Integrating IEHPs into the Health Care Workforce: Insights from a WES Social Media Forum

Integrating IEHPs into the Health Care Workforce Lead Image: Photo of a nurse standing in a hospital room [1]

The COVID-19 crisis profoundly exposed the need to integrate internationally educated health care professionals (IEHPs) into the United States workforce. However, even prior to the pandemic, the U.S.—particularly [2] rural and other underserved communities—suffered from a severe shortage of health care workers. According to the Harvard Law Petrie-Flom Center, internationally trained physicians account for a quarter of all doctors in the U.S. [3], and they disproportionately serve where there are physician shortages. Nevertheless, despite the pandemic going into its second year, IEHPs still face significant barriers to employment nationwide.

A recent social media forum hosted by World Education Services (WES) sought to explore the challenges and opportunities in IEHP inclusion by discussing the policy landscape as it stands now and identifying policy priorities for the coming year. The goal of the conversation was to examine ways to permanently integrate IEHPs into the U.S. workforce. Although lawmakers in some states have taken steps to address barriers to IEHP licensure for the duration of the health crisis, these stopgap measures are not a long-term solution.

Using the hashtags #ImmigrantsThrive [4] and #WeAreAllWelcome [5], the Twitter chat brought together organizations, advocates, and stakeholders to discuss the many barriers IEHPs face today. Participants also identified resources, strategies, and policy solutions to tackle the licensing challenges barring internationally trained medical professionals from practicing in the U.S. Given the current and projected health care needs in the country, fully integrating these professionals will be essential to the most effective functioning of the U.S. health care system.

Below are the key topics and insights the discussion covered:

1. IEHPs have a great deal of expertise and experience to contribute to the U.S. health care workforce—yet they are still being sidelined. It is crucial to build on the momentum gained during the pandemic, especially in states that temporarily eased licensure requirements, allowing IEHPs to work. In those states, these measures need to be made permanent.

According to the Migration Policy Institute [6], 165,000 IEHPs in the U.S. are underemployed or unemployed. Their skills are needed not only to fight the virus, but to provide culturally informed and bilingual care in underserved immigrant and refugee communities. Given projections that the demand for health care workers across the U.S. will grow substantially [7] over the next decade, IEHP expertise will also be crucial to the care of the nation’s growing elderly population [8].

While IEHPs often want to contribute their skills [9] to their communities, outdated licensure requirements continue to hold many back. Currently, requirements for medical licensure [10] in many U.S. states do not recognize qualifications or experience obtained internationally. As a result, IEHPs who hope to be licensed must retake their medical examinations and redo their graduate residency training in the U.S. This process is complicated, time-consuming, and expensive, costing IEHPs thousands of dollars.

In 2020, the health crisis drew the attention of lawmakers in a handful of states to those challenges. With their states’ medical personnel overwhelmed, governors in six states—Colorado, Massachusetts, Michigan, Nevada, New Jersey, and New York—issued executive orders (EOs) that granted IEHPs temporary licenses to practice. While these EOs are a positive first step, they are only temporary—to date, none of the six states have granted permanent licensure to IEHPs. Ensuring that these IEHPs can continue to support and care for their communities will require that these measures or similar ones are made permanent.

2. Laws passed in Washington State should serve as a roadmap for other states seeking to implement permanent policy change.

In 2020, Washington State passed the groundbreaking law SB 6551 [15], which created pathways to licensure for “exceptionally qualified” international medical graduates (IMGs) and formally established a working group to examine how IMGs could help to address the state’s physician shortage. The Washington law is unique in that it is the first legislation in the U.S. to create a permanent pathway to IMG licensure. In early 2021, the state went even further in its support of IMGs, passing SHB 1129 [16]. This legislation exempts qualified IMGs from graduate U.S. residency requirements [17], creating limited licenses that allow IMGs to practice under the supervision of fully licensed medical professionals.

3. U.S. policymakers should look abroad for effective solutions. Canadian programs for integrating immigrant and refugee health professionals into the workforce, such as Ontario’s Staffing Supply Accelerator Group, can serve as a model for the U.S.

While a handful of U.S. states have passed legislation to better integrate internationally trained medical professionals, change has been slow throughout much of the nation. For inspiration, policymakers would do well to look abroad.

In fact, WES identified [24] more than 150 programs just over the Canadian border that are aimed at supporting IMGs and IEHPs. Among these programs is the Staffing Supply Accelerator Group [25], whose mandate includes “removing barriers [26] to enable more internationally-trained professionals to become qualified to practice in Ontario.” The group was established by the government of Ontario.

U.S. policymakers could also adopt some of Canada’s credential and employment-based bridging programs. For example, seven provinces currently use Practice-Ready Assessment [27] (PRA) programs, adapted from the pan-Canadian National Assessment Collaboration PRA model [28], to provide an alternative route to licensure to certain IMGs. By completing a clinical assessment program, IMGs in these programs can obtain a license to practice in a rural, remote, or underserved area.

4. Storytelling is an important tool for sustaining momentum.

Narratives can inspire change and bolster advocacy efforts. Putting a face to an abstract issue and crafting a story around it helps policymakers and the public better understand the systemic barriers that prevent IEHPs from re-establishing their professions. Powerful personal stories are essential to advocacy efforts in support of IEHPs.

A case in point is Lubab al-Quraishi [29], who came to the U.S. as an Iraqi refugee in 2014. Despite having seven years of experience working as a surgical pathologist in Iraq, Lubab was prevented from pursuing a medical career because of the high cost of licensing exams in the U.S.

It required a pandemic for that to change. In April 2020, just weeks after New Jersey relaxed its licensing requirements for IEHPs, state officials granted her a temporary medical license to help treat coronavirus patients. Reflecting on the events leading up to that moment, Lubab commented [30], “I feel sad because here we are—we have been here all the time, and nobody paid attention to us before this crisis started.”

Lubab is just one of the 165,000 underemployed or unemployed IEHPs in the U.S. The stories of many others are just waiting to be told.

5. Eliminating barriers to immigrant and refugee employment in critical health care sectors will remain a top priority for the country and individual states in 2021 and beyond.

Although positive first steps have been taken, much work remains to be done. More than a year into the pandemic, far too many immigrant and refugee health care workers are underemployed or unemployed. Working to reform restrictive occupational and professional licensing regulations that bar immigrants and refugees from fully utilizing their skills and experience will continue to be a priority for the foreseeable future.

Although policy changes are unlikely to occur overnight, advocates of immigrant and refugee inclusion can still help IEHPs pursue meaningful careers outside of the health care sector or adjacent to it. Programs and resources [37] created by members of the IMPRINT coalition [38], a WES-based network that supports the economic inclusion of internationally educated immigrants and refugees, can help IEHPs navigate alternative career pathways in the U.S.

Now more than ever the U.S. must take action to ensure that immigrant and refugee health workers can pursue their careers and provide expert medical care—especially in underserved areas. As the U.S. seeks to rebuild, promoting immigrant inclusion will be crucial to powering the country’s economic recovery and achieving health equity.

We thank the following partners for participating in our recent Twitter chat and helping to make it a success: