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Immigration. It's a hot potato. Don't touch!

Ouch! Oh!

There is probably no more sensitive and contentious political issue today than this.

Usually, issues have two sides to them. Immigration, according to recent polls has at least four strongly held positions by the majority of Americans. This makes it hard to discuss … and probably not too smart … but I am going to try.

Why? Because for healthcare, immigration is a reality that needs to be dealt with, regardless of individual political positions.

In my home town of Nashville, the Asian population increased by 93.2 percent between 1990 and 2000 and the Hispanic population increased by 446.4 percent. The increase in those two population segments accounted for about half (47.2 percent) of the county's population increase. Metro's Refugee Services Division says that more than 100 countries are now represented in the Nashville area.

There are enough statistics about immigration to fill a textbook, but here's one of the most telling: a recent Census Bureau report noted that nearly half of the nation's children under five are racial or ethnic minorities. No matter what happens with borders and policy, this is the picture of our future.

Like everyone else in the country, healthcare providers surely have their personal opinions about the immigration issue and what should or shouldn't be done about it. The reality, however, is that healthcare providers live the issue daily.

To me at least, there are two things that need to be addressed. (And whether the "glass is half empty or half full" is up to the individual reader.)



An Adjustment in Services

Healthcare providers increasingly need to provide services in different languages and in a way that is culturally sensitive to patients.

While the language services might seem the most ominous, in reality many hospitals are coping with this issue fairly well by using a variety of scheduling options, bilingual volunteers, printed materials in foreign languages, partnering with other social service agencies and the like.

Instead, the major issue arises in dealing with cultural differences, particularly those that go to fundamental beliefs about the appropriateness of various healthcare and genetic analysis, treatments and outcomes. Cost will clearly be an issue as well, but culture will trump money as the front-line concern for caregivers.

Finding a way to navigate this tricky cultural divide lies in more education: for patients and providers. There is a growing and urgent need for cultural awareness training for providers. In high immigration areas, such training has been around for some time. In areas like Nashville, where the population dynamics are changing dramatically, such training should rise to the level of required continuing education, with the requisite credentialing. It probably won't be long before it makes the "check off" list of agencies such as the Joint Commission.



New Sources of Talent

Healthcare is in a "crisis of talent" and not because of immigration. The causes are well documented and don't need to be repeated here. Immigration is but one part of the problem, but has the potential to be a large part of the solution.

Clearly, as healthcare policy makers confront the shortage issues [nursing, technicians, etc], they must turn to immigrants as a potential source of talent. While stereotypically we tend to think of immigrants as coming largely from poorly educated groups, many are, in fact, very highly educated. Unfortunately, when our current regulations and programs of certification were first created, the need for flexibility in admitting legitimate, and very well trained foreign healthcare professionals into U.S. practices wasn't anticipated.

A major effort at reviewing the healthcare education standards in foreign countries is way overdue, especially since many of the faculty in such programs are American-trained or are from other Western countries with similar standards of education and practice.

In addition, with the availability of public domain treatment protocols and medical journals available free on the Internet, healthcare "best practices" — like those in business, engineering and other complex areas — is becoming a global standard, rather than a United States standard.

So, when it comes to immigration, we can quickly pass this "hot potato," or we can grab it and prepare ourselves for the reality that immigration is an established fact for healthcare.

It makes no more sense to ignore it than it would to return to "bleeding" as a cure-all.



Dr. Richard W. Oliver, CEO of American Sentinel University, has taught strategic, technical, and healthcare management courses at Vanderbilt and Cornell University's business schools. He is the author of seven books on management and biotechnology.

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