Ethnic Discrimination in U.S. Healthcare Hiring: Identification from H-1B Cap-Exempt Hospitals

Ethnic discrimination is a persistent driver of labor market exclusion for workers from historically underrepresented racial and ethnic groups in the United States. For Asian and Hispanic applicants, however, name-based audit estimates conflate two distinct channels: direct ethnic bias and employer beliefs about visa cost. The channels imply different policy remedies, and existing designs cannot tell them apart. We propose a pilot study for a 15,000 resume correspondence audit in US healthcare hiring that recovers ethnic discrimination net of immigration-status effects. We exploit a sharp institutional discontinuity: nonprofit hospitals affiliated with universities are exempt from the H-1B cap and lottery, while otherwise identical nonprofit hospitals are bound by it. We randomly assign immigration status (citizen, lawful permanent resident, F-1 student) and name-signaled ethnicity (White, Hispanic, Indian, Filipino) within cap-subject and cap- exempt hospital strata. We identify ethnic discrimination cleanly within the cap-exempt stratum and decompose its mediation by visa friction in the cap-subject stratum. This pilot will 1. Validate resume signals including names and 2. Explore the feasibility of design features including number of positions available, power analysis calculations given realized response rates, and whether our hypothetical candidates are appropriate matches for our targeted positions.