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Immigrants with medical backgrounds face steep career barriers despite health care worker shortage

A woman wearing a green jacket stands at the front of a classroom next to a model of the human body.
Ari Snider
Maine Public
Aimee Biba teaches a Certified Nursing Assistant course at Portland Adult Education. Biba worked as a nurse anesthetist in the Democratic Republic of the Congo, but when she immigrated to the U.S. she had to redo nursing school in order to continue her career.

Sitting in his home in Portland, Jean, a physician and surgeon from the Democratic Republic of the Congo, said working in the medical field was more than just a job.

"I call it a task," he said. "It is not really only a career, but it’s a task to save people's life."

But that task was interrupted when Jean and his family had to flee the DRC due to his involvement in human rights advocacy. Eventually, Jean arrived in the US and claimed asylum. We’re only using his first name as his immigration case remains unresolved.

Jean said he wanted to restart his medical career in Maine. But he felt it would be impossible after learning that just the first step of the medical licensing exam costs around $1000. And that’s just one step – a report released by Portland Adult Education found the total cost of re-licensing can run between $10,000 and $15,000.

"Myself when I came, I had $40 in my pocket, couldn't even rent an apartment," Jean recalled. "So how can you tell me to go pay money to get the registration for the [US Medical Licensing Exam]?"

Jean was eventually able to get work as a Certified Nursing Assistant – an entry level job far below his qualifications as a doctor. But in 2020 he left that position to work for a company that produces COVID-19 rapid tests. He said he wanted to contribute to the pandemic response, but that he would rather be helping people as a doctor.

"When you have the skills, and you cannot practice them, it hurts," he said.

A man stands in the doorway of his apartment.
Ari Snider
Jean is a physician and surgeon from the Democratic Republic of the Congo. Like many physicians who arrive in the U.S. as refugees or asylum seekers, Jean is stuck working well below his prior levels of qualification.

And Jean is not alone. Before the pandemic, the Migration Policy Institute estimated that there were some 270,000 immigrants in the U.S. with medical backgrounds who were either unemployed or working in jobs for which they were overqualified, due in large part to licensing barriers.

Susan Bell, a medical sociologist at Drexel University, said these barriers deprive the US not only of skilled workers, but also of the cultural and linguistic knowledge they bring with them.

"We desperately need in the United States a more diverse healthcare system, that is, of providers to be able to provide care to an increasingly diverse patient population," she said.

For many immigrants who arrive in the US with medical backgrounds, the most accessible path back into their field is through entry level work.

In Maine, that can look like enrolling in a CNA course, like the one taught by Aimee Biba at Portland Adult Education.

Biba has personal experience with the challenges of starting over. She was a nurse anesthetist in the Democratic Republic of Congo before moving to the US in 2011, and said she was not able to get credit for previous work or educational experience. So, she went back to nursing school for four years, while continuing to work fulltime as a housekeeper to support her family.

"And some time I was going to bed at two o'clock, sleep for two hours, because I have to wake up in the morning and go to my job," she said. "It was tough."

The experience of starting over at square one is pretty common, said Sally Sutton, program coordinator at the New Mainers Resource Center, a workforce integration program at Portland Adult Education.

"And you may have 25 years of experience, but that doesn't count, in terms of what you can get credit for," she said.

Sutton said other major barriers include difficulty getting access to transcripts or other documents, not qualifying for financial aid due to immigration status, and the day-to-day economic pressure that can make it difficult to find time for school.

For physicians, Sutton said it’s even more challenging – because they must complete a residency, competing against recent US medical school graduates for a limited number of spots.

The result, she said, is that virtually none of the doctors she’s worked with are able to return to their previous level of certification.

"We don't have systems here that know how to take advantage of people who are here as refugees and asylum seekers," she said.

To address the residency hurdle, Sutton said Maine could learn from other states, including Washington State, which passed a law last year allowing foreign medical graduates to obtaintemporary licenses without completing a residency.

But that license can only be renewed for up to four years. Sutton said that Maine has a lot to gain by finding a more durable solution, and risks falling behind if it doesn’t.

"I've talked to some physicians here who are ready to move to Washington State," Sutton said. "And again, that's not even quite the right answer yet. So if we can figure this out, this could be a real attraction."

Meanwhile, medical providers in Maine say they need the help now.

"We need these people and we want their skill sets," said Helene Kennedy, vice president of talent at MaineHealth, the state’s largest health system. Kennedy said vacancy rates have about doubled since the pandemic began, a trend also reported by other large healthcare networks in the state.

Kennedy said some sort of accelerated program for foreign-trained nurses could be particularly helpful.

"If we could have a bridge program where they could get through the requirements, and we could have them at the bedside in 6 to 12 months instead of four years, that would be amazing," she said.

And some immigrants are taking action themselves. Jean, the Congolese physician, helped create a new social media group of other Maine immigrants facing similar barriers.

He said one of his goals for the group is to do more public advocacy.

"To let different high-ranked level of people - like governor, senators - know that we exist, that we are here, and we’re ready to help," he said.

In the meantime, he said he’s considering picking up another job as a CNA.