The Code

The Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Health Professionals to the United States (Code) is a first of its kind agreement that sets out standards for fair and transparent recruitment, the provision of cultural and clinical orientation, and best practices to ensure that recruitment is not harmful to health systems in the home countries of these health professionals. It was drafted by a diverse group of stakeholders and has been endorsed by leading organizations such as the American Nurses Association, the American Hospital Association, the Service Employees International Union, the American Association of International Healthcare Recruitment, and the American Health Care Association.





Why is the Code Necessary?

For-profit recruitment firms interested in meeting the needs of shifting labor markets are a natural by-product of globalization. International recruitment brings with it public policy challenges such as:

  • First, the information asymmetry that exists between the recruiter and the individual being recruited place the latter in an inherently vulnerable position. When the recruited individual does not fully understand the terms of their contract, or when those terms change, the needs and rights of the recruited health professional can easily be abused. The Code outlines fair contract practices that all recruiters should adhere to.
  • Second, active international recruitment increases the “pull” from low income to high income countries that already exists because of wage differences and opportunities for professional advancement. Some governments view active recruitment of healthcare workers as beneficial to their economies. Others, however, have expressed concern that it exacerbates their own shortages. For those that publicly fund health care education, there may be additional objectives relating to the loss of investment. This may be beneficial to some source countries, while for others that are experiencing their own shortages of highly skilled professionals, it can, at least in the short term, exacerbate problems of access to quality health services. The Code suggests potential "best practices" that should be sought by subscribers.
  • While licensure and language ensure some degree of preparedness to practice in the U.S., foreign health care professionals report that clinical and cultural orientation programs are critical to ensuring their success in the U.S. Currently different recruiters and employers have managed these challenges in very different ways. The Code outlines numerous ways subscribers can support the FEHP's transition into the U.S. workforce.

In this initiative, stakeholders with divergent interests and viewpoints have partnered to ensure that, to the extent that international recruitment exists, it operates in a manner that is sensitive to all three of these issues. The principles of the Code encourage respect for the needs and interests of all parties: the source countries, the migrant health professionals themselves and the communities these professionals will serve in the United States.

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Corporate Social Responsibility

While the specifics of international recruitment make this initiative somewhat unique, the effort forms part of a broader international trend towards Corporate Social Responsibility (CSR). According to a study conducted by KPMG, one of every three of the top performing American businesses report publicly on their efforts to conduct their activities in a socially responsible manner.  A key strategy for companies operating in a global arena has been to participate in the development of multi-stakeholder voluntary Codes of Conducts that include monitoring of participating companies.

See for example:

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Code FAQs

What is the Code?
What does the Code cover?
Why was the Code developed?
Who authored the Code?
How were these organizations selected?
Who uses the Code?
How was the Code developed?
Who funded this work?
How is compliance with the Code monitored?
What is the difference between Endorsers and Certified Subscribers of the Code?
What is the WHO Code of Practice on the International Recruitment of Health Personnel and how does it compare to the Alliance’s Code?


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