America is experiencing critical shortages in health care fields, despite a deep reservoir of skilled, immigrant health care workers. These certificate programs can bridge that gap.
Hamida Ebadi didn’t want to come to the U.S. She wanted to use her skills and training to help her own people in Afghanistan. She’d already served as the director of Maternal and Child Health, managing all the country’s maternal hospitals, and worked as an advisor to the deputy minister of public health. 
But the fact that she’d studied public health at Johns Hopkins in the U.S., and worked on an Afghanistan-based team coordinating with the U.S. Centers for Disease Control, had drawn unwanted attention. “We heard some threats from our neighbors,” Ebadi says. Those threats on her life, plus a suicide bomb attack near her children’s school, finally pushed Ebadi and her husband, an orthopedic surgeon, to apply for visas and move to America in 2014 with their four children, then ages nine to 20. Ebadi herself was 49 at the time.
Highly-skilled immigrants like Ebadi face unique challenges when they get to the U.S. For many, the first and biggest challenge is that their medical degrees and other credentials earned in their home countries aren’t recognized here. “We know that there are many immigrants that were doctors or nurses in their country of origin that are working here as dietary service workers or otherwise,” says Daniel Bustillo, the director of the Healthcare Career Advancement Program (H-CAP), a national labor-management partnership devoted to innovation in health care career education. “We don’t have a good mechanism for translating their credentials into our system,” Bustillo says. That means that even as headlines lament worker shortages in crucial health care fields, there’s a deep reservoir of qualified workers who can’t access those jobs.
Finding a job was, of course, among the host of challenges Ebadi faced when she arrived in America. “It’s very hard for health professionals especially, who had good jobs in their country, but when they come to the U.S., they start from scratch,” she says. 
Through the International Rescue Committee, Ebadi was introduced to a program run by the Baltimore Alliance for Careers in Healthcare (BACH) which provides trainees with certificates that can help them get good jobs. This program combines classroom and on-the-job training, allowing participants to advance as quickly as they can demonstrate competency in certain required skills. It’s one of many such programs that are designed to help immigrant workers like Ebadi advance quickly into jobs that better match their skills. 
According to a 2019 report by the Migration Policy Institute (MPI), supported by Lumina Foundation, adults of immigrant origin make up 30% of all working-age adults who lack postsecondary credentials, making this a crucial population to target with efforts to increase postsecondary attainment. MPI’s research has also found that non-degree credentials, including certificates like the ones Hamida received, significantly increase labor-force participation, particularly for first- and second-generation immigrant women. Amid the COVID-19 crisis’ historic levels of unemployment — the highest since the depression era — these efforts to empower and increase labor-force participation are more urgently needed than they’ve been in generations, with Pew Research noting that the unemployment rate for immigrant workers is significantly higher than it is for their U.S. born counterparts. 
The BACH program was designed in partnership with local hospitals, including Johns Hopkins, and with the Community College of Baltimore County, explains Kiera McCarthy, BACH’s Apprenticeship Manager. Participants start by taking an unpaid course in career readiness that helps prepare them for work in the U.S. BACH covers the cost of this course, so it’s unpaid, but free to participants, who receive a Community College of Baltimore County Continuing Education certificate upon completion. Then, they apply for an apprenticeship that provides on-the-job training while they work towards another certificate. 
“When they first start, they’ll start at maybe 50% of the final wage,” McCarthy explains. On-the-job training gives them the opportunity to demonstrate mastery of key skills, and as they progress, their pay increases. Participants can work through this program at their own speed, McCarthy says. “Hopefully, for immigrants, if they worked in the health care field in the past, they might be able to demonstrate mastery of those skills sooner,” she says. On the other hand, if English or another aspect of the program proves challenging, they’re not penalized for taking the time to improve. 
Ebadi went through the Environmental Care Supervisor track at Johns Hopkins Hospital, training to run a housekeeping team. Upon completing the program, she received a Journeyworker certificate from the Maryland Department of Labor. Ebadi says she’d prefer to be treating patients, “but because my credentials have not been accepted by the U.S. government, at least this position gave me some training to improve my managerial skills.” 
Once in the program, Ebadi appreciated the fact that she could get paid while getting up to speed on work culture in the U.S. “I had the opportunity to learn about the culture, to learn about some other processes like payroll processing and annual evaluations, training of the staff, grievance processes—a lot of new things,” she says. She’d managed people in Afghanistan, but found the work culture in the U.S. to be very different. “People here are very open, and they discuss everything openly with their managers and supervisors,” Ebadi says.” And there are some policies that get implemented here, like writing up people, disciplining, those kinds of things—it’s very strict here, and in our country, it’s not as strict.”
Certificates, apprenticeships, and other post-secondary credentials can be enormously valuable in creating pipelines into professions, Bustillo says. But there’s also a great need for programs that help people advance within a profession. “Especially in health care, we have tremendous occupational segregation,” he says. Bustillo says that as many as 70% of the home care workers H-CAP works with, for example, are immigrant workers, and there’s a real risk of segregating black, and brown and immigrant workers into these kinds of lower-paid fields within health care. 
The BACH program is designed to help both immigrant workers new to the U.S. health care system and internal workers who want to advance at a place like Johns Hopkins, McCarthy says. The initial idea was to focus specifically on immigrant and refugee workers, but hospitals also wanted to create ladders for internal workers, she adds. “From the employer’s perspective, they have found that nationally, the apprenticeship retention rate is significantly higher.” 
For her part, Ebadi appreciated the opportunity to move directly into a supervisory role. “If I compared this job with my previous job and my background, it would be frustrating,” she says. But she says that after three years at Hopkins, she’s now working as a Patient Referral Coordinator with the Baltimore Medical System. “My plan is to go back to Hopkins with the same position I have now or a better one,” Ebadi says. “I’d prefer to work either with patients directly or at least in a public health position. It’s not going to be easy at this age. But I will try.”
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This piece was produced in partnership with Lumina Foundation. Lumina Foundation is an independent, private foundation in Indianapolis that is committed to making opportunities for learning beyond high school available to all. You can learn more about their mission to prepare people for informed citizenship and success in a global economy here.