Make no mistake about it … there is a nursing shortage, according to David Bartholomew, president and CEO of HCCA International. Yet the Franklin-based company’s model to bring in U.S.-licensed nurses from the Philippines and India is hitting a snag as the federal government and politics are hampering the nurses’ attempts to enter the country.

 

“HCCA is a great business, a fantastic business model. If you see a Filipino nurse at almost any hospital across the country, HCCA probably had something to do with it,” Bartholomew said, adding HCCA services have helped ease the nurse-recruiting challenges faced by hospitals, clinics and other providers. Traditionally, HCCA has placed nurses, who are HCCA employees, into hospitals on a 30-month contract. After the 30 months, 74 percent of the nurses stay at the hospital where HCCA placed them. “The hospitals love it because they get to keep them after the contract,” he said.

 

The problem today, however, is visa retrogression, a rollback in the processing of visa applications by the U.S. Citizenship and Immigration Services. The result is a backlog, thus reducing the flow of trained nurses to the country. These nurses enter the United States via H-1B visas, which allow American companies to hire skilled overseas workers. Not only does the healthcare industry take advantage of this program, hosts of technology-related companies like Microsoft, IBM and Oracle are big users of the option.

 

“We typically would be bringing in somewhere between 300 and 500 nurses a year. We typically would have 50 or 60 hospitals that would have our nurses, and we have 900 nurses over in the Philippines who are ready to come over … but the government won’t let anybody in,” Bartholomew said. These nurses have passed their U.S. license requirements and the NCLEX (the National Council Licensure Examination), have the hospital bedside experience required by HCCA and have completed the H-1B visa-application process.

 

Bartholomew attributed retrogression to three issues, and the first is the slowed economy. Nurses who would have retired in the last few years are delaying that move, while others are returning to full-time work from part-time work or returning to the work force after having retired. Thus, the country has developed a false sense of security that the predicted nursing shortage hasn’t and won’t materialize. This has fueled the notion of H-1B opponents who believe there’s no need to increase immigration numbers. However, the reality is quite different, Bartholomew said, and down the road, nurses will be retiring in droves and leaving hospitals, clinics and practices scrambling to fill the void.

 

Second, the possibility of comprehensive immigration reform at the federal level is resulting in a wait-and-see attitude. Powerful immigration coalitions, particularly Hispanics, are lobbying first and foremost on behalf of immigrant workers already in the country, not those trying to get in.

 

Third is America’s unemployment rate. “There’s a real political force out there saying, ‘Why would we give any jobs to foreign workers when the U.S. worker needs them?’” Bartholomew said. Yet, American nurses aren’t having trouble finding work, he contended; there just aren’t enough of them. “These are skill sets that are needed, and they’re needed right away. But it’s not politically correct to support something that’s not giving the U.S. worker the job,” he said.

 

Bartholomew joined HCCA International, formerly an internal arm of HCA, in January 2009, but he had been an investor since 2001. He took the helm to help the company retool its mission while faced with today’s political challenges. “The company is in great financial shape, is sitting on a lot of capital and just needed to find a way to diversify,” he said.

 

Some new strategies are taking advantage of HCCA’s nurses who are already trained and still in their native countries. The company is looking to place those nurses in countries other than the United States. More than 100 are at work today in the United Kingdom and another 100 or more are working in the United Arab Emirates. Another new business model, called HCCA Health Connections, sends work from American hospitals and other providers to the Philippines, where the U.S.-licensed nurses are available for reviewing charts and other medical records, processing medical claims, offering telephone triage and answering physician phones after hours, supporting diabetes supply fulfillment, managing workers’ compensation cases, making discharge follow-up calls and coaching patients on chronic disease management and wellness.

 

“You can do it over in the Philippines for probably half the cost that it takes to do it here in the U.S.,” Bartholomew said, predicting that this service will grow as more providers implement electronic medical records and telehealth technologies.

 

On the domestic front, HCCA has gotten into the staffing of clinical research sites, particularly in the pharmaceutical, nutritional and medical-device arenas. HCCA recruits and then provides medical professionals with experience in Phase I through Phase IV clinical trials. HCCA is also recruiting and staffing nurse anesthetists.