Yet a large and highly skilled workforce of internationally educated physicians, nurses and other health practitioners is largely untapped due to barriers to licensing and certification. accreditation. According to the Migration Policy Institute’s think tank in Washington, DC, some 165,000 internationally educated immigrants to the United States have degrees in health-related fields, but are unemployed or underemployed in full health crisis.
Many of these workers have invaluable experience dealing with epidemics of infectious diseases such as SARS, Ebola or HIV in other countries, but must stay away from the covid pandemic.
The pandemic highlights licensing hurdles that predate covid, but many believe it may serve as a reminder to state legislatures to tackle the problem of this crisis and beyond. Already, five states – Colorado, Massachusetts, Nevada, New Jersey and New York – have adapted their licensing guidelines to allow internationally trained healthcare workers to lend their life-saving skills in the context of staff shortage caused by a pandemic.
“It’s really the taxi drivers, the employees, the people walking your dog,” said Jina Krause-Vilmar, CEO of Upwardly Global, a non-profit organization that helps immigrant professionals enter the marketplace. American work. “They also happen to be doctors and nurses in their home countries, and they just aren’t able to plug in and play in the system as it’s set up.
It left doctors like Sussy Obando, a 29-year-old Colombian, to jump through the hoops to become a doctor in the U.S. In 2013, she graduated after six years of medical school in Colombia and then passed one year treating patients in underserved communities. But when Obando arrived in the United States, his credentials and experience weren’t enough.
Although guidelines for licensure vary from state to state, internationally trained physicians are typically required to pass a medical licensing exam costing over $ 3,500 and then complete at least a year of on-the-job training, called residency, in the United States. Obando, this means revising their English and learning the relevant medical terminology. She also needed clinical experience in the United States to qualify for residency, which US-trained physicians obtain through medical internships.
“If you don’t know anyone in this field, you have to go door to door to find someone who gives you the opportunity to rotate,” Obando said.
She tried emailing the Hispanic doctors she found online asking if she could rotate with one of them. She ended up paying $ 750 to enter a rotation in psychiatry at the McGovern School of Medicine at the University of Texas at Houston.
“I tried to get into internal medicine,” Obando said. “But since psychiatry was cheaper, I have to go.”
She also worked for almost a year as a volunteer at the MD Anderson Cancer Center in Houston, and is now participating in clinical trials of covidies vaccines at the Texas Center for Drug Development. She applied for residency through a national program that matches medical school graduates with residency slots. But it’s difficult for internationally educated physicians to secure a place, as many are reserved for graduates of US medical schools. And many residency programs are only open to recent graduates, not those who graduated from medical school years ago.
“It’s competitive for people who have trained in the United States to enter a residency program. If you’re trained outside the United States, it’s even more difficult, ”said Jacki Esposito, director of U.S. policy and advocacy for World Education Services, a nonprofit that helps immigrants find employment. employment in the United States and Canada.
That’s why states like Colorado have eased the residence requirement during the pandemic. Early on, Colorado officials realized they couldn’t certify doctors and other health workers because covid lockouts had voided required licensing exams. Under an executive order from Democratic Governor Jared Polis in April, state officials created a temporary licensing program that allows medical school graduates to begin practicing under supervision for six months, then extended it until ‘in June 2021.
Officials created a similar route to obtain temporary permits for foreign graduates of medical schools who did not have the minimum year of residency.
Colorado also created temporary licenses for internationally trained nurses, certified nurse aides, medical assistants, and many other health care professionals. All of these licenses require the supervision of a licensed professional and are only valid as long as the governor’s declaration of public health emergency remains in effect.
The state has also relaxed the rules for the scope of practice of these health workers, allowing them to perform any tasks assigned to them by their supervisors.
“So if you are an occupational therapist you can get the vaccine as long as they delegate to you and they are satisfied that you have the skills and the knowledge,” said Karen McGovern, deputy director of legal affairs in the legal affairs division. professions and professions. at the Colorado Department of Regulatory Agencies. “You can go beyond your statutory skills and practice for what needs to be done during the pandemic.”
As of mid-December, the state had received 36 applications from internationally trained doctors seeking temporary licenses, even though only one candidate met all the criteria. New Jersey, by contrast, received more than 1,100 applications for temporary medical licenses last year. (Michigan also issued an executive order authorizing temporary licenses, but it was later revoked.)
Many healthcare professionals stuck on the fringes have unique skills and experience that would be invaluable during the pandemic. Victor Ladele, 44, completed his medical studies in Nigeria and treated patients during a drought in Niger in 2005, in the midst of the Darfur genocide in Sudan in 2007 and after a civil war in Liberia in 2010. Sa family moved to the United States. years later, but Ladele was recruited to help fight the Ebola outbreak in West Africa in 2014. What he thought was a three-month stay turned into a two-year assignment .
Back in Edmond, Oklahoma, working with a United Nations program that helps new businesses get started, Ladele found that the challenges of the covid pandemic parallel many of his past experiences. He saw how an Ebola contact tracing program told people with coughs or fever to call a hotline, which would direct them to a health center. But as soon as the initiative was launched, rumors began to spread on social media that European doctors in health centers were harvesting organs. It took months of outreach to tribal and religious leaders to build confidence in the system.
He has seen similar information spread about covids and masks.
“If in Oklahoma, public health officials had sensitized all church pastors and got their support for the masking, would there be more people using masks?” Ladele said.
Ideally, he says, he would like to spend about half of his time seeing patients, but the authorization process remains a challenge.
“It’s not insurmountable,” he says. But “when I think about all the hurdles to accreditation here, I’m not really sure it’s worth it. ”
Upwardly Global helps healthcare professionals navigate this unknown application and accreditation system. Many internationally trained health workers never had to write resumes or interview for a job.
While the pandemic has temporarily eased entry into five states, Krause-Vilmar and others believe it could be a model for addressing labor shortages in underserved areas of the country. By September, the Federal Administration of Resources and Health Services had designated more than 7,300 areas of health care shortage, requiring an additional 15,000 health professionals.
“We have had a crisis of access to health care, especially in rural areas, in this country for a long time,” she said. “How can we begin to imagine what that would look like in terms of more permanent licenses for those people who help us recover and rebuild?”
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