IMPRINT: Immigrant Professional Integration
Minnesota has become a national leader in helping foreign-trained physicians practice in the United States. While immigrant and refugee communities are severely underrepresented in the state’s licensed physician workforce, an estimated 250 to 400 unlicensed immigrant physicians live within its borders. But, in the past few years, Minnesota has taken notable steps to recognize the potential of its skilled immigrant population and to address the issue of brain waste head on.
In order to practice medicine in the U.S., doctors must pass the first two parts of the United States Medical Licensing Exam, be certified by the Educational Commission for Foreign Trained Medical Graduates, enter a residency program, then pass a third licensing test. While 95 percent of seniors in U.S. medical schools are accepted into a medical residency, most foreign-trained physicians are impeded at this step by several obstacles. Residency programs require residents to have graduated from medical school within the past five years. International medical graduates, however, are seldom recent graduates, making them ineligible for many of these programs regardless of their prior experience. Residency programs also require one year of clinical experience – difficult, if not impossible, to obtain if not currently enrolled in medical school.
Minnesota has only a handful of residency providers, yet quality assurance mandates small classes. In fact, the national limit on residencies has not increased for 20 years. With a growing number of medical graduates competing for these capped residency slots, foreign-trained physicians find themselves in a “residency bottleneck” with slimmer odds and tougher competition.
In 2014, Minnesota took action. With new legislation in place, the state established a 15-member task force to develop strategies for integrating refugee, asylee, and other immigrant physicians into the Minnesota health care system. Members representing health care, higher education, community-based organizations, workforce development, finance, and government, as well as foreign-trained physicians teamed up, along with public agencies including the Minnesota Department of Health, the Minnesota Board of Medical Practice, the Minnesota Department of Employment and Economic Development, and the Council on Black Minnesotans. In its first year, the task force met monthly from July to December and held an open forum attended by over 50 immigrant physicians.
Minnesota’s task force found that creating pathways to enable international medical graduates to practice would not only enhance the state’s primary care workforce, but also help with its increasingly urgent physician shortages, health disparities, and rising health care costs.
The task force’s key recommendations included:
The following year, based on these recommendations, the Minnesota legislature invested a million dollars to promote the integration of IMGs in the state’s workforce. Minnesota has used the funding to establish the International Medical Assistance Program, designed to help facilitate such integration while simultaneously addressing health disparities and the severe shortage of medical care in underserved areas.
Minnesota’s International Medical Assistance Program implements the program through community based organizations like the New American Alliance for Development (NAAD), residency program providers, and other stakeholders. Community based organizations provide career guidance and support, funding assistance for testing fees, interview preparation, and general support so its participants can become “residency ready.” The University of Minnesota offers a clinical assessment as well as rigorous nine month clinical experience program to further assist IMGs in meeting residency requirements. Last, but not least, the IMG assistance program offers funding for residency spots dedicated to IMGs in primary care. Thus far, the University of Minnesota Pediatric Residency Program and Hennepin County Medical Center Internal Medicine Program have applied for and received funding. Participants selected in the dedicated IMG residency spots must sign a commitment to work in a rural or urban high-need area and pay fifteen thousand dollars into the program once they join the workforce. The first group of residents started in 2016 and is working steadfastly on their pathway to practice medicine. The University of Minnesota Pediatric Residency Program currently has three IMGs selected as a result of the IMG Assistance program. The state funds two of the residents and the university funds the remaining resident. Hennepin County Medical Center also has one IMG in their program.
In creating its task force, the Minnesota Department of Health responded to two intersecting needs: the hundreds of foreign-trained medical professionals eager to practice, and the thousands of Minnesotans who need care. The strategies they are implementing can fortify their physician workforce for years to come, and help the state to be a leader in healthcare innovation.
You can learn more about the International Medical Graduate Program here.