Experienced doctors looking to immigrate to the United States often have trouble transferring their experience to an American hospital because of visas and licensing. Could easing the restrictions help solve a workforce shortage in the healthcare field?
WSHU’s Ebong Udoma spoke with CT Mirror’s Katy Golvala to discuss her article, “Immigrant physicians: A solution to workforce shortages?,” as part of the collaborative podcast Long Story Short.
WSHU: Hello, Katy. Most people aren't aware of the complicated federal and state requirements for immigrant medical practitioners to be allowed to practice in the U.S. Could you explain this? Maybe you could talk about Mark Costa, a native Brazilian psychiatrist who emigrated with his family and two children to Connecticut about 13 years ago.
KG: Yeah. So traditionally, you know, if you go to medical school in the U.S., you have to complete a three-year residency. And then you can become a practicing physician. Now, for people who, let's say, were practicing in their home countries, maybe they live in Brazil, like Mark Costa, for example. So he was a psychiatrist for nearly two decades in Brazil. And then in 2011, he and his family emigrated to the U.S. So what he would have to do like any, you know, primary care physician, cardiologist, whatever, when they come to the U.S., they need to pass all the U.S. medical exams.
WSHU: But even before they get to that, they have to deal with immigration.
KG: Yeah, that's right.
WSHU: The license comes from the state, but first you have to have the federal immigration stuff in order before you can even get the license.
KG: For people who want to come to the U.S., traditionally, the two avenues for physicians are a J-1 visa, so that is for people who completed medical school in another country and are coming here to complete their residency. So the J-1 allows them to stay for three years to complete their residency training, but then it requires them to go back to their home country for at least two years before they can apply for permission to come back to the U.S. So there are a lot of international medical graduates coming to the U.S. to do their residency training. And then we're basically just losing them because of this home country residency requirement, which requires them to go back for two years.
The other option is an H1-B visa. And that is not unique to physicians. This is an employer-sponsored visa for people to come to the U.S. So, for example, you know how a big company like Google or Microsoft might sponsor someone to come to the U.S. So that does not have a requirement to return to your home country for any number of years, but it is tied to a single employer.
So immigration, I think, Khuram Ghumman, one of the physicians I spoke to who came from Pakistan to the U.S., described it as a complicated web. And I think that's putting it pretty nicely. The process to actually get to this country is very difficult. And then for immigrant physicians who do end up making it to this country. So you brought up Mark Costa, who came in 2011, his mother was American, so he actually got American citizenship through her. So you think, okay, easy. He comes to the U.S. He does his requirements again. And then he will be, you know, able to practice psychiatry in the U.S. We have such a need for mental health professionals here. Sounds like a win-win. Instead, he came up against the challenges that many immigrants who are health care workers face when they come to the U.S. and think that they will just be able to continue their careers.
WSHU: Those are the state requirements.
KG: And these are now the state requirements. Exactly.
WSHU: So could you just explain what those state requirements are?
KG: Yeah. So now this differs by the type of health care worker you are. So it's gonna be different for nurses versus physicians. But since we're talking about physicians, let's stick with that. States have the power to give you the license to practice medicine. And so in order to get that license, you need to pass all medical exams. And then you need to complete a three-year residency training, which people like Mark Costa have already completed in another country. But the U.S. says we want you to study, you know, our medical system.
WSHU: The thing about the residency is that they need three years. But people feel that they can do that, in a shorter period of time, to get used to the American system. Tennessee has just passed a law, which shortens that period. Could you just talk about the Tennessee law?
KG: Yeah. So now there are states that are saying we have a need for physicians, and they're looking to tap into immigrants from other countries who have practiced medicine elsewhere in order to address that shortage. So Tennessee became the first state to do this last year. They passed a law saying, You know what, actually, you don't have to redo residency training to practice medicine in our state. You have to pass all your medical exams, you have to prove English fluency.
In some of these cases, you know, Tennessee, Illinois, Florida, and Virginia, I believe, are the four states that have passed laws getting rid of the residency requirements. So in some cases, you have to commit to practicing in an underserved area. Some cases, you have a requirement that you work under supervision. But these four states have gone ahead and said, We want to get rid of this residency requirement to enable more people to practice in the U.S. And then two other states, Alabama and Colorado, have shortened the amount of time that a working physician from another country would have to do residency. So now Alabama is saying instead of three years two, you only have to spend two years, and Colorado has taken it down to one year.
WSHU: I thought something interesting was what Dr. Saud Anwar (D), who's the co-chair of the Health Committee in the state legislature, had to say about reaching out for immigrants to come in, were when there are some locally trained physicians who are having a hard time getting residency placement, and that the first effort should be to try and get those people who have been trained locally, and who haven't had the residency, get them on board. And that will help start to solve the problem. And not have most of the complications that you have from bringing in immigrants who'd been trained outside the country.
KG: Yep. So every year, about 7% of U.S. medical school graduates do not get placed in a residency. So Senator Anwar, I believe, proposed a bill to get those people to work. But to be clear, they would not be working as physicians; the goal of that would be to be able to use their talents because they have all this training for medical school to be able to use their talents within the healthcare workforce in some capacity.
WSHU: So all these other states have done that. But Connecticut is reticent about going that way.
KG: I think it's just not something, at least from speaking to the co-chairs of the Public Health Committee; I just don't think it's something they've considered yet. I mean, these laws are relatively new; Tennessee was the first state to pass them. That was last year, it just went into effect on July 1 of this year. So legislators may want to see how that goes in Tennessee before they consider it here. But it is certainly something that at least Rep. Cristin McCarthy Vahey, he said, maybe Connecticut should look into it, given the shortages we're facing, and the fact that we have an immigrant population here who could be pretty well served by physicians that are perhaps, you know, from their home countries or speak their languages.
WSHU: And that's a point that Costa brought up when you talked with him about the fact that there are people who speak Portuguese that would have benefited from him being able to if he were allowed to practice as a psychiatrist here.
KG: Yeah, I mean, I can't really imagine getting any type of medical service, probably, particularly mental health services, in a language that is not my primary language. And that's the point that Costa brought up. You know, he's been here for almost 15 years. And he said that he would prefer to get mental health services in Portuguese because it's his native language. So I do think there is a very, that is some point that supporters of programs like this make is that in enabling these physicians to practice in the US, you're also giving the immigrant population an opportunity to get culturally competent care.
WSHU: Then in the meantime, what is Costa doing now?
KG: So he is a research scientist at Yale School of Medicine's Department of Psychiatry. So he is researching, you know, mental health disorders, substance use disorder, health disparities. So his research work, you know, he's doing a lot of qualitative interviews. He's still speaking to people about their mental health, but he never ended up getting accepted to a residency program. So He had to stop treating patients directly. He had to give up clinical work, which he says is something that he still misses. He misses sitting across from someone, talking to them about what they want to address, and treating them as a unique individual.
WSHU: Okay. And so, in the meantime, we still have a shortage of medical practitioners.
KG: That's correct.
