There are currently 1.1 million immigrants, refugees, and U.S.-born healthcare professionals with undergraduate health-related degrees that are underutilized but could be called upon to help fight the COVID pandemic. This article, the first in a two-part series, outlines the doctor shortages in American healthcare and begins to outline immediate action states can take amidst the pandemic.
The dearth of medical professionals in America has been a growing problem that the COVID-19 crisis has exposed. The absence of a sufficient supply of personal protective equipment, forces doctors, nurses, and other frontline healthcare professionals to work absent any protections, leaving them vulnerable to catching the virus. As of New Year’s Eve, the Centers for Disease Control and Prevention (CDC) reported 331,789 positive COVID cases among healthcare professionals; the count continues to increase daily. The growing gap between able-bodied professionals and those infected necessitates tapping into other resources.
Shortage of Doctors in America
By 2023, the Association of American Medical Colleges (AAMC) predicts the U.S. population will increase from 326 million to 361 million. The increase will be headed by the adult population over the age of 65, who are projected to grow 45% in the next decade. The surge will accompany a growing demand for physicians as the aged require more care and service, followed by a decreasing supply — as of now, two in five active physicians turn 65 or older in the next decade — leading to a physician shortage of up to 139,000 by 2033. The shortage will be particularly felt in specialist fields; with physician shortfalls of up to 86,700 across non-primary care specialties and 28,700 in surgical specialties. While large-population states — like California, Florida, and Texas — are estimated to have the highest nominal shortages, states like Mississippi, New Mexico, and Louisiana will suffer from the most significant physician shortage per capita, with shortages of over 100 per 100,000 people in the coming decade.
Despite increases in training, a 1997 Medicare funding cap on medical school education has created an undersupply of residency slots, resulting in more medical graduates than hospital residency programs can accept. The scarcity of medical personnel is especially evident in rural communities across America accounting for 66% of the total primary care Health Professional Shortage Areas (HPSA), compared to the 34% in urban areas. Further exacerbating the problem will be the aging population in rural communities who will require more attention in the coming decade.
The pandemic has exposed the need for more healthcare personnel and accelerated the threat of predicted shortages. Fortunately, there is an untapped resource of foreign-born immigrant and refugee doctors within our country that can alleviate the growing need for doctors.
Foreign-Born Healthcare Workers and the Problem of “Brain Waste” in America
Of the 2.6 million immigrants already employed in some part of the healthcare sector, there are currently 263,000 additional foreign-born immigrants with healthcare-related undergraduate degrees who are not being properly utilized or who are unemployed. Of those, 15% are foreign-trained professionals who could be a vital resource on the frontline. These individuals tend to be younger than their U.S.-born counterparts, a critical component as the virus continues to disproportionately affect those over the age of 60.
Foreign-trained professionals (FTPs) have long been the focus of what many analysts call the “brain waste” problem in America. An array of factors prevent FTPs from maximizing their training and education in the United States., instead of either resorting to lower-paying and unrelated occupations or leaving the workforce altogether. Factors contributing to this phenomenon include having a degree from an unfamiliar foreign university or the inability to provide sufficient evidence of similar credentials. Yet, these individuals come armed with some of the most policy-relevant characteristics, including multilingualism, relative age vis-à-vis their U.S. counterparts and the connections formed within immigrant communities and ethnic enclaves—groups disproportionately affected by COVID.
Immigrants and refugees on temporary visas can be vital resources, especially in small towns and rural communities. International medical graduates (IMG) who are non-U.S. citizens account for about a quarter of active physicians, and yearly, about 4,000 foreign-trained doctors enter the country on J-1 visas. Unfortunately, federal and state law limitations and stringent visa restrictions have stifled their efforts to continue helping.
Relax Residency and Licensing Regulations
Some of the most prevalent factors for this condition involve rigid licensing regulations, the high cost of taking the U.S. medical board exams and the lack of a streamlined process for certifying foreign training. These factors should be re-evaluated to engage those that have the proper training. Rules and regulations are being relaxed for immigrants in many high-income countries to prevent physician burnout and shortage. The United Kingdom decided to fast-track recognition of qualifications of refugees from Germany, while Australia lifted the maximum working hours requirements for its foreign-trained nurses. Buenos Aires’ municipalities recruited Venezuelan health care personnel who may have expired credentials, and countries like Spain and Portugal are granting permanent residences to their immigrants in exchange for their efforts.
Fortunately, in the U.S., some states eased restrictions to address these problems. New York Governor Andrew Cuomo reduced the residency requirement to one year and will allow nurse practitioners from any state to practice in New York without a license. New Jersey Governor Phil Murphy issued one of the most flexible orders, granting temporary licenses to physicians who have practiced in other countries within the past five years and have at least five years of experience in the healthcare field. These measures have the potential to create more supply, but more should be done.
The Educational Commission for Foreign Medical Graduates (ECFMG) matches more than 7,000 IMGs to U.S. residency programs each year; however, many remain unmatched due to a cap on residency slots. As recently as the last year, more than 2,800 doctors, who had passed all the necessary U.S. Medical Licensing Examinations (USMLE), remained unmatched. States should create programs to grant these doctors temporary residencies, allowing them to assist at testing sites or work with a licensed doctor as a physician assistant or nurse. States could follow the model enacted by Missourians in 2017, which allowed citizen, resident and “legal resident alien” medical graduates who had completed at least two levels of the licensing examinations to serve as physician assistants.
Although New Jersey took the lead in granting foreign-trained doctors to practice without strings attached, the ECFMG should coalesce its efforts to push states to relax the residency requirements for foreign-trained doctors. Many states require IMGs to have an additional two years of U.S. residency compared to their U.S. counterparts. This requirement has almost nothing to do with medical board type and licensure standards for doctors trained in the United States. The unnecessary qualifications should be lifted in light of the coronavirus pandemic to onboard doctors who are already in the country. Eliminating license requirements specific to foreign-trained doctors, physician shortages would be reduced by 10% in a third of all states across the United States
Conclusion
As the focus of medical resources shifts from managing and treating COVID cases to distributing the Moderna, Pfizer and Johnson & Johnson vaccines, states should now more than ever consider recruiting permanent legal residents and U.S. citizens with medical training from their home country. These professionals can support existing services to alleviate some of the personnel-capacity issues overwhelming hospitals. Even those who have been out of the practice for several years can still be employed in non-technical areas, like testing, tracing and vaccinating. Failing to enlist them exacerbates the “brain waste” dilemma in the United States and contributes to the growing deficit of healthcare professionals. Relaxing license and residency requirements will not only help with the current pandemic but also better prepare the U.S. healthcare system for the aging population and avoid the looming shortages of healthcare professionals.
Photo by Sam Varghese.
Pooja Vora received her bachelors from Temple University in 2011, after which she worked as a paralegal for eight years in various areas of the law; immigration, patent, and tax. Currently, she is a Masters Candidate at Georgetown University, McCourt School of Public Policy where she is pursuing her interest in immigration, education, housing, and racial equity issues. At McCourt, she was a Research Assistant for Eva Rosen, where she was responsible for researching court eviction cases and researching different eviction laws. This past year, she, along with other McCourt colleagues, participated in a sprint led by the U.S. Census Bureau to develop an app aiming to help resettled refugees find services near their place of residence.
Pooja is a founding member and past president of the McCourt Migration and Refugee Policy Initiative whose mission centers around highlighting and promoting evidence-based migration issues. She is also a student representative on the McCourt Diversity and Inclusive Environment Committee, working with staff and faculty members to advocate for and promote a more diverse student body and environment. Ultimately, she hopes to combine her areas of interest and pursue policy issues to advance equity for all children in the K-12 education system.