When Deeb Salem was a medical student in Boston in 1967, he recalls meeting an older Cuban pediatrician who worked sweeping hospital floors. Occasionally, Salem and fellow students would ask the man, who came to the US seeking asylum, medical questions.
“It stuck in my head for many years how unfortunate it was that we may have people that leave other countries, that are physicians after having successful clinical careers, but their ability to get licensed in the US is close to zero,” said Salem, who is now senior vice president of academic integration for Tufts Medicine and was the Massachusetts Medical Society’s representative on a 2022 Special Commission on Foreign-Trained Medical Professionals.
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Since then, Salem said he has continued to meet immigrant physicians working in hospitals as technicians or other lower-skilled jobs because they cannot get a residency or they need a job that will pay them a salary immediately.
At a time when Massachusetts needs more medical professionals, there is an untapped well of medical knowledge in the state: foreign-trained doctors and nurses. Massachusetts has long been a welcoming state for immigrants, yet its system for licensing medical professionals is unduly onerous. Making it easier for doctors and nurses to get licensed to practice would help those immigrants; it would also serve the Commonwealth by providing a culturally and linguistically diverse workforce of skilled professionals.
A commission first studied the issue in 2014 under then-governor Deval Patrick. That commission found that 1 in 5 foreign-trained health care professionals were unemployed or underemployed, working in a low-wage, low-skilled job. It recommended providing clearer guidance to immigrants on licensing, developing educational programs, and reexamining licensing requirements.
Fast-forward to 2022 and another commission established to study the issue, this time for then-governor Charlie Baker, reported that nearly one-quarter of internationally trained nurses are unemployed or working in low-skilled jobs, as are 13 percent of all immigrants to Massachusetts with health care-related degrees from outside the United States.
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The exact number of people affected by this issue is unclear, but the Migration Policy Institute estimated, based on 2017 data, that Massachusetts has around 3,000 foreign-educated immigrant adults whose health care-related undergraduate degrees are not being fully utilized. The 2014 commission report said there were 12,000 foreign-born health care professionals in Massachusetts, of whom two-thirds were educated outside the United States.
That is a large pool of talented people whose skills are being underused at a time when 1 in 4 Massachusetts doctors report plans to leave medicine in the next two years and acute care hospitals have an estimated 19,000 unfilled positions in a variety of medical fields. The state needs more doctors in specialties like primary care and in regions like Bristol and Plymouth counties and parts of Western Massachusetts.
The Healey administration and the Legislature should work quickly to implement the recommendations of the 2022 commission, which included a diverse group of medical professionals.
Some of the administrative steps are straightforward, like developing clear guidelines to inform immigrants about the requirements for obtaining licensure.
But addressing the biggest barrier facing foreign-trained doctors would require a major legislative change. Currently, foreign-trained doctors can only get licensed in Massachusetts after completing a three-year US residency, compared to the two years required for US-trained doctors, in addition to passing the required exams. But practically, getting a residency can be nearly impossible for these doctors. Residencies are competitive, and most programs only consider recent medical school graduates. Residencies are low paid and require grueling hours, which may not be practical for a mid-career physician.
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One solution is legislation introduced by state Senator Jason Lewis and state Representative Jack Lewis, based on recommendations made by the special commission, that would create a pathway to licensure for physicians without a residency. A doctor would still have to pass the US medical licensing exam. They could then apply for a renewable one-year limited license to participate in a mentorship program at a health facility that serves an area with a physician shortage, where the doctor would have their skills evaluated. After completing that, the doctor would get a two-year license under which they could work independently but only in an underserved area. They could then obtain a full license.
Jack Lewis said the bill would “help folks who are eager to give back to the community, who have the skill set, experience, and desire to give back, and also meet unmet needs within our Commonwealth.”
Massachusetts would not be first to remove the residency requirement for foreign-trained doctors. Tennessee this year removed the requirement altogether, while New Jersey waived it temporarily during the COVID-19 pandemic. Minnesota offers a nine-month program to prepare doctors for residencies, and the program funds two to three residencies each year.
For nurses, who do not have a residency requirement, the biggest barriers to licensure tend to be administrative. The report proposes common sense ways to eliminate redundant requirements — like rules requiring nurses to take an English proficiency test and have their credentials evaluated by an outside agency even if they already passed the test or completed the evaluation in another state. During the COVID emergency, nurses licensed in other states were allowed to practice here, but since that policy ended, nurses are incentivized to work in states with easier licensing processes. Some other states also accept a broader range of English tests and credential evaluation services.
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There is a lot of talk about the need to diversify the medical profession. Licensing experienced doctors who speak other languages and understand other cultures would be a boon to patients who want culturally competent care while also helping to meet the Commonwealth’s need for skilled medical professionals.
Editorials represent the views of the Boston Globe Editorial Board. Follow us on Twitter at @GlobeOpinion.
