Foreign-trained doctors, nurses seek to reduce barriers to practice

Foreign-trained health professionals hearingDr. Skarlleth Cuevas testifies before the Joint Committee on Public Safety as Dr. Laith Almatwari and Dr. Afsaneh Moradi look on.

One of MIRA’s top priorities this session is to pass a bill to set up a commission to address barriers to licensure for health care professionals, so they be deployed in high-need areas.

BOSTON, October 24, 2017 – Dr. Afsaneh Moradi was a family physician in her native Iran, but when she came to the United States, the best job she could get was as a cashier.

After five years of study to pass her exams, and countless hours of volunteering, she now works in research and provider education, at Cambridge Health Alliance. But she still hasn’t been able to return to her passion: treating patients.

“It would be a blessing to practice anywhere that allows me to make a difference in my patients’ lives,” Dr. Moradi told the Joint Committee on Public Health today. It would be even more meaningful, she added, if she could apply her skills to serving low-income communities and immigrants.

Across Massachusetts, more than one in five foreign-trained health professionals like Dr. Moradi – doctors, nurses, pharmacists, physical therapists, dentists, etc. – is jobless or underemployed, held back by costly licensing requirements, language barriers, lack of targeted career services, and other factors.

Not only is this a huge waste of talent, and an economic hardship for the people involved – it also affects public health. More than 7% of Massachusetts residents, including more than 500,000 low-income people, lack adequate access to primary care, dental care, or mental health services. If even half these practitioners returned to their careers, they would significantly narrow that gap.

State Sen. Jason M. Lewis (D-Winchester) and Rep. Jack Lewis (D-Ashland) are sponsoring legislation to address the problem. The bills (S.1216 and H.3248) would create a commission to explore ways to reduce licensing and other barriers to professional integration, enabling these providers to provide health services to state residents in areas of greatest need. The commission’s findings would also benefit U.S. citizens who study medicine abroad.

MIRA has made this bill a priority for successful immigrant integration. In testimony today, Legislative Director Amy Grunder noted that foreign-trained health professionals can be a major asset for our state, “but if we are to realize the full benefits… it is crucial to create policies to integrate these talented practitioners into our health care system.”

There are many options, Grunder said: from better guidance on state licensing board websites, to targeted career services, to dedicated residency programs, or limited licensing in exchange for a five-year commitment to practice in underserved areas. Massachusetts can pioneer its own initiatives, or learn from what’s been done in other states – and even right at home.

For example, the Welcome Back Center for Internationally Educated Nurses at Bunker Hill Community College helps nurses navigate the complex process of re-credentialing, including academic support and test prep. There is already limited licensing available for foreign-trained dentists in Massachusetts. “Both program models can be expanded to include more opportunities for practice, and to include other health professions,” Grunder said.

Westy Egmont, who leads the Immigrant Integration Lab at the Boston College School of Social Work, also testified in support of the bills. Immigrants play a crucial role in health care already, he said, and they are likelier than U.S.-trained providers to work in primary care and serve disadvantaged populations. In addition, they bring invaluable language and cultural knowledge.

The most powerful testimony of the day, however, wasn’t from experts or advocates, but from doctors and nurses who told their own stories.

Along with Dr. Moradi, legislators heard from Dr. Laith Almatwari, who worked with the U.S. Army in Iraq as a medic and interpreter, facing threats that forced him to leave his country. He moved to Egypt, where he studied urology and kidney transplantation and worked for four years. But now, after being admitted to the U.S. as a refugee, he worries that he won’t be able to practice in his specialty.

Dr. Skarlleth Cuevas, a Costa Rican general practitioner, moved to Massachusetts so her severely ill son could receive specialized care. But finding a job to support them, she told the committee, turned into an ordeal. Walmart rejected her as overqualified, but health care providers offered only volunteer positions. With extra training, she was able to get a low-level job at a nursing home. Every day, she longs to return to her calling.

“Please help us,” she urged the legislators.

Foreign-trained health professionalsDr. Judith Thermidor, center, describes the barriers faced by foreign-trained physicians, flanked by Marie Lucie Mars Seignon, a former trauma nurse with Doctors Without Borders, and Haidar Al-Sara, who testified about foreign-trained doctors working as medical interpreters because they can't get licensed.

Dr. Judith Thermidor, a Haitian physician trained in Mexico and France, with a diploma in global health delivery from the Harvard School of Public Health, said the road to practice as a foreign-trained physician in the U.S. “is extremely difficult, above all when you are from a poor country.”

There is little guidance for immigrant health professionals on how to qualify to practice, Dr. Thermidor noted, and there are no programs to help international medical graduates prepare for the licensure exam. Thus, despite her credentials and medical experience, she’s employed as a health promoter, coordinating medical appointments and helping people navigate the health care system.

Helping doctors like her return to practice could help Massachusetts build an “equity-oriented” health care sector that increases social inclusion and social justice, Dr. Thermidor said.

“We understand the values, culture, and languages of low-income, minority, and immigrant populations, who often receive inadequate health services, or mismanaged chronic diseases because of language barriers and cultural norms and beliefs,” she said. “I would like to practice medicine here in Massachusetts. I only ask for guidance and good policies.”


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