nurses Association.
ANA appreciates the opportunity to testify on behalf of the
global profession of nursing and the Nation's 2.9 million
registered nurses. ANA is also the U.S. member of the
International Council of Nurses. ICN and its 128 member
countries work together to ensure quality nursing care for all
and the presence worldwide of a respected nursing profession
and a competent and satisfied nursing workforce.
I have been a registered nurse for 28 years. During my 13
years in health care policy development, I have witnessed many
attempts to address domestic nursing workforce problems through
immigration. ANA's position on this issue has not wavered. ANA
supports the mobility of individual nurses. However, we oppose
the use of immigration to solve America's nursing workforce
shortages.
It is inappropriate to look overseas for nursing workforce
relief when the real problem is the fact that Congress does not
provide sufficient funding for schools of nursing, the health
care industry has failed to maintain a work environment that
retains experienced nurses, and the Government has not engaged
in active planning to build a sustainable health workforce. The
recruitment of educated nurses from developing countries
deprives their home countries of highly skilled health care
practitioners upon whose knowledge and talent their citizens
heavily rely.
We are now almost 10 years into another critical nursing
shortage that is impacting all aspects of health care delivery.
Yet, in 2007, baccalaureate nursing programs turned away over
36,000 qualified applicants, and in 2005-2006, over 88,000
qualified applicants were turned away from all types of basic
nursing education programs.
Retention of the current nursing workforce also continues
to be problematic. Consistently high turnover rates and
dissatisfaction with the current work environment complicate
efforts to address the nursing shortage. A study reported in
the Journal of Nursing Administration showed that 43 percent of
experienced nurses score abnormally high on indicators of job
burnout. A 2007 PricewaterhouseCooper's study reported that 27
percent of new nursing graduates leave their first job within a
year.
ANA conducted an online survey on working conditions,
attracting more than 10,000 respondents. Fifty percent of the
respondents are considering leaving their current job, and a
quarter are considering leaving the profession altogether. More
than 50 percent stated that they believe that the quality of
nursing care on their unit had declined over the last year and
that more than 48 percent would not feel confident having a
loved one receive care where they work.
It is disheartening to be here contemplating large-scale
nurse immigration yet again when we have failed to implement
longstanding recommendations to address the shortage. In
addition, there are serious ethical questions about recruiting
nurses from other countries when there is a worldwide shortage
of nurses.
According to the Leonard Davis Institute of Health
Economics, from 1990 top 2000, nurse recruitment shifted toward
low-income countries and those with a low supply of nurses. The
very real problem caused by mass immigration of nurses out of
developing countries prompted the World Health Organization to
adopt a resolution urging member states to address the negative
impact of migration on health systems.
Similarly, the ICN stated that it condemns the practice of
recruiting nurses to countries where authorities have failed to
implement sound human resource planning and to seriously
address problems which cause nurses to leave the profession and
discourage them from returning to nursing.
The time has come to invest in long-term solutions. I urge
you to fully fund domestic nursing education. Due to lack of
funding, last year, the Federal Government was forced to turn
away more than 93 percent of applicants to a loan repayment
program and more than 96 percent of the applicants to a
scholarship program. ANA also urges you to support the Nurse
Education, Expansion, and Development Act. This legislation
would provide flexible funding to schools of nursing to help
them increase their capacity to educate new nurses.
Finally, we challenge our partners in the health services
community to work with us to improve nurse retention. This
shortage will not be truly resolved until the work environment
supports experienced nurses.
In the end, ANA is concerned that the influx of foreign-
educated nurses only serves to further delay debate and action
on serious nursing education and workplace issues. We look
forward to working with you and our industry partners to create
an environment conducive to high-quality nursing care. ANA
appreciates the Subcommittee's discussions on this issue, and
we plan to continue to work with you to seek a solution that
meets the needs of America's citizens, nurses, and our global
colleagues.
Thank you.
[The prepared statement of Ms. Peterson follows:]
Prepared Statement of Cheryl A. Peterson
Good morning Madam Chair and Members of the Subcommittee, I am
Cheryl Peterson, MSN, RN, Senior Policy Fellow at the American Nurses
Association. I am pleased to be here today representing the American
Nurses Association (ANA) in recognition of your efforts to address the
employment-based immigration system for highly-skilled professionals
including registered nurses (RNs). ANA is the only full-service
association representing the interest of the nation's RNs through its
54 constituent member nurse associations.
I have been a registered nurse for 28 years. During my 13 years of
work in health care policy, I have been witness to many attempts to
address domestic nursing workforce problems through immigration. ANA's
position on this issue has not wavered. ANA supports the ability of
individual nurses to choose to practice in the location of their
choice. However, we oppose the use of immigration to solve America's
nursing workforce shortages.
ANA maintains that it is inappropriate to look overseas for nursing
workforce relief when the real problem is the fact that Congress does
not provide sufficient funding for domestic schools of nursing, the
U.S. health care industry has failed to maintain a work environment
that retains experienced U.S. nurses in patient care, and the U.S.
government does not engage in active health workforce planning to build
a sustainable nursing and health professions workforce for the future.
Over-reliance on foreign-educated nurses by the health care industry
serves only to postpone efforts to address the needs of nursing
students and the U.S. nursing workforce. In addition, there are serious
ethical questions about recruiting nurses from other countries when
there is a world-wide shortage of nurses. The recruitment of educated
nurses from developing nations deprives their home countries of highly-
skilled health care practitioners upon whose knowledge and talents
their citizens heavily rely.
domestic nurse recruitment
As this Subcommittee is aware, we are now almost ten years into a
critical nursing shortage that is impacting all aspects of healthcare
delivery. With an estimated 2.9 million RNs, the profession is the
largest workforce component of our healthcare system. Nurses provide
care in virtually all locations in which health services are delivered.
Thus, the worsening shortage poses a serious challenge to the domestic
healthcare system.
While this shortage is alarming, it is heartening that many
Americans are interested in pursuing nursing as a career. The American
Association of Colleges of Nursing reports that enrollment in entry-
level baccalaureate nursing programs increased by 5.4 percent from 2006
to 2007. The National League for Nursing's 2005-2006 survey of all pre-
licensure nursing education programs (associate degree, baccalaureate
degree, and diploma programs) documented a 5 percent rise in admissions
across all RN programs. More good news is that once students enroll in
nursing programs, they tend to remain there and graduate to enter the
workforce. Overall graduation rates grew by 8.5 percent during 2005-06;
at the same time, nine out of every 10 bachelor's nursing degree
candidates enrolled in 2005 remained enrolled or completed her/his
nursing degree by 2006, compared with a retention rate of 72 percent at
four-year undergraduate institutions nationwide.
The bad news is that even this growth in capacity is failing to
meet the demand for domestic nurse education. According to the American
Association of Colleges of Nursing, schools of nursing turned away
36,400 qualified applicants to baccalaureate programs in academic year
2007. The National League for Nursing's (NLN) 2005-2006 study revealed
that 88,000 qualified applications were denied due to lack of capacity
in all three types of basic nursing programs. Baccalaureate degree
programs turned away 20 percent of applications, while associate degree
programs turned away 32.7 percent. In fact, one to two year waiting
lists to get into domestic nursing programs are now commonplace.
nurse retention
Consistently high turnover rates and dissatisfaction with the
current work environment also continue to complicate efforts to address
the nursing shortage. Experienced nurses are reporting high levels of
burn out, turnover among new nurses is very high, and large numbers of
nurses are leaving the profession outright. A study reported in last
month's Journal of Nursing Administration shows that 43 percent of
experienced nurses score abnormally high on indicators of job burnout.
In a study released last year, the Price Waterhouse Cooper's Health
Research Institute reported that 27 percent of new nursing graduates
leave their first jobs within a year. These studies are consistent with
many others taken over the last two decades.
In an effort to ascertain the extent and cause of nurse discontent,
ANA recently conducted an on-line survey of nurses across the nation.
More than 10,000 nurses took the opportunity to express their opinions
about their working conditions. Results from the survey, revealed on
May 21, show that more than 50 percent of nurses are considering
leaving their current job, and that nearly a quarter of all nurses are
considering leaving the profession altogether. Sixty percent reported
that they knew nurses on their unit who had left due to concerns about
working conditions. It should concern all of us that the majority of
nurses involved in this survey believe that the poor working conditions
in their facility are harming patient care. More than 50 percent of the
respondents stated that they believe that the quality of nursing care
on their unit had declined over the last year, and that more than 48
percent would not feel confident having someone close to them receive
care in the facility where they work.
Years of discontent with the work environment have led us to a
situation in which an alarming number of our experienced RNs have
chosen to leave the profession. The 2004 National Sample Survey of
Registered Nurses conducted by the Department of Health and Human
Services shows that a large number of nurses (488,000 nurses--nearly 17
percent of the nurse workforce) who have active licenses are no longer
working in nursing. Numerically speaking, if these nurses were to re-
enter the workforce today, the current shortage would be solved.
immigration
The ANA opposes the use of immigration as a means to address the
growing nursing shortage. As you are well aware, immigration is the
standard ``answer'' proposed by employers who have difficulty
attracting domestic nurses to work in their facilities. It is
disheartening to be here contemplating large-scale nurse immigration
yet again, when we have been down this road many times before without
success.
In addition to the impact of nurse immigration on the domestic
workforce, there are serious ethical questions about recruiting nurses
from other countries when there is a world-wide shortage of nurses.
According to the Leonard Davis Institute of Health Economics, the
source countries for foreign-educated nurses shifted toward low-income
countries and those with a low supply of nurses during the period of
1990 to 2000. This same report notes that almost 20% of the world's
nursing population is in the United States, including half of all
English speaking professional nurses.
While the Philippine government's policy is to export professional
labor, including nurses, the Philippine health care system has been
strained by the rapid exodus of nurses. Philippine experts estimated
that about 120,000 nurses had left the Philippines last year alone. An
estimated 50,000 RNs left the Philippines between 2000 and 2005, but
nursing schools managed to produce only 33,370 nurses over the same
period. Press reports state that the resulting ``brain drain'' has
pushed the Philippine health care system to the brink.
The very real problems caused by mass emigration of nurses out of
the developing world have caused international health associations to
condemn current practices. In 2004, concerns about the impact of health
care worker migration on countries origin prompted the World Health
Organization to adopt a resolution urging member states to develop
strategies to mitigate the adverse effects of migration of health
personnel and minimize its negative impact on health systems. These
same concerns prompted the International Council of Nurses to revisit
the issue of nurse migration. Last year the ICN issued a position
statement reaffirming the fact that the ``ICN condemns the practice of
recruiting nurses to countries where authorities have failed to
implement sound human resource planning and to seriously address
problems which cause nurses to leave the profession and discourage them
from returning to nursing.''
In addition, ANA is concerned that immigrant nurses are too often
exploited because employers know that fears of retaliation will keep
them from speaking up. For instance, last year 27 nurses from the
Philippines walked off their jobs in New York citing years of
maltreatment by their employers and misrepresentations by their
recruiters. Their complaints are very similar to those that I have
heard made by literally hundreds of other immigrants. They were
promised that they would be employed as RNs, but were made to work as
lesser-paid staff; they were made to work unreasonable hours; they were
not paid overtime. In the end, when these nurses walked off the job due
to concerns about the quality of care being provided in their
facilities, their employers brought criminal suits against them. While
the majority of these suits have been dismissed, the legal
entanglements that these nurses were forced to endure stands as a stark
warning to other immigrants.
ANA is pleased to have been part of the AcademyHealth's efforts to
develop a Voluntary Code of Ethical Conduct for the Recruitment of
Foreign Educated Nurses to the United States. This Code reflects a
significant consensus building process that has resulted in a document
that can guide efforts to reduce potential harms and increase benefits
experienced by the U.S., the foreign-educated nurse, and potentially by
the source countries. Stakeholders at the table included professional
associations, hospital facilities, international recruiters, unions and
academia. The next step is to establish a monitoring mechanism by which
signatory companies and organizations can be held accountable.
real solutions
ANA concurs with our colleagues at the American Hospital
Association that the nursing shortage is a real concern that requires
urgent action. We also agree that nurse immigration is a short-term
``band aide'' approach to fixing the problem. ANA urges you to look
beyond this eternal band aide and to support real long-term solutions
to the ongoing nursing shortage.
To begin with, I urge you to make a real investment in domestic
nursing education. It is extremely short-sited to look overseas for RNs
when more than 80,000 qualified students are being turned away from
domestic programs every year. There are two programs already up and
running at the Department of Health and Human Services that could make
a real difference today. The Nurse Education Loan Repayment Program
repays up to 85 percent of outstanding student loans for RNs who work
full-time in a health care facility deemed to have a critical shortage
of nurses. Similarly, the Nursing Scholarship Program covers the
educational costs of nursing students who agree to work in shortage
facilities. Both of these programs hold the promise of recruiting
students into the nursing profession and to directing domestic nurses
into facilities with the greatest need. Unfortunately, no real
investment has been made in these programs. In fact, last year, the
Health Resources and Services Administration was forced to turn away
more than 93 percent of the applicants to the loan repayment program
and more than 96 percent of the applicants to the scholarship program.
In real numbers, this means that more than 9,000 RNs interested in
working is the very facilities that are here today requesting an
increase in nurse immigration were turned away from these programs due
to lack of funding. Clearly, it is time to invest in nursing students
In addition, ANA urges you to support the Nurse Education,
Expansion, and Development (NEED) Act of 2007 (S. 446, H.R. 772). This
legislation would provide flexible funding to domestic schools of
nursing to help them increase their capacity to educate new nurses.
Funding would be contingent on these schools increasing capacity, and
on graduating students capable of passing the licensure exam required
to become registered nurses. The NEED programs are necessary to allow
our schools to address the myriad of problems they encounter when
attempting to expand enrollment, the most notable of these currently
being the nursing faculty shortage.
In addition to supporting domestic nurse education and recruitment,
we challenge our partners in the hospital community to work with us to
improve nurse retention. This shortage will not be truly solved until
the environment of care supports the maintenance of experienced nurses
in patient care. As long as nurses are driven away by hostile work
environments, as long as the new nurse turn-over rate hovers around 25
percent per year, we will not have adequately addressed the root causes
of this shortage.
I am happy to report that nurses, in conjunction with health care
facilities, are finding the means to combat this dissatisfaction. Real
positive changes that make real results are underway in the nation's
Magnet Hospitals. The American Nurses Credentialing Center's Magnet
Recognition Program(r) identifies health care facilities that have
fostered an environment that attracts and retains competent nurses
through its respect for the values, art, and science of nursing. The
Magnet designation was first granted to a group of hospitals that were
able to successfully recruit and retain professional nurses during a
national nursing shortage in the early 1980's. To this day, Magnet
facilities outperform their peers in recruiting and retaining nurses.
In fact, the average length of employment among registered nurses on
staff is roughly twice that of non-Magnet hospitals. Most importantly,
patients in Magnet facilities experience better outcomes and higher
satisfaction with their health care.
Currently, 289 health-care organizations in 45 states have been
designated as Magnet facilities; including 14 facilities and systems in
California, and six in Iowa. The Magnet Recognition Program(r) has been
cited in reports by the American Hospital Association, the Joint
Commission and others as an example of an innovative program that
enhances recruitment and retention of nurses at the facility level. I
believe that is it irresponsible for any facility to seek to solve
their nurse staffing problems through immigration before they have done
the internal work needed to improve retention. We know what works, and
it mainly boils down to respect for the knowledge and needs of staff
nurses, and an investment in quality patient care
conclusion
In the end, ANA is concerned that the influx of foreign-educated
nurses only serves to further delay debate and action on the serious
workplace issues that continue to drive American nurses away from the
profession. In the 1980's a Presidential task force called to
investigate the last major nursing shortage developed a list of
recommendations. These 16 recommendations, released in December, 1988,
are still very relevant today--they include issues such as the need to
adopt innovative nurse staffing patterns, the need to collect better
data about the economic contribution that nurses make to employing
organizations, the need for nurse participation in the governance and
administration of health care facilities, and the need for increased
scholarships and loan repayment programs for nursing students. Perhaps
if these recommendations were implemented we would not be here today.
Certainly, we will be here in the future if they are ignored.
ANA maintains the current nursing shortage will remain and likely
worsen if the glaring needs of schools of nursing are ignored and if
challenges in the workplace are not immediately addressed. Registered
nurses, hospital administrators, other health care providers, health
system planners, and consumers must come together in a meaningful way
to create a system that supports quality patient care and all health
care providers. We must begin by improving the environment for nursing.
ANA looks forward to working with you and our industry partners to
make the current health care environment conducive to high quality
nursing care. We appreciate the ongoing work and continued negotiations
that the Subcommittee is engaged in on this issue and hope to continue
to work with you to seek a solution that meets the needs of America's
nursing workforce and our global colleagues. The resulting stable
nursing workforce will support better health care for all Americans.
Ms. Lofgren. Thank you very much.
And our last witness is Mr. Francy.
STATEMENT OF STEVEN FRANCY, EXECUTIVE DIRECTOR,
RNS WORKING TOGETHER, AFL-CIO
Mr. Francy. Yes. My name is Steve Francy. I am the
executive director for RNs Working Together.
I want to thank you for the opportunity to present our
views on the issue of whether the expansion of work visas to
foreign nurses is an appropriate solution to the nursing
shortage that our Nation faces.
First, a little bit about the organization RNs Working
Together: We are a coalition of 10 AFL-CIO unions who represent
over 200,000 working registered nurses. Each affiliate union
has two of its nurse leaders who serve on my leadership
committee. We are a democratic organization and operate by
building mutual agreement among our Members regarding issues
that concern registered nurses.
First of all, the continuing shortage of registered nurses
is a problem that virtually everyone acknowledges. If you were
to walk the halls of American hospitals and ask a nurse what is
the number one problem she or he faced, they would probably
say, ``We do not have enough staff to deliver quality care.''
While we appreciate everyone's efforts in trying to address
this crisis, we do not believe that relying upon thousands of
additional foreign nurses to deliver health care in the United
States is an appropriate solution to the nursing shortage.
There are many factors that contribute to the nursing
shortage. Two of the major factors that I would like to draw
your attention to today is our inability to train enough
Americans to become registered nurses and the difficult working
conditions that nurses face. To resolve these and other factors
that contribute to the nursing shortage will require a focused,
comprehensive strategy.
First, we do not have the capacity to train enough nurses.
Last year alone, approximately 150,000 qualified applicants for
nursing schools were turned away because there were not enough
seats available. Our inability to train these applicants is due
to a shortage of RN faculty who are often paid less than
practicing nurses.
Congress needs to pass legislation that will increase the
capacity of nursing schools to train nurses. This would include
incentives to attract nurse faculty as well as to actively
recruit and provide financial assistance to those Americans who
would like to become nurses.
In addition, it is estimated there are about 2.9 million
licensed RNs in the United States, but only 2.4 million are
providing care to patients. Hundreds of thousands of licensed
nurses have left the bedside in favor of the many other job
options now available from outpatient care, computer jobs,
pharmaceutical jobs, or leaving nursing entirely.
A key reason for this migration away from the bedside is
that chronic understaffing and unmanageable workloads are a
day-to-day reality. While increasing the number of visas may
seem like an easy solution, in reality, it does nothing to
retain nurses that are already trained, skilled professionals.
Stopping this leakage of nurses will require Congress to
direct their attention to this issue and pass legislation that
will directly improve working conditions. Examples include
prohibiting mandatory overtime, passing minimum staffing
ratios, and safe patient care to reduce injuries of nurses.
We are confident by taking these steps, many of those
nurses who have left the profession and are now thinking about
leaving the profession will come back and care for America's
sick.
As you know, America is not the only country facing a
nursing shortage. Indeed, there is a worldwide shortage of
registered nurses. Thus, the use of immigration policies that
allegedly benefit one country in the short run can be
devastating to a developing country's ability to deliver health
care to their citizens.
Some countries have even a greater shortage of nurses, and
any loss of the nurses they have trained can undermine their
government's efforts to staff their own hospitals and clinics.
In 1 year alone, Ghana lost more than 500 nurses, more than
double the number of its new graduates. In the Philippines, not
only are they losing more nurses than graduate from nursing
school, now even doctors--some doctors--are training to become
nurses in the hope that they will find employment in the United
States. In Zimbabwe, it has been estimated that the nurse-to-
patient ratio is one nurse to every 700 patients.
Obviously, nurses in developing countries will find coming
to America for a job very attractive because of the increase in
their income, but expanding nurse visas simply outsources nurse
training to developing countries and robs them of many of the
nurses they have trained.
In sum, taking nurses from poor countries will have a small
short-run impact on the U. S. while increasing the short-and
long-term misery of poor and developing countries.
Again, I understand that increasing the number of work
visas seems like an easy solution. However, we believe that
developing a comprehensive long-term strategy that addresses
the factors contributing to the nurse shortage in our country,
such as increasing our capacity to educate new nurses and
improving working conditions, is a more productive use of time
and resources and is the only real way in which America can
solve this long-term issue.
Thank you for this opportunity to provide testimony
regarding this important and difficult issue.
[The prepared statement of Mr. Francy follows:]
Prepared Statement of Steven Francy
My name is Steven Francy and I am the Executive Director of RNs
Working Together, AFL-CIO. I want to thank you for the opportunity to
present our views on the issue of whether the expansion of work visas
to foreign nurses is an appropriate solution to the nursing shortage
that our nation faces.
First a little about the organization RNs Working Together (RNWT).
We are a coalition of ten AFL-CIO unions who represent over 200,000
working registered nurses. Each affiliate union has 2 of its nurse
leaders who serve on the RNs Working Together Leadership Committee. One
of their responsibilities is to set policy for our organization. We are
a democratic organization and operate by building mutual agreement
among our members regarding issues that concern working registered
nurses.
First of all, the continuing shortage of Registered Nurses is a
problem that virtually everyone acknowledges. If you were to walk the
halls of America's hospitals and asked a nurse what is the number one
problem that they face, they would probably say, ``we do not have
enough staff to deliver quality care.'' While we appreciate everyone's
efforts in trying to address this crisis, we do not believe that
relying upon thousands of additional foreign nurses to deliver health
care in the United States is an appropriate solution to the nursing
shortage.
There are many factors that contribute the current nursing
shortage. Two of the major factors that I would like to draw your
attention to today is our inability to train enough Americans to become
registered nurses and the difficult working conditions that working
nurses face. To resolve these, and other factors that contribute to the
nursing shortage, will require a focused, comprehensive strategy.
First, we do not have the capacity to train enough nurses. Last
year alone, approximately one hundred and fifty thousand (150,000)
qualified applicants for nursing schools were turned away because there
were not enough seats available. Our inability to train these
applicants is due to a shortage of RN faculty who are often paid less
than practicing nurses. Congress needs to pass legislation that will
increase the capacity of nursing schools to train nurses. This would
include incentives to attract nurse faculty as well as to actively
recruit and provide financial assistance to those Americans who would
like to become nurses.
In addition, it is estimated that there are 2.9 million licensed
RNs in the U.S., but only 2.4 million are providing care to patients.
Hundreds of thousands of licensed nurses have left the bed-side in
favor of the many other job options now available from outpatient jobs,
computer jobs, quality management, doctor's offices, pharmaceutical
jobs or leaving nursing entirely. A key reason for this migration away
from the bedside is that chronic understaffing and unmanageable
workloads are a day-to-day reality. While increasing the number of
visas may seem like an easy solution, in reality it does nothing to
retain nurses that are already trained, skilled professionals. Stopping
this leakage of nurses will require Congress to direct their attention
to this issue and pass legislation that will directly improve working
conditions. Examples include prohibiting mandatory overtime and
requiring hospitals to meet safe minimum staffing levels. We are
confident that by taking these steps, those nurses who have left the
profession and those that are now thinking about leaving the profession
will come back and care for America's sick.
As you know, America is not the only country facing a nurse
shortage. Indeed there is a worldwide shortage of registered nurses.
Thus the use of immigration policies that allegedly benefit one country
in the short-run can be devastating to a developing country's ability
to deliver health care to their citizens. Some countries have an even
greater shortage of nurses and any loss of the nurses they have trained
can undermine their government's efforts to staff their own hospitals
and clinics. In one year alone, Ghana lost more than 500 nurses--more
than double the number of its new nurse graduates. In the Philippines,
not only are they losing more nurses than graduate from nursing
schools, now even doctors are training to become nurses in the hopes
that they will find employment in the U.S. In Zimbabwe, it has been
estimated that the nurse to patient ratio is 1 nurse to 700 patients.
Obviously, nurses in developing countries will find coming to America
for a job very attractive, as they will experience a great increase in
their incomes. But expanding nurse visas simply out sources nurse
training to developing countries and robs them of many of the nurses
they have trained. In sum, taking nurses from poor countries will have
a small short-run impact on the U. S. while increasing the short and
long-term misery of poor, developing countries.
Again, I understand that increasing the number of work visas seems
like an easy solution. However, we believe that developing a
comprehensive long-term strategy that directly addresses the factors
contributing to the nurse shortage in our country, such as increasing
our capacity to educate new nurses and improving working conditions, is
a more productive use of time and resources and is the only real way in
which America can solve this long-term issue.
Thank you again for the opportunity to provide testimony regarding
this important and difficult issue. I can answer any question you can
have.
RNs Working Together is a coalition of the following 10 AFL-CIO
unions representing over 200,000 registered nurses. We are America's
largest organization of working registered nurses.
American Federation of Government Employees
American Federation of State, County and Municipal Employees
American Federation of Teachers (AFT-Health Care)
California Nurses Association/National Nurse Organizing Committee
Communications Workers of America
JNESO/International Union of Operating Engineers
Office and Professional Employees International Union
United American Nurses
International Union, United Autoworkers
United Steelworkers
Ms. Lofgren. Thank you very much, Mr. Francy.
And thanks to all three of these witnesses.
Now is the time when we can address our questions to the
witnesses.
Mr. King, would you like to go first?
Mr. King. I would be happy to. Thank you, Madam Chair.
And I especially also want to thank the witnesses for your
testimony.
It is a subject matter that has been consistently presented
to me in the district that I represent that goes back many
years. We have had a nursing shortage in my district, and, in
fact, I remember bonuses being paid to recruit our nurses to go
to other locations in the country, none of which you represent.
But I remember sitting in a room at Crawford County
Memorial Hospital where all of our children were born, and I
had a conversation there with nine nurses. Of the nine nurses,
seven of them, their husbands farmed, and they were tied to the
land, and they could not accept the higher offer to go
elsewhere in the country, the $10,000 bonus at that time, which
probably is higher now.
So I am watching market forces push on this as well as the
education. I was really quite struck by the number of nursing
students that were qualified applicants that were turned away.
I think I saw 150,000 was the number that, Ms. Stonestreet,
you testified to, and I am curious as to how many RNs there are
in the United States that are qualified and what percentage
that works out to be, one out of every how many are nurses?
Ms. Stonestreet. I am not sure that I understand the
question. There are, in fact, different numbers that are
reported in the literature about how many qualified applicants
are available to enter into nursing school, everything from
88,000 I have seen, 150,000, but the bottom line is I think
part of the difference in the numbers and how they calculate
that has to do with whether they are counting applications or
applicants and how many are offered positions.
But the fact of the matter is we do not have a good long-
term strategy and a short-term strategy in place right now to
be able to get those----
Mr. King. Excuse me. I have information in front of me that
is from the National Sample Survey of Registered Nurses that
says that there are 2.9 million registered nurses nationwide.
Does that seem to be in the----
Ms. Stonestreet. Yes.
Mr. King. [continuing]. Context you were talking about? And
we are expecting a shortage of about a million. Now I have to
express a little bit of skepticism because in my public life
every profession that I know of is going to have a shortage of
employees. It just demographically works out that way. And what
do we do about it?
I ask you to take advantage of the opportunity to respond
to Mr. Francy's testimony that says, ``Let's put an American
solution in place.'' And why would we not ramp up our schools?
Why wouldn't we find a way to bring in all the qualified
applicants? Why wouldn't we pay an additional $12,000 or
$14,000 or $18,000 more to nurses that are currently practicing
that would be excellent teachers instead? Why would we not tool
that up and say, ``We can fix this.''
Ms. Stonestreet. Well, I think there are several
different--and I appreciate the comments that were made here--
components.
Number one, there are a number of individuals who are
registered nurses in our country today who are not practicing
in hospitals, who are not practicing within the direct-care
environment. I mean, this room might actually be a microcosm of
our country, the experience that I have seen, individuals who
go on and they have been trained as an RN, they practice, but--
--
Mr. King. But does his testimony contribute to the
solution? Do you disagree with Mr. Francy's testimony?
Ms. Stonestreet. I do not disagree with the long-term
solution. What I do disagree with is that we need a solution
today. If there is one thing that keeps me awake at night, it
is that we do not have enough nurses to take care of our
patients today.
Mr. King. Let me just speculate, and then I will turn this
back to Mr. Francy.
Thank you.
I look at these numbers, and they range from 40,000 to
150,000 applicants that are turned way, because of a shortage
of teachers. It seems to be the number one reason. And
facilities are another, and I have watched education facilities
in my district be ramped up because we need to do this, and I
certainly support that and encourage it.
But if it is 150,000 applicants that are turned away and we
are going to have a cumulative shortfall of a million by the
year 2020 or about 2008, so it is less than 100,000 a year that
would be the accumulated shortfall, would there be a reason you
could think of, Mr. Francy, why we could not meet that need
here without having to go out and short other nations for the
nurses that they are training?
Mr. Francy. I think that we could in addition to those that
apply now. If we were to actively recruit in the United States
and provide financial aid to Americans that were interested in
entering the nursing profession, I do not see any reason why we
could not.
Mr. King. Now I would just follow up and say as a
representative of AFL-CIO and the nurses, you and I agree that
this country needs a tighter labor supply because the wages and
benefits that are paid to our workers, both skilled and
unskilled, are directly proportional to the supply and demand.
Would you respond to that, Mr. Francy?
Mr. Francy. Again, you know, I think that there are
certainly issues with suppressing wages with foreign workers in
some cases, in organizing drives, for example, union organizer
drives. Foreign workers are more vulnerable to threats that if
they support the union that they would be deported from the
United States.
Ms. Lofgren. The gentleman's time has expired. I know we
have votes very soon.
Mr. King. I thank you, Madam Chair, and I am happy to yield
back.
Ms. Lofgren. Thank you.
I would turn now to Mr. Gutierrez for any questions he may
have.
Mr. Gutierrez. Thank you. Thank you very much.
Well, thank you for your testimony here this afternoon.
I have an experience in Chicago where two of the largest
hospital organizations--one is being attempted to be organized
by AFSCME and the other one by SEIU. Do you have any
information on how that is going and how that might affect the
nursing shortage or ability of nurses?
Mr. Francy. Well, I know that AFSCME Council 31 is
organizing the Resurrection system in Chicago, and it has been
a very difficult and long, drawn-out fight. Other than that, I
do not have any specific information.
Mr. Gutierrez. Because when I met with AFSCME and I met
with SEIU, what it is trying to organize, interestingly enough,
are religious institutions. There is one under the United
Church of Christ, and the other, under the Catholic Church, and
it seemed to me that many of the conversations that we had were
around nurses and the hours that nurses were required to work.
Mr. Francy. Yes. If you ask nurses what is their number one
problem, they will tell you that it is short staffing. In fact,
in one nurse survey, 83 percent of RNs responding to the survey
said that increasing staffing levels would be very successful
in retaining and recruiting new nurses. So it is a huge
problem.
Mr. Gutierrez. You know, as someone who advocates
comprehensive immigration reform, I am very, very mindful to
all of the witnesses about, as we move forward, making sure
that where we build the jobs, it is really jobs that Americans
do not want.
I think American citizens should be afforded, those that
are born here should be afforded the absolute opportunity to a
job anywhere in the United States, regardless. I think that
should be paramount to any comprehensive immigration reform
program that we have, and so the testimony today really is
important because we do not want to deny American workers or we
do not want to create a situation which denies American workers
the opportunity.
These are not low-skilled, low-wage job opportunities,
which we many times speak to the need as our economy creates
hundreds of thousands of low-skilled, low-wage jobs in
different demographic areas throughout the United States that
we may need.
And so I thank the witnesses because we have their full
written testimony which we read and then listened to your 5
minutes on the clock which is a great summary of what you have
to say.
And lastly, as we look at this, I would say let's deal with
it in a comprehensive manner because it is not only nurses.
There are other sectors of our economy where we want to make
sure that we supply needed labor, and I think we will need that
labor.
I mean, as a baby boomer myself--I know all three of you
are too young--I keep thinking about, you know, over 40 percent
of our workers in the next 20 years, the youngest one will be
65 years of age. That is something that we have not encountered
in our economy before.
I just read in The Washington Post we are living longer,
and they said that Black and Hispanic males are, I mean,
tightening with White males and women. That is a good thing.
That is a good thing. That means that there is more parity in
health care and in economics and the people that are living
about the same time.
But, you know, it is like 81 years for women and 78 years
for men, and when you consider the drain that we are going to
have, I think we really need to have a global view of how we
address this within our workforce. You know, another 10 years,
I will be 64. Another 15 years, I will be 70.
I want to make sure there is a nurse there. I want to make
sure that there are qualified nurses there. I want to make sure
that our health care system can be responsive not only to me,
but literally the tens of millions of others like me who will
be retiring and in much need.
So, if you think the problem is bad today, give this
another 15 years. It is going to be critical to our economy.
So I thank you all for your testimony.
Ms. Lofgren. Thank you, Mr. Gutierrez.
I just want to say a couple of things and ask a couple of
questions.
First, let me say Mr. King is from Iowa. There have been a
number of emergencies, as we are well aware in Iowa, and he had
to go take a call from Secretary Chertoff, and I know that
everyone will understand that is his first obligation,
obviously, today.
Before I was in Congress, I was on the board of supervisors
of Santa Clara County, and one of our obligations there was to
run the county hospital, and I chaired the hospital committee
for 12 years, and every week we would oversee, and I learned a
lot about the whole health care business in that.
One of the things we had a very tough time was recruiting
nurses, and it got to the point where we were in high school
helping to pay for kids to go to nursing school. We were also
recruiting in Ireland. I mean, we did everything.
And the other thing we did was we raised salaries
substantially. I mean, when I first was elected, the salaries,
I thought, were pretty low. They ended up being quite high,
actually, which is good because it is a hard job and it takes a
great education, and so that was a good development.
But what is interesting is that as those salaries rose,
nobody raised the salaries of the professors, and so now we
have a shortage situation. I am a co-sponsor of Lois Capp's
bill to increase--a strategy because I know people in the
technology world, for example, who decided they would rather be
a nurse. I mean, these are people with science backgrounds that
they have been turned away from nursing schools because there
are not enough slots. So, clearly, I think everybody agrees we
have to remedy that.
You know, I have been one who has supported mandatory
staffing ratios. I think that is part of the picture of having
high nurse satisfaction, but, in order to do that, you have to
have enough nurses. So the question is which comes first, how
do we implement this strategy that I think there probably is
not that much disagreement really in terms of where we want to
end up, how do we get there.
Ms. Peterson, at the end of the day, do you support or does
the ANA support or oppose the bill that Wexler, Sensenbrenner,
and Feeney have introduced? Can you address that?
Ms. Peterson. Yes, I can.
At this point, we will not oppose it. There are elements of
it that we think are useful, but I want to just step back for
one moment because one thing I said in my testimony is we are
10 years into this nursing shortage. Ten years we have been
talking about education, 10 years we have been talking about
faculty, and yet the reality for nursing education funding is
it has not gone up all that dramatically.
So to sit here and talk about Congressman Wexler's bill
that has elements of it that are good--we appreciate the NEED
Act being included, we appreciate that there is some
understanding of the need for the circulation of workers to be
able to go back home and be able to come back in, but the
fundamental problem that you have already spoken to still has
not been addressed, and we have been talking about this for 10
years.
So, at this point, we will not oppose it. We recognize it
as a short-term strategy. We do not like it. We believe that we
need to be addressing the fundamental problem, and that is
funding for nursing education, and, quite frankly, if we get to
the end of the time period of Mr. Wexler's bill, at the end of
that period, and we still do not have any data and we still
have not seen see an increase in nursing education funding and
we still have not seen some of these other workforce issues
being addressed, we will not be supporting it again.
Ms. Lofgren. I understand. That is very helpful
information.
Maybe, Dr. Stonestreet, I do not know if you know this or
not, but isn't there at least a funding mechanism in the Wexler
bill?
Ms. Stonestreet. Yes.
Ms. Lofgren. I mean, I am not saying it is going to cover
all of it, but it will help.
Ms. Stonestreet. Right, but there is $1,500 per nurse who
is employed. The facilities that would bring them over would
pay that, which would go into the funding for education.
Ms. Lofgren. But I think, you know, if you look at the
city--for example, San Jose State in my district has a school
of nursing, but they have had to turn people away because they
do not have enough professors, and there is really a capacity
problem there, even though they have great applicants. I do not
blame the university, they do not have the money, and we have
to do something about this as a nationwide strategy, it seems
to me, and I understand the frustration.
I was in the minority in the House for 12 years, and I have
been in the majority now for 16 months, and so we have not
achieved everything we wanted to achieve in that timeframe, but
the speaker has put a tremendous emphasis on funding for
education and also science funding, and I personally know that
she believes that is such a compelling need for our country
that I have actually renewed confidence that some of these
items that have been languishing are going to be dealt with
because I do not think the three of you are really disagreeing
when it comes to that, and that is the interesting thing.
You know, my light is on, and that would not be fair to Ms.
Jackson Lee, who I will now recognize for 5 minutes.
Ms. Jackson Lee. Thank you very much, Madam Chair.
And let me suggest to the witnesses and those who were on
the first panel that when you see Members rushing in--of
course, the Chairwoman has indicated, the challenges for the
Ranking Member--some of us have been on other Committees. But
we rush in for the very reason that we are very much in sync
with the Chairwoman's continued march toward a solution.
We on this side of the aisle have always wanted or wished
for, if you will, a comprehensive approach to immigration
reform that would in essence broadly speak to many of the
issues that we are having a hearing on, but you will also find
very sympathetic advocates for the funding of more education
for engineers, for nurses.
And, of course, our colleague Congressman Gutierrez
mentioned that a nursing crisis is a health crisis, it is a
life and death crisis, and so I apparently came in on the very
appropriate panel.
But please know that I want to put on the record that we
have been meticulously meeting over these 16 months and
building the building blocks to say that we have to have a
comprehensive immigration reform package. I would also
acknowledge, because many of us have legislative initiatives
that track sort of the same theme, to solve this problem both
in terms of benefits, in terms of the need for additional
expertise that immigrants bring--and also border security--the
legislation that I have, the comprehensive Save America Act,
also responds to the question of American workers, hiring
American workers, training American workers, using resources
that you would have to invest in underemployed areas and areas
where we need more training.
So let me acknowledge where we are trying to go and accept
also the burden of being in the minority and the lack of focus
on nursing education, since the witnesses are addressing that
question. I have purview of A&M School of Nursing in my
congressional area, and it is climbing the mountain of
excellence. It is getting better and better and better and
better every year, but the resources are limited.
So let me acknowledge that the immigration aspect is only a
piece of the puzzle, that we certainly need to look at the
domestic supply of nurses, and we have to acknowledge that
Congress has not done enough and find a way to reach an
immediate balance. So I would ask the question that you may
have had already in your testimony, if each of you would answer
it as to tell me the length and breadth of the nursing
shortage, number one. Number two, a quick infusion of dollars
into nursing education, how quick would we get relief, and that
means we are talking about drawing upon the domestic base.
And then what is the enhanced value of an immigration
component through visas that would allow these skilled workers
to come in? We had an electrical engineer. I have heard from
African-Americans who indicate they are presently available. No
one recruits them. So what would be the immediate benefit of an
immigration fix, if you will, that would bring nurses in from
around the world?
I know some of you are taking notes, and I appreciate it,
and apologize. I want to add a component of transitional
training, what that means is language and techniques maybe,
comfort level. You could include that in your answers.
And I will start first with who seems to be writing the
fastest, Jana Stonestreet.
Ms. Stonestreet. I appreciate that. Thank you.
I think I will address first of all the immediate benefit.
In our hospital system--and I can speak for it, but within San
Antonio, within the Baptist Health Care System--we have
presently 236 nursing positions that are open. So an immediate
benefit that we would get for this short-term relief with the
immigrant nurses would be to be able to fill those positions.
We have had 88 nurses that we actually interviewed 2\1/2\
years ago. Eighty of those still, even though they are
qualified and ready to come, are not able to come yet because
of the immigration restrictions that are present.
Ms. Jackson Lee. The caps?
Ms. Stonestreet. The caps that are present today. So the
immediate solution would be to help us.
And I think one of the things that we have talked about is
the work environment, and which comes first, the chicken or the
egg, how does it really come. Well, if you do not have enough
nurses today, then the environment is not as positive because
we are working shorter, it is more stressful, and so on. So, if
we can get over kind of a little bit of the hump and be able to
get enough nurses to be able to work and to fill the positions,
it can help us carry through and create that better environment
that we all really work for.
You know, one of the things that is somewhat offensive as a
nurse executive within a hospital system--and that has been my
role since 1991 within three hospital systems--is the
implication that we are not trying to create the best
environment, not trying to create an environment that is
positive. I will tell you we are doing, you know, cartwheels
trying to be able to make that happen.
Ms. Lofgren. Dr. Stonestreet, the time has expired, and if
you could just very quickly sum up, and then if we could get
quick answers from the other two witnesses because we have run
out of time.
Ms. Stonestreet. Absolutely. I think those are the key
points that I wanted to be able to make and, hopefully, have
then answered your question.
Ms. Jackson Lee. Thank you.
Ms. Peterson?
Ms. Peterson. Thank you very much.
I guess I will talk to the piece of the transitional
challenges that you added at the end. ANA just completed a
series of three regional conferences where we were trying to
look at what types of programs existed in hospitals and also
within the recruiters who recruit and bring the nurses here.
When we bring them here, how do we be sure that they are
successful?
We know that one of the biggest barriers is really language
and communication, and so the programs that we saw--some were
in Chicago. There is one at Johns Hopkins, also University of
Pennsylvania--they have made an effort to try and really, one,
assist the foreign-educated nurse when she or he comes to the
U.S. in terms of just understanding how do I get a bank
account, where am I going to live, how do I get from here to
there, and then they have courses that are related to
understanding language and lingo, and in particular medical
terminology here in the U.S.
The other critical piece to that is helping them to
understand the culture, meaning the relationship between
physicians and nurses and other health care providers, and also
understanding that relationship from the perspective of
patients, family, and community.
Ms. Lofgren. Thank you.
Mr. Francy, you are doing cleanup, and then we will
adjourn.
Mr. Francy. Thank you. One of the things that was kind of
implied was kind of the bang for the buck, and we have talked a
lot about education, and if you considered this bottle of
pouring more water into that, that would be increasing the
supply of education which would fill it up.
Ms. Jackson Lee. Which is crucial.
Mr. Francy. Crucial. But there is a hole in this bottle and
there is leakage. Water is coming out. Those are nurses that
are leaving the profession. They are leaving the profession
because of staffing levels, of injury rates--it is a very high
injury profession--and mandatory overtime, et cetera, and so
the point I am trying to make is that education is
fundamentally a part of this solution, but also addressing the
working conditions of registered nurses has to be part of the
solution to plug this hole so, while we are pouring in, it is
filling up and not just, you know, going up and down.
Ms. Jackson Lee. I thank the witnesses.
Madam Chair, I yield back to you by reemphasizing my
continued point of the importance of recruiting American
workers for these positions as we look to emergency relief, and
taking Mr. Francy's point of working conditions so that no
matter who you are, African-Americans or Anglos, Asians, or
Hispanics who are Americans here, who could be workers need to
be included in this package as we look to solve this problem
through the immigration process, and, of course, the final
point is continue to push for comprehensive immigration reform.
I yield back.
Ms. Lofgren. Thank you.
The gentlelady yields back.
We will now be adjourning our hearing. I want to thank each
of you as well as the first panel.
A lot of people do not realize that the witnesses are
volunteers, really coming to help the Congress try and get it
right when we look at legislation. We do appreciate your
service for your country as witnesses.
We will keep the record open for 5 days. If we have
additional questions for any of you or the first panel, we will
forward them and, if that occurs, we would request that you
answer them as promptly as possible.
Once again, than you very much, and this hearing is
adjourned.
[Whereupon, at 2:08 p.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
Material Submitted for the Hearing Record
Prepared Statement of the Honorable Zoe Lofgren, a Representative in
Congress from the State of California, and Chairwoman, Subcommittee on
Immigration, Citizenship, Refugees, Border Security, and International
Law
I would like to welcome the Subcommittee Members, our witnesses,
and members of the public to the Subcommittee's hearing to explore the
need for green cards for highly educated employees in the fields of
science, technology, engineering and mathematics (STEM), as well as
nursing.
There is a recognized shortage of U.S. employees available to fill
jobs requiring the highest educational levels, particularly in the
fields of STEM.
According to the National Foundation for American Policy:
Major U.S. technology companies today average more than 470
U.S.-based job openings for skilled positions, while defense
companies have more than 1,265 each, indicating U.S. businesses
continue to experience difficulty in filling positions in the
United States for skilled labor of all types.
At the same time that our country is experiencing a shortage in
U.S. employees at the highest educational levels, employers from
Europe, Australia, Canada, and even China and India, are increasingly
attracting to their shores the highly educated, high achieving
scientists, engineers, mathematicians and researchers that are the
foundation for innovation. In 2000, for example, 75% of the world's
engineers were hired by U.S. employers--just six years later, in 2006,
that percentage dropped to 63%.
Today, more than half of the graduates from U.S. universities in
masters and Ph.D. programs in science and engineering are foreign-born.
To ensure that America remains the greatest source of innovation in the
world, we must not only educate more U.S. students in STEM, we must
retain the best and brightest innovators among them so that they can
work with us, rather than compete against us in other countries.
In addition, at the same time that nursing schools are unable to
produce enough nurses to meet existing health care needs around the
country, the demand for nurses is projected to continue increasing at
high rates as the Baby Boom Generation hits retirement and birth rates
plunge. Currently, 12.4% of the U.S. population is age 65 and older;
that percentage is projected to increase to 16.3% in 2020 and 20.0% in
2030.
I look forward to hearing from our witnesses today on how the
current immigration system has failed to respond effectively to these
economic and health care needs, and what might be done to address the
situation in the near and long term.
Prepared Statement of the Honorable John Conyers, Jr., a Representative
in Congress from the State of Michigan, and Chairman, Committee on the
Judiciary
Today we are looking at long-term legal immigration solutions for
graduates in the fields of science, technology, engineering and
mathematics--known as ``STEM''--as well as in the field of nursing.
We have bipartisan legislation before the Committee on both issues.
I would like to thank Zoe Lofgren, Robert Wexler, and Jim Sensenbrenner
for their leadership on H.R. 6039 and H.R. 5924.
Before I comment on these bills, I would like to point out that on
the issues before us today, labor and business interests have worked
together in good faith to develop pragmatic solutions. Nursing groups
and the SEIU have worked with the hospitals to come up with a good
first step in dealing with the nursing shortage. The engineers and the
high-tech companies have come to a common ground to get the best
foreign talent while preventing worker exploitation. It's my hope we
can make the same commitment to break the immigration logjam.
Turning first to Ms. Lofgren's bill, H.R. 6039, this measure will
help the United States to keep the best and brightest STEM graduate
students.
Think for the moment of a foreign student at University of Michigan
or Wayne State who does an internship with one of the car companies.
The reality is that the major automakers are working round the clock on
critical research and development of fuel-cell technologies, electric
vehicle technologies, and other fuel-efficient alternatives. And, the
reality is that many of the researchers on the cutting edge are foreign
students.
With soaring oil prices clobbering hard-working Americans all
across the country, this work is absolutely essential to our national
interests. The research that these engineers perform, and the products
they develop, will keep American manufacturers competitive, and will
keep and create jobs in Michigan and in the United States.
But when they graduate, they can't move into a permanent job offer
from the American company, but have to leave the country and go wait in
the horribly backlogged line for employment visas. So if the American
automaker or supplier wants to continue their research, the engineer
will at best have to work for a foreign subsidiary in Canada, India, or
Mexico. More likely, we will lose them altogether It makes no sense to
make these graduates leave.
The current system is bad for the graduates, bad for the companies,
and hurts the communities that they had been part of while in school.
By focusing on the green card track, these workers are at less risk of
exploitation than in a temporary guestworker program. As a result, the
Institute of Electrical and Electronics Engineers is in favor of this
approach.
The notion that high-skilled immigrants are an economic engine is
proved every day, as we see other countries--such as Singapore and
Switzerland--try to snatch the best and brightest foreign students away
from us.
As with all immigrants, these graduates aren't just an economic
engine, but a cultural engine as well. Their continued presence will
have a long-term benefit to effect on our communities and our Nation.
This is not just a theory, or rhetoric. Just look at Senator Barack
Obama, the son of a graduate student at University of Hawaii, or
Governor Bobby Jindal, whose mother came to Louisiana State University
as a graduate student in physics.
Secondly, on the nursing front, we will hear from our experts about
H.R. 5924, Mr. Wexler's bipartisan bill with Mr. Sensenbrenner as an
original cosponsor. This bill seeks to address the nursing shortage. As
many citizens in our Nation are aging, there is a rising shortage of
nurses, home care workers, and physical therapists, especially in rural
areas.
Congressmen Wexler and Sensenbrenner have worked with the Hospital
Administrators, the Nurses Association, and the SEIU to address this
shortage with a blend of immigrant and domestic capacity-building.
The idea is an elegant one. First, the bill exempts up to 20,000
nurses and therapists per year from the notoriously backlogged
employment-based visa caps.
Then, using funds from fees paid by the hospitals who benefit from
employing those foreign nurses, the bill will fund grants to U.S.
nursing schools, which in recent years have had to turn away more than
100,000 applicants a year because they lacked sufficient faculty and
laboratories.
This is a good start to deal with this pressing problem. We will
need to do more. I hope to soon introduce legislation to provide even
more funding for the schools and nursing scholarships, and to get more
PhD-level instructors and experienced nurses into faculty positions.
We also need to have a concerted effort for retention. Nursing is a
hard job, and the average tenure is from 4 to 7 years because of the
stress and the current health care system. When we get to universal
health care--as we must--it will be the nurses who are on the front
lines.
These two proposals are exactly the kind of cooperation and
pragmatism that we should encourage and support. I applaud these bills'
sponsors for taking these productive steps, and I thank the witnesses
for appearing before us today.
Prepared Statement of the Honorable Sheila Jackson Lee, a
Representative in Congress from the State of Texas, and Member,
Subcommittee on Immigration, Citizenship, Refugees, Border Security,
and International Law
Thank you, Chairwoman Lofgren, and ranking member King, for
convening today's very important oversight hearing on green cards for
highly skilled workers. This hearing will explore the need for green
cards for highly educated employees in the fields of science,
technology, engineering and mathematics (STEM), and nursing. I welcome
the testimony of today's witnesses.
Increasingly, the evidence continues to show that immigration is
good for the economy, jobs, and a critical part of our nation's
prosperity. There is a recognized shortage of U.S. employees available
to fill jobs requiring the highest educational levels, particularly in
the fields of science, technology, engineering, and mathematics.
Major U.S. technology companies today average more than 470 U.S.-
based job openings for skilled positions, while defense companies have
more than 1,265 each, indicating U.S. business continue to experience
difficulty in filling positions in the United States for skilled labor
of all types. A number of companies have thousands of skilled positions
available, with this level of openings persisting for a year or more.
This is part of longer-term trend that threatens to harm America's
economic future, with U.S. companies lacking access to the skilled
professionals needed to grow and innovate inside the United States.
Foreign-based educated nurses play a vital role in relieving
shortages in many U.S. hospitals. However, the entry of most foreign
nurses is blocked or delayed for years due to a failure to increase
immigration quotas. Despite nursing shortages, U.S. immigration policy
actually treats nurses worse than other professions. Medical literature
shows that the nursing shortages contribute to death and illness for
U.S. patients. Foreign-educated nurses are only one solution, research
and interviews find relief from strict immigration quotas would help
patients, hospitals, and the nation as a whole.
The need for nurses is projected to continue to increase as the
U.S. population ages and the birth rates drop. Currently, 12.4% of the
U.S. population is age 65 or older. That percentage is projected to
increase to 16.3% in 202 and 20.0% in 2030.
In this hearing, the subcommittee will explore whether and how the
current immigration system has failed to respond effectively to these
economic and health care needs, and what might be done to address this
situation in the near future.
The Immigration and Nationality Act authorizes a minimum of 140,000
visas per year to immigrants based upon employment in the United
States. All but 5,000 of such employment-based immigrant visas go to
highly skilled and highly educated immigrants. Yet the wait times for
these immigrant visas also continues to rise. The current wait for
highly educated immigrants ranges from two to six years, depending upon
education and achievement and country of origin. Highly educated
immigrants from India and China suffer from particularly long backlogs.
Approximately 400,000 to 500,000 intending employment-based immigrants
are believed be caught in the legal immigration backlog.
The 140,000 employment-based immigrant visa numbers allocated
annually have proven insufficient to meet the needs of U.S. employers
in certain preference categories, most notably in the second and third
preferences, which are the categories most used by highly educated,
high achieving immigrants in STEM fields and nursing.
More and more, employers from Europe, Australia, Canada, China and
India are beating U.S. employers for valuable talent. In 2000, 75
percent of the world's engineers were hired by the U.S. In 2006, 63
percent of the world's engineers were hired by the U.S. Today, more
than half of the graduates of U.S. universities in masters and Ph.D.
programs in science and engineering are foreign-born. We must do all
that we can to ensure that America stays competitive in math, science
and engineering. America must continue to attract the best and the
brightest innovators to venture to the U.S. to help us maintain our
advantage.
Notably, there are two legislative proposals that would address
this problem. The first, H.R. 6039, a bipartisan bill authored by
Congresswoman Zoe Lofgren, would provide that masters and Ph.D. level
graduates from U.S. U.S. universities in science, technology,
engineering, and math could accept employment offers from American
companies and receive a permanent resident visas. There are an
estimated 12,000 graduates per year in this category.
The second is H.R. 5924, the Emergency Nursing Supply Relief Act, a
bipartisan bill introduced by Congressman Wexler and Congressman
Sensenbrenner. This bill provides a three-year exemption from current
Employment-Based visa caps for up to 20,000 RNs and physical therapists
each year. The bill is also designed to enhance the training and
retention of U.S.-educated nurses, applying a $1,500 fee on employers
for each application for a green card for grants to U.S. nursing
schools, which have turned away over 100,000 applications. H.R. 5924
would also incorporate a pilot program for retention grants, subject to
appropriations, that will fund career enhancement training for
healthcare workers.
I welcome the witnesses' insightful testimony. Thank you, I yield
the balance of my time.
Prepared Statement of the Honorable Earl Pomeroy, a Representative in
Congress from the State of North Dakota
Chairwoman Lofgren and Ranking Member King, I would like thank you
for holding this important hearing to discuss methods to address
shortages of highly skilled workers, including health care
professionals in our country.
Right now, we are in the middle of a severe shortage of physicians
in the United States, especially in rural and lower income communities.
This problem is expected to get much worse in the coming decades, with
experts saying that by 2020, the United States will have a shortage of
85,000 to 200,000 doctors. Without a doubt, this projected shortage
will hit rural and low-income areas the hardest. It is imperative that
Congress act now to ensure that these vulnerable populations have
access to qualified physicians and needed medical services.
To help address the shortages, Congress created the Conrad 30
program in 1994. Under this program, foreign doctors who have received
medical training in the United States are granted a waiver from a visa
requirement to return to their home country for two years. In exchange
for this waiver, the doctors must commit to providing health care to
underserved populations in the United States for three years. In the
nearly 15 years of this program, thousands of doctors have been placed
in rural and low-income areas in all 50 states.
Unfortunately, at a time when the need for doctors is growing, the
number of doctors entering the Conrad 30 program is in decline. For
that reason, I introduced H.R. 5707, the Conrad State 30 Improvement
Act. This legislation makes the Conrad 30 program permanent.
Importantly, the bill improves incentives for doctors to enter the
program by providing a green card cap exemption for doctors who
complete the program. In addition, it creates a means by which the
current cap of 30 doctors per state under the program can expand, while
still protecting those states that have had a hard time recruiting
doctors under the program.
There have been discussions within the medical community for years
about the best way to expand the Conrad 30 program, and this
legislation is the first approach universally supported by the medical
community. Today, I would like to insert letters into the record in
support of this bill from the following organizations:
Association of American Medical Colleges
American Medical Association
American College of Physicians
American Hospital Association
Health Partners Medical Group and Clinics
Immigration Voice
National Cooperative of Health Networks Association
National Health Care Access Coalition
National Organization of State Offices of Rural
Health
National Rural Health Association
National Rural Recruitment and Retention Network
(3RNet)
North Dakota Hospital Association
I appreciate your attention to this important program, and I look
forward to working with you on this legislation as we move forward. The
Conrad 30 program has greatly benefited my state, and I believe that
the changes to this program will be valuable for helping to combat the
growing shortage of physicians. Thank you.
Prepared Statement of Mary Amundson, M.A., Center for Rural Health,
University of North Dakota School of Medicine and Health Sciences
My name is Mary Amundson and I am an assistant professor at the
Center for Rural Health, University of North Dakota School of Medicine
and Health Sciences in Grand Forks, North Dakota. Thank you for
allowing me to provide testimony on the Conrad State 30 program which
helps to address a vital issue facing not only rural America but also
urban areas across the country as well.
I have been working in the area of physician recruitment and
retention for the past nineteen years, working with communities and
health care providers to improve access to primary care services
through a variety of federal and state programs.
Access to health care is a fundamental issue facing America's rural
citizens. Rural Americans account for approximately one-fourth of the
U.S. population; however, only about 10 percent of the physicians
practice in rural areas. Rural communities in North Dakota, and
throughout the country, are experiencing the closing of essential
access points such as rural primary care clinics, home health care
services, and even rural ambulances. The health care safety-net for
rural America is threatened and the health status of rural Americans is
compromised. Rural Americans do not seek unnecessary services, they do
not seek more than what they need; they do however, expect that their
legitimate access to health care services are commensurate with meeting
the service needs of populations in more urban settings.
The Conrad J-1 Visa Waiver Program initiated in 1994 has been a
very important program not only for North Dakota but for all 50 States
and the District of Columbia. The amendments proposed in this new
legislation will increase the supply of physicians to underserved areas
all across the country.
Physician shortages are not unique to North Dakota but are evident
in all 50 states and the District of Columbia. The demand for primary
care physicians, especially the specialties of family medicine and
general surgery is at an all time high. For example, the American
Academy of Family Physicians (2008) notes a steady decline in the
number of students choosing family medicine from 1997-2007. Today's
medical students who are tomorrow's physicians, are not choosing
primary care due, in part, to life style and income which negatively
impacts access to care for those citizens living in rural areas where
the shortage of providers is most evident. ``Departing from past
reports, the 16th Report to Congress from the Council on Graduate
Medical Education (COGME) report warns of a physician deficit of 85,000
by 2020 and recommends increases in medical school and residency
output.'' \1\ Added to this dilemma is the fact that, according to the
American Medical Association, 250,000 active physicians will retire by
2020.
---------------------------------------------------------------------------
\1\ COGME's 16th Report to Congress: Too Many Physicians Could Be
Worse Than Wasted. Robert L. Phillips, Jr, MD, MSPH1, Martey Dodoo,
PhD1, Carlos R. Jaen, MD, PhD2 and Larry A. Green, MD1
---------------------------------------------------------------------------
In 2004, the U.S. Department of Health and Human Services reported
that 34.9 million Americans live in federally-designated health
professional shortage areas where there is less than one primary care
physician for every 2,000 persons in urban, suburban, and rural areas.
Nationally, 67 percent of the non-metropolitan areas in the U.S. are
located in federally designated Health Professional Shortage Areas. By
way of example, in North Dakota, 81 percent of the state is located in
Health Professional Shortage Areas. Further, 91 percent of the state is
located in Medically Underserved Areas which are also eligible areas
for the Conrad Program.\2\
---------------------------------------------------------------------------
\2\ Medically Underserved Areas are calculated based on population
density, infant mortality/low birth-weight, provider ratios, and
percent elderly
---------------------------------------------------------------------------
Health provider need is determined by the number of vacancies or
job openings. For example, on a recent survey of health care facilities
in North Dakota, 46 percent of our health care facilities (32/69)
reported vacancies for family medicine or internal medicine physicians.
Of the facilities recruiting these providers, 73 percent of the sites
were located in underserved areas.
If it were not for the Conrad J-1 Visa Program, I can assure you
that more of our rural health care facilities all across the country
would be closed today. For example, the health care facility in Crosby,
ND, a town of about 1,000 people, utilized this program starting in
1995. From 1995-2005, the community recruited five physicians through
this program that sustained their health care services. These
physicians allowed the continuation of services to the citizens of
Crosby until a U.S. physician was finally recruited to the community
this past year. The Conrad Program provided a much needed bridge to
services until a more permanent physician could be found. Scenarios
like these can be cited in communities all across the nation
particularly in the Midwest and West.
Although there is a call from the Association of American Medical
Colleges to increase medical school class size, this will take time
which our fragile rural health care systems don't have; our health care
systems simply won't survive. Immediate policy solutions to the
physician shortage problem are needed today.
The initial legislation enacted by Congress in 1994 provided a much
needed resource to aid communities in recruiting providers; however,
due to a decrease in the number of physicians entering training on the
J-1 Visa, changes are needed. The Conrad 30 program has been very
successful in providing 5,732 waivers from 2001-2007 and the proposed
amendments by Senator Conrad will make it even stronger.
As I have stated, the Conrad 30 program is essential in increasing
and assuring access to care for millions of Americans and we are
appreciative of this program. However, advocating for its re-
authorization every two years is precarious for these Americans.
Consequently, the proposed legislation that makes the program permanent
is extremely important to stabilizing health care services.
States are seeing a steady decline in the number of J-1 physicians
applying for Conrad waivers from a high of 1,033 in 2003 to 866 waivers
in 2007.\3\ This decline is due to the increase in the number of
physicians entering the country on H-1B Visas. These visas do not
require service to the underserved; these physicians simply need an
employer. Policy changes need to be included that address the H-1B visa
issue.
---------------------------------------------------------------------------
\3\ Texas Primary Care Office, Conrad 30 Program and from the GAO
Report released in November 2007.
---------------------------------------------------------------------------
The Conrad State 30 Improvement Act proposes five principal reforms
to the Conrad program. First, the Conrad State 30 Improvement Act would
make the program permanent. Second, the act would allow physicians on
H-1B visa to obtain a Conrad 30 waiver slot in return for a three-year
service obligation in a federally designated shortage area. Third, the
act would offer a green card cap exemption for physicians who have
completed the Conrad 30 program. Fourth, the bill would provide
increased flexibility for states to manage the program to meet their
needs by increasing the Flex slots from five to ten per state. These
slots are used for doctors employed at facilities that are not located
in federally designated shortage area that serve patients who live in
these designated areas. Finally, the bill would create a fair mechanism
which would allow the 30 doctor per state cap to increase under certain
conditions.
When the Conrad J-1 Visa Waiver program was first implemented in
1994, not all states participated in the program. But within a few
years, states were realizing the benefits of this program and all
states now participate. This is a very successful program and is
helping to address our needs as a nation to improve access to care
among the nation's most vulnerable populations. The amendments in the
Conrad State 30 Improvement Act are important to further improve the
program and ensure that physicians are available to serve the nations
underserved.
In conclusion, the Conrad State 30 Improvement Act strikes the
right balance between big and small states and has support from across
the medical community, from groups that have disagreed in the past on
how to improve the program. Those groups that have endorsed the bill
include the American Hospital Association, the American Medical
Association, the Association of American Medical Colleges, American
College of Physicians, the National Cooperative of Health Networks
Association, National Health Care Access Coalition, National
Organization of State Offices of Rural Health, National Rural Health
Association, National Rural Recruitment and Retention Network (3RNet),
North Dakota Hospital Association, and HealthPartners (MN).
Thank you for this opportunity to write in support of a critical
program that improves the lives of millions of Americans.
I would be happy to work with you to elaborate on issues and answer
your questions. For information regarding this testimony, please
contact:
Prepared Statement of Jack Krumholtz, Managing Director Federal
Government Affairs, Microsoft
Letter from Darrell G. Kirch, M.D.,
the Association of American Medical Colleges (AAMC)
Letter from Rick Pollack, Executive Vice President,
the American Hospital Association
Letter from Roger Cochetti, Director--U.S. Public Policy, CompTIA
Letter from Immigration Voice, the National Cooperative of Health
Networks Association, the National Health Care Access Coalition, the
National Organization of State Offices of Rural Health, the National
Rural Health Association, the National Rural Recruitment and Retention
Network (3RNet), and the North Dakota Hospital Association
Letter from Michael D. Maves, MD, MBA, Executive Vice President, CEO,
the American Medical Association
Letter from Nancy McClure, Senior Vice President,
HealthPartners Medical Group and Clinics