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An innovative Washington law aims to bring overseas-trained doctors back to hospitals

Growing up in Somalia’s capital, Mogadishu, where people sometimes die from preventable or treatable diseases such as diarrhea, typhoid and malaria, Abdifitah taught Mohamed a painful lesson: Adequate health care is essential. In 1996, Mohamed’s mother died of septicemia after spending nine months in hospital with a gunshot wound. Her death, says Mohamed, inspired him to study medicine, and for about four years he worked in Somalia, Sudan and Kenya treating the sick and injured.

But Mohamed has not been able to work as a doctor since 2015 when he went to the United States, where his wife emigrated in 2007 United States Medical Licensing Examination (USMLE) – a three-step examination for obtaining a medical license in the United States, in which medical proficiency, Principles and skills are tested – and subsequent completion of medical specialist training. However, he did not expect that after spending thousands of dollars applying for 150 residency programs, none would give him a chance.
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“It was clear to me that I had to take the exams – and everyone agrees on that,” says Mohamed. “But I didn’t realize that I wouldn’t get a chance for an interview.”

Now a new program in Washington State, where Mohamed lives, could soon get him back to work. In May Washington Governor Jay Inslee signed law giving internationally trained medical graduates the opportunity to earn a two-year medical license with the option of renewal. Participants may forego residency training – one of the most arduous steps to becoming a doctor – but must meet certain other requirements, including proficiency in English, passing all three levels of the USMLE, and working under the supervision of a fully licensed medical practitioner. According to the Washington Medical Commission, around 40 internationally trained doctors are slated to apply for the program as of this month. Experts say the program could serve as a model for other states to launch similar efforts of their own and provide a path for some of the estimated 270,000 unemployed or underemployed workers with foreign medical training currently reside in the US to work in their field.

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International medical graduates have long struggled to get medical approvals in the US, but the current political moment could lead to permanent change, says Jeanne Batalova, senior policy analyst at the Migration Policy Institute. The COVID-19 pandemic has exacerbated the existing shortage of doctors, nurses and therapists as people burn out amid the exposure. Meanwhile, the demand for doctors is expected to increase as the general population ages – the American Association of Medical Colleges recently estimated that the US could be in shortage of 54,100 to 139,000 doctors by 2033, and that 40% of current practicing doctors will be over 65 within the next decade, while the nation’s population is over 65, who tends to have the most medical care needed to grow by 45% over this period. That has led U.S. officials and lawmakers to scramble to reach untapped talent, including those living here with medical skills and knowledge acquired overseas. While Washington implements the largest permanent program to release foreign doctors to work in the state, governors of six other states have issued emergency orders similar to helping internationally trained doctors get to work.

Many immigrants and refugees encounter barriers to working in the U.S. health service that have nothing to do with their skills or education, says Dr. José Ramón Fernández-Peña, President of the American Public Health Association and Founder and Director of the Welcome Back Initiative, which supports immigrants who want to work in medicine. Above all, however, doctors who have been working in the medical field for years and who have passed the USMLE must complete specialist training in order to enable newly qualified doctors to receive practical training. In part, he blames protectionism for the “not very logical” situation. “Some of the re-licensing procedures for these people are obviously based on public safety concerns, but if you look closely, some are really rooted in turf protection,” he says.

When doctors trained abroad, as Mohamed did, try to get US residency permits, they often have a particularly difficult time getting into the highly competitive system. Nearly 40% of international non-citizenship medical graduates failed to find a hospital for a U.S. residency program in 2020, compared with just 6% of domestically trained graduates. corresponding the National Resident Matching Program. According to Jina Krause-Vilmar, president and CEO of Upwardly Global, a nonprofit that supports immigrant and refugee professionals in their careers, the size limit on residency programs says hospitals exclude many internationally trained doctors. Such programs often favor applicants who have recently completed their medical degree over many international medical professionals seeking a suitable partner, and many of these applicants lack adequate clinical experience in the United States. As U.S. medical schools enroll more students, residency programs have not kept up. corresponding the Association of American Medical Colleges, which makes competition for a job even tougher.

Supporters hope that Washington’s program will help relieve some of the stress those already in the field are feeling. Micah Matthews, assistant executive and legislative director of the Washington Medical Commission responsible for issuing the temporary licenses, says his agency has seen an increase in complaints about doctors’ behavior during the pandemic – a sign that there are many burned out. “Whenever someone is tired and exhausted, they’re more likely to say something they probably wouldn’t have said,” says Matthews. “We hope that the international medical graduates can alleviate some of this burden and prevent more people, for example, from going into early retirement or from giving up the medical profession entirely.”

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There are other good reasons to welcome more international medical graduates to the American healthcare system: Many have insight into other cultures, speak several languages, and are often people of color. Dr. Mohamed Khalif, a Somalia-born and China-trained doctor who founded the Washington Academy for International Medical Graduates, an activist organization that helps doctors return to health care and spearheaded efforts to pass Washington’s new law, led a separate effort to employ overseas trained physicians in professions where they can use some of their skills, including roles in health education. Doctors trained abroad often end up in poorly paid jobs with no relation to the health system – Khalif, for example, worked as a security guard and in a cake factory despite studying medicine and training in five languages. Like other overseas-trained doctors who spoke with TIME, Khalif says his goal is to help those who are often left behind by the U.S. healthcare system. “Ultimately, it is people who have no access who are hurt, especially people of color, immigrants and people who speak different languages,” says Khalif.

For Abdifitah Mohamed, seeing how hard the pandemic has hit immigrants, people of color and key workers only heightened his sense of urgency to get back to work. Washington’s program, he says, “is really a gift from God. Because at least I do [will be] to be able to wear my lab coat to help my community, my people. ”Before Mohamed can apply, however, he must be sponsored by a hospital or clinic that is willing to oversee him while he is his Has a limited license (clinics are currently in talks with program organizers). But Mohamed says he is ready to fight the pandemic. He’ll be especially excited to tell his two American-born daughters, four and two years old, that he’s back in the field.

“They always ask me a question: When will you be a doctor? I still cry when I hear this question because I don’t have an answer, ”he says. “I can hardly wait for the day when I wear my lab coat and see my first patient.”

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