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Column: How Foreign-Born Students Fill America’s Demand for Skilled Workers

  • Brad and Zita Ficko try to persuade their twin children Ziva and Kelvin, 4, to finish their dinner so they can have strawberries for dessert at their home in West Lebanon, N.H., on Aug. 9, 2018. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to Valley News — Jennifer Hauck

  • After dinner in their backyard Ziva Ficko, 4, giggles when her father Brad Ficko turns her upside down on Aug. 9, 2018 in West Lebanon, N.H. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to Valley News — Jennifer Hauck

For the Valley News
Published: 9/1/2018 10:39:56 PM
Modified: 9/1/2018 10:40:22 PM

The tricycles of their twin 4-year-old children, Ziva and Kelvin, rest on the front lawn of their home in a tidy neighborhood in West Lebanon. The twins’ mother is Zita Ficko, a native of Slovakia and 2012 graduate of Dartmouth College’s Geisel School of Medicine who is close to completing her residency in urology at Dartmouth-Hitchcock Medical Center. Their father, Brad Ficko, is a Canadian with a doctorate from Dartmouth who works at a bioengineering technology startup in the Upper Valley.

Zita and Brad Ficko are a perfect example of how foreign-born students (especially in fields such as in engineering and medicine) are helping to meet the demand by American employers for highly skilled workers.

About 1 million foreign students are enrolled in higher education in the U.S. today, about double the number from the mid-2000s. Roughly 1 million individuals are awarded green cards each year. The precise number of those on this journey of endurance from student to green card holder is difficult to estimate, but it appears that over the past 10 years, several hundred thousand foreign-born students have taken this journey, almost all into increasingly strong labor markets. They have either received their green cards or are waiting for them. A recent study by the Washington, D.C.-based Center for Immigration Studies found that success on the path the Fickos and others like them are taking is driven by “merit, career-building skills, and luck.”

Brad Ficko got a doctorate in biomedical engineering at Dartmouth while on a student visa. Then, partly because he was a STEM student (one who is studying the highly valued topics of science, technology, engineering or math), he was able to extend his stay and work under a temporary after-graduation visa program. He then switched to yet another visa program, chosen on the advice of the couple’s immigration lawyer. His next step is to obtain, with the support of his employer, a green card for permanent residency.

“Our end goal is for one of us to get a green card,” Zita Ficko said. “As a green card spouse, you can work. As a temporary visa spouse, you cannot work.”

Temporary visas for skilled workers, which some half-million or more workers today may be holding, have been a target of immigration restrictionists. The Trump administration is imposing tighter procedural rules on American employers that recruit workers. The administration’s actions arise out of complaints that these workers take jobs from native-born Americans.

Three questions help to determine if this complaint is justified, or if labor is short in a sector. Is the unemployment rate exceptionally low? Is there notable pressure to increase salaries? And is employment expected to grow at a faster than average rate?

In fields such as medicine and bioengineering, the answers change by time, geography and the national economy. Fluctuations in unfilled skilled job openings over the years undercut blanket assertions of chronic labor shortages. But, in a maddening glitch in American immigration policy, no government agency is charged with understanding how immigrant workers have, or will, affect employment.

‘Life Was Not Easy’

In an interview on the patio of their home in West Lebanon on a pleasant summer morning, Zita Ficko, who has lived in the United States since 2004, described what she sees as the contradictions of America’s immigration policies. “I got a free ride through Yale (University) as an undergraduate,” she said. “My medical education at Dartmouth Medical School was subsidized. The federal government is sponsoring me as a doctor. Yet I still am waiting for my green card.”

She was born in 1985 near the small city of Topolcany, in what was then communist-ruled Czechoslovakia. (The communist regime in Czechoslovakia collapsed in 1989 and the country split into the Czech Republic and Slovakia in 1993.) The family eventually moved to Bratislava, the capital of Slovakia. “Our family was not affiliated with the Communist Party,” she recalled. “Life was not easy.”

Her grandparents on her mother’s side lost their land, and her father’s grandparents had their factory taken. “Because a relative who was a Catholic priest fled to West Germany, we were considered somewhat suspect.”

Her father was educated as an engineer. Her mother is a professor of economics, an expert in how state-driven economies privatize. “The first time I saw the bigger world was when my mother brought me when I was 11 to Ann Arbor on her Fulbright scholarship at the University of Michigan,” she said. On her first day at school in America she knew seven English words. Soon, she was speaking English well.

They returned to Slovakia, and in her last two years in high school she enrolled in a special program to earn an international baccalaureate. That was by accident. A friend had asked her to take the entrance exam with her. But the program was taught in English and it was Zita, not her friend, who passed.

First Yale, Then Geisel

She learned from other students in the program that some were applying to universities in the United Kingdom and the United States. What little she knew about American colleges came mostly from American movies. The fact that some Ivy League colleges had need-blind admission policies induced her to apply to Yale, which accepted her. She majored in economics and biology and graduated in 2008.

She became an emergency medical technician while an undergraduate. Another of her many part-time jobs during college involved translating into English the videotaped testimonies of Slovakian Jews who had survived the Holocaust. “It was pretty rough,” she said, her muted voice contrasting with her normally exuberant manner.

From an early age, the human body fascinated her. She decided to become a doctor, despite her parents’ warning that, in Slovakia, women had a hard time advancing in that field. She was admitted to the prestigious medical school at Charles University in Prague, in the Czech Republic, but was put off by what she saw as its regimented academic culture.

Looking again toward America, she learned that some medical schools require foreign students to put up as much as $250,000 in escrow, but the Ivy League’s medical schools impose no special burdens on foreign students. She attended Dartmouth Medical School (now the Geisel School of Medicine), where she estimates that about one-tenth of the class was foreign-born. After she completes her residency in urology, she plans to practice at Springfield Hospital in Springfield, Vt. She’s now on an H-1B visa, the most common temporary visa for skilled workers.

She and her future husband met in New Haven, Conn., where he worked for Pitney Bowes while pursuing a bachelor’s degree in computer engineering at the University of Waterloo, in Canada. He came to Dartmouth for his doctorate in biomedical engineering in 2009. They were married in 2011.

Major Role for Foreign-Born Doctors

Zita Ficko is a relatively rare instance of a foreign-born individual who came to the United States for her undergraduate degree and was trained entirely in the United States. About 7,000 foreign-born students applied to American medical schools for entrance in 2018, a decline from past years. Most foreign-born doctors come to this country after they have completed their basic medical education abroad.

A unique arrangement controls this flow of professionals. Sixty years ago, the medical establishment enabled the creation of the Educational Commission for Foreign Medical Graduates. This commission sets standards on which medical school degrees are recognized. It manages exams that effectively require these doctors to complete a medical residency before practicing here. In no other major profession does a domestic workforce exert as much influence over the inflow of workers from overseas.

And what a major role these doctors have. More than a quarter of a million doctors with medical degrees from foreign countries practice in the United States, making up about one-quarter of all practicing doctors. Some of these “international medical degree” doctors are American citizens who traveled overseas to study, but the vast majority are foreign-born.

Foreign-educated doctors are more likely to practice in primary care disciplines, while their native-born counterparts often enter higher-paying specialties. Some 55 percent of foreign-educated doctors are in internal medicine or pediatrics, compared with 22 percent among U.S.-educated doctors.

They also are more much more likely to work in relatively poor areas with diverse populations. One study found that in areas where per-capita income is below $15,000 per year, 42.5 percent of all doctors are foreign-trained. Where 75 percent or more of the population is non-white, 36.2 percent of the doctors are foreign-trained.

This pattern of immigrants complementing this country’s workforce — rather than competing with it — is repeated throughout the economy.

Despite her 40-minute commute from West Lebanon to Springfield, Zita Ficko said, she and Brad plan to stay in their pretty, secluded neighborhood not far from the Miracle Mile. She did say there could be a future for her in medicine back in Slovakia. For example, she might be able to train urologists there in robotic surgery. “I would not rule out returning to train doctors (on) procedures that they do not yet do there.”

But then she repeated what is foremost on her mind. “I hope to transition to a green card while I work at Springfield Hospital.”

Peter Rousmaniere, of Woodstock, blogs about immigration issues at He can be reached at

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