Why we need more immigrant doctors like my grandfather
This reality for foreign-educated doctors persists to this day.
After years of working as a doctor in the coastal Honduran city of La Ceiba, my grandfather sought to further his medical education overseas with the goal of returning to Honduras as a better doctor. He began his search for programs at various embassies in the capital of Tegucigalpa. Two programs struck him instantly: one at a public hospital in Montevideo, Uruguay, and another at a Jewish hospital in Providence, Rhode Island.
The opportunity at the Uruguayan hospital was his top priority for a few reasons: it would be just as prestigious and useful as the position in the United States, his family would be moving to a Spanish-speaking country with no language barrier, and he would not have to complete the second residency that the Rhode Island opportunity would require. However, that opportunity did not go his way, leaving him with the Rhode Island opportunity. With that, he swore off Uruguay, and his family packed their bags and set sail for Rhode Island, later settling down in Long Island, NY, where they still live.
Upon arrival in Rhode Island, he would have to start from scratch, on the same level as recent US medical school graduates (USMGs). To become a licensed doctor as an international medical graduate (IMG), he would have to complete all that is required of a USMG, including passing all three US Medical Licensing Exams (USMLEs) and completing an accredited residency or fellowship program. He would also have to demonstrate written and spoken fluency in English.
These sound like reasonable requirements for anyone seeking to practice medicine in the United States. Nobody should practice without demonstrating the necessary knowledge and proficiency in the field—the USMLEs serve this purpose. Furthermore, in a country that primarily speaks English, it makes sense that all doctors have proficiency in the language. However, requiring a residency or fellowship program for doctors who have already practiced medicine in their home country does not make nearly as much sense. The residency requirement becomes even more unfair as IMGs are about half as likely to receive placement in a residency program as their USMG counterparts.
If someone has comparable experience from home, is proficient in English, and can pass the USMLEs, why should they wait to be licensed in medicine? Especially as the United States is projected to have a shortage of approximately 140,000 physicians by 2030, it makes sense that some changes need to be made to smooth the path to licensure for doctors without sacrificing integrity.
Some states have already begun addressing this problem by making small changes to their licensure codes. Tennessee, for instance, has completely lifted the residency requirement for IMGs to obtain a license. Instead, IMGs need only complete the exams and practice for a not uncommon probationary-like two years that assesses their aptitude. The effects of this change on the physician supply remain to be seen but will likely help address the state’s growing shortage in care. New Jersey and New York lifted the residency requirement to issue temporary licenses at the beginning of the COVID-19 pandemic. At the same time, other states turned to a more risky policy and asked former physicians and nurses to come out of retirement and allowed medical students to graduate earlier.
Unfortunately, the US medical school system is not currently capable of producing the requisite number of physicians to meet the growing demand of an aging population. Given this, and despite all the barriers they face, IMGs already make up around a quarter of practicing doctors in the United States.
Many of these IMGs serve dual purposes in their careers as they can provide healthcare to underserved immigrant communities in their native tongue. For instance, my grandfather was one of the few native Spanish-speaking pediatricians on Long Island, which has a large Spanish-speaking population. Because of this, all his patients were from families that spoke Spanish at home. He provided the most important service to thousands of children over nearly 40 years of practice who would otherwise have had a language barrier or lack of comfort with only an English-speaking doctor. It would benefit patients of all linguistic backgrounds to receive healthcare from doctors who can communicate with them in the language they feel most comfortable in. That way, the patient can fully express and articulate everything they are feeling, what they are concerned about, and what they need or want from their doctor.
Of course, expanding access to licensure for IMGs will not alleviate the coming shortages alone, but it could help. To address the problem entirely, additional changes in the medical education system will have to be made on the domestic front. However, making it more straightforward for qualified immigrant and refugee doctors like my grandfather to practice in the United States can make for a fairer system to alleviate some of the immense stress on the medical market.