1. The Welcome Back Initiative Integrating Highly Qualified Immigrants into the US Health Workforce José Ramón Fernández-Peña, MD, MPA Initiative Director WES Forum New York, November 12, 2009 ®

2. Who We Are Our mission is to build a bridge between the need for more culturally and linguistically diverse health professionals and the untapped resource of immigrants trained in a field of health in their country of origin who are living in the US. Our mission is to build a bridge between the need for more culturally and linguistically diverse health professionals and the untapped resource of immigrants trained in a field of health in their country of origin who are living in the US. The Welcome Back Initiative currently includes centers in California, Massachusetts, Rhode Island, Washington, Maryland, Texas, and New YorkThe Welcome Back Initiative currently includes centers in California, Massachusetts, Rhode Island, Washington, Maryland, Texas, and New York

3. Why? The lack of minority health professionals is compounding the nations persistent racial and ethnic health disparities. (Sullivan Commission, Sept. 04)

4. Composition of Selected Health Professions by Race and Ethnicity White (%) Black (%) Hispanic (%) Asian/PI (%) American Native (%) General Population * 65.612.215.44.50.8 MD 73.05.04.017.00.1 DDS 89.01.02.07.00.1 RN 82.09.03.06.00.4 PharmDS 76.06.03.014.00.3 LPN 73.019.04.03.00.8 Data Source: HRSA, US Census 2008 Population Projections *1.5% of the population is of two or more races.

5. Immigration Facts Immigrant numbers and growth rates are significant. The foreign-born population in the United States tripled in the past four decades and currently totals about 37 million, or nearly 12 percent of the total population. By 2010, the foreign-born population is expected to increase to 43 million, or 13.5 percent of the total population. In 2000, two-thirds of all the foreign-born lived in the traditional "big six" immigrant states (California, New York, Texas, Florida, Illinois, and New Jersey), down from three- quarters in the decades before 1995. US Census Bureau

6. From 1990 to 2000, the foreign-born population grew by 145 percent in 22 "new growth" states, compared to 57 percent average growth nationwide. The biggest growth between 1990 and 2000 occurred in the Southeast, Mountain, and Plains states, led by North Carolina (274 percent), Georgia (233 percent), Nevada (202 percent), Arkansas (196 percent), and Utah (171 percent). The foreign-born averaged 25 percent of the population in central cities in 2000, with the highest percentages in Miami (60 percent), Los Angeles (40 percent), and San Francisco, San Jose, and New York (all above 35 percent). More immigrants now live in suburbs (12.8 million) than in central cities (9.8 million). US Census Bureau

7. In 2007, twenty-seven percent of foreign-born U.S. residents possessed at least a four year degree and 11 percent of immigrants possessed advanced degrees – a greater proportion than the 10 percent rate among native-born residents. U.S. Census. (2009). Educational Attainment in the United States. Washington. 3.

8. In February 2009, while the rest of the economy shed 681,000 jobs, the health care sectored gained 27,000 new jobs. The need for nurses is particularly acute. Nation-wide, in 2008, the vacancy rate for nurses was estimated to be approximately 8 percent, or 135,000 RNs. American Association of Colleges of Nursing. (2009). Nursing Shortage Fact Sheet. Last accessed 6/7/09 at http://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htm.

9. Professions - All Centers Other includes: psychologists, speech therapists, pharmacists, midwives, physical therapists, social workers. Total Participants: N= 9,346 as of 3 rd Quarter. 2009.

10. N= 9,346 as of 3 rd Quarter, 2009 Working In Health? - All Centers Time in the US Gender

11. Heard About WB? English Level (Self- Reported)

12. 60% of Participants are Latino 44% of Participants are Latino 60% of Participants are Latino

13. 14% of Participants are Latino 21% of Participants are Latino 62% of Participants are Latino

15. Individual level Barriers English Language Proficiency Time & Economic Issues Lack of Familiarity with US Health System Loss of Professional Identity

16. Structural Barriers Complexity of Licensing Processes Complexity of Licensing Processes Inconsistent Messages from Educational Institutions Inconsistent Messages from Educational Institutions Complex Bureaucracies (Abroad and US) Complex Bureaucracies (Abroad and US) Conflicting Interests of Key Stakeholders Conflicting Interests of Key Stakeholders

18. Outcomes (through 3 rd Quarter, 2009) 2,212 Validated their Credentials 1,253 Passed Licensing Exams 679 Obtained License in their Original Professions 533 Obtained Advancement in Health Career 1,477 Obtained Employment in the US Health Sector for the First Time 82 MDs Accepted into Residency Programs

19. Welcome Back Initiative San Francisco WBC San Diego WBC Boston WBC Rhode Island WBC Puget Sound WBC (WA) Suburban Maryland WBC Alamo Area WBC (TX) New York WBC Phoenix? WBC Denver WBC Los Angeles WBC

20. Welcome Back Centers San Francisco, CA Hosted by City College of San Francisco & SFSU (415) 561-1833 San Diego, CA Hosted by Grossmont College (619) 409-6417 Boston, MA Hosted by Bunker Hill Community College (617) 228-4226 Providence, RI Hosted by Dorcas Place ( 401) 273-8866 ext 155 Puget Sound, WA Hosted by Highline Community College (206) 878-3710 ext 33 Suburban Maryland Hosted by Montgomery County DHHS (240) 777-1004 Alamo Area, TX Hosted by Alamo Community College District (210) 485-0245 New York. NY Hosted by La Guardia Community College (718) 482-5498 www.welcomebackinitiative.org