MPR Airs Segment on Foreign Trained Physicians

Foreign-trained doctors could soon have easier path

by Elizabeth BaierFeb 27, 2015

For three years, Abdelsalam Elshaikh has worked as nursing assistant at Charter House, a Mayo Clinic retirement community that houses a short-term rehabilitation center. Every night, his duties include wheeling patients recovering from hip and knee surgery to the dining room.

Elshaikh, a medical school graduate from Sudan, longs to do the kind of work he spent years preparing for. But as a foreign-trained doctor, he must overcome a complicated, lengthy and expensive process that could take him years to finish.

“I had a lot of questions in my mind about how I’m going to live in the United States,” he said. “I didn’t know if I’m going to achieve what I’m going to do. But I know myself. I’m a very determined person. I will do whatever I want to do.”

Minnesota may become a national leader in helping foreign-trained physicians to practice in the United States. Proposed strategies include dedicating spaces for those doctors in medical residency programs.

The state Task Force on Foreign-Trained Physicians estimates Minnesota is home to as many as 400 immigrant physicians who have not yet been certified to practice, though social service providers say that number is probably higher. Many are doing other work, such as taking supporting roles in health care, serving as interpreters or driving cabs.

Elshaikh, 30, is determined to beat the odds.

After graduating from medical school in 2008, Elshaikh decided he wanted to practice medicine in the United States — even if it meant he would have to retake many of the same steps. As a doctor in his homeland, he would see many patients with malaria and tuberculosis. But he wanted to practice a fuller range of medicine.

Elshaikh applied for a visa through the U.S. State Department’s Diversity Immigrant Visa Program, which each year grants about 50,000 visas to people from countries with historically low rates of immigration to the United States.

Abdelsalam Elshaikh helped Viola Klingsporn.

Abdelsalam Elshaikh helped Viola Klingsporn get ready for dinner, Feb. 13, 2015, during her stay at the Charter House in Rochester. Alex Kolyer for MPR News

To earn the right to practice in the United States, foreign-trained 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 and pass the third licensing test.

The process is long, so Elshaikh began his medical residency in his homeland and waited.

“The medical education in the United States is very different for us as far as the standards,” Elshaikh said. “The English language, the details of the basic medical science — all the first year physiology, biochemistry, molecular biology. We don’t study that thoroughly because they concentrate on what you are going to see in Sudan.”

In 2010, after winning one of the coveted visas, Elshaikh moved to Sarasota, Florida to be near his sister and started over — this time, as a nursing school student. A couple years later, he moved to Minnesota.

At Charter House, Elshaikh works the night shift so he can study during the day. He received $3,000 in state grants from Workforce Development Inc. to help pay for the exams.

The high cost of exams is one of the biggest challenges immigrant physicians face when trying to practice in the United States, said Jinny Reitman, Rochester area manager for Workforce Development. Another is being accepted into medical residency programs.

It costs $7,500 to $15,000 for a foreign-trained physician to prepare for and pay for exams leading up to a residency, fees that residents typically pay themselves, according to the task force’s recent report.

“So what we’ve seen is that their testing scores are great, the skills portion is great,” Reitmann said. “They were working as physicians in another country so they’ve done the work, but they have to start from scratch here as far as getting a residency to accept them and then to complete the residency program in order to practice.”

According to the Minnesota Department of Health, about 14 percent of Minnesota’s physicians are people of color, but African-Americans and Latinos are under represented, as are members of most of Minnesota’s largest refugee and immigrant communities.

Elshaikh chatted with patients and families.

Abdelsalam Elshaikh chatted with patients and families during dinner at the Charter House. Alex Kolyer for MPR News

There are also persistent health disparities between whites and people of color in the state. Reitmann said adding more immigrant physicians would help tackle the health disparities between white residents and minorities in more effective ways.

“Individuals are more likely to go and use the health care system if their [doctors are] able to communicate well and able to understand their culture and their questions and where they’re coming from and their family needs and those kinds of things,” Reitmann said. “I think it can increase our health care usage as well.”

The legislative task force is calling for ways to streamline the process to help more foreign-trained doctors practice in the United States.

Among the legislative task force’s recommendations is for the state to develop a standardized assessment and certification program to measure the clinical readiness of immigrant physicians, as well as dedicating residency positions for immigrant physicians, according to Barbara Porter, Mayo Clinic’s College of Medicine Administrator, who served on the task force.

“We’re not asking to displace U.S. medical school grads,” Porter said. “We’re simply asking that the access and the opportunity be increased for international physicians to get into our Minnesota workforce.”

Elshaikh has passed the first two parts of the medical exams and will take the third in late March. If he clears that hurdle, his next step will be to apply to residency programs around the country. He hopes his experience at Mayo Clinic will give him the edge he needs to get into one the programs.

“It’s very hard, it’s very competitive,” Elshaikh said. “I know all the challenges. But I have been blessed with meeting physicians from Mayo who were very, very helpful, supportive, encouraging.”

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Now is the Time to Advocate for Change

This is a message for all immigrant internationally trained physicians and those that care about receiving the best culturally and linguistically appropriate healthcare. The Final Report of the Foreign Trained Physicians Task Force has been sent to the Legislature. The best way to make your senators and representatives familiar with and become advocates for this issue is to contact them by email or by phone. You can find your representative by googling “Who represents me”. The Health and Human Services and Higher Education Committees are most involved in this issue, but the main person to contact is your own representative. He or she represents you. Please do not put this off, as times to be heard in committees are filling up fast. Thank you.

Task Force on Foreign Trained Physicians Final Report

On January 23, 2015, the multi-organizational, multi-specialty Task Force on Foreign Trained Physicians (otherwise known as immigrant internationally trained physicians) was forwarded to the legislature. This was the result of a five month long group of meetings, chaired by Dr. Edwin Bogonko. This is actually the result of nearly 10 years of work with you, the physicians, with NAAD and with W.I.S.E.  Please take time to read the report in its entirety. Then call us to see how you can help 651-255-5828, or email us at naad.mn@gmail.com. Your involvement is crucial in bringing this from a “Report” to a Legislative Bill. There is not a lot of time to act, so please move quickly. Thank you.

http://www.health.state.mn.us/divs/orhpc/workforce/iimg/finalrpt.pdf

Open Discussion with the MN Task Force on Immigrant iIMGs on Monday, November 10, 2014;

Everyone who is interested please attend an open discussion with the Minnesota Task Force on Immigrant IMGs which is being held at the International Institute of Minnesota, 1694 Como Avenue, St. Paul, MN 55108, on Monday, November 10, 2014. The Task Force is interested in hearing from immigrant physicians and others who are interested in how to integrate these professionals (IIMGs) into the Minnesota health care workforce. The meeting, again, is on Monday, November 10, 2014. There is a 6:00 pm social time, followed by discussion from 6:30 to 8:30. This is an excellent chance for your voice to be heard. Do not miss out on this opportunity!!!

To register email: darcy.dungan-seaver@state.mn.us or call 651-2-1-3855.

For more information about the Task Force on Immigrant IMGs, visit: http://www.health.state.mn.us/divs/orhpc/workforce/iimg/index.html

Minnesota Task Force on IMGs to Meet October 22, 2014

The Minnesota Task Force on how best to advance IMGs in Minnesota meets on October 22, 2014 at 9 am at the Northwest Area Foundation, 60 East Plato Blvd., St. Paul, MN  55107 http://www.nwaf.org/about/location/.

There will be discussions on developing an “ideal PRP” by James Pacala, MD. More reports on alternative pathways and how to estimate pool of IIMGs in MN.

Discussions will continue on PRP and residencies. All interested are urged to attend. Thank you.

Foreign Training as it Impacts Patient Outcomes in the US

Foreign trained doctors make up 20% of the doctors in America and 30% of the family physicians.  Comparisons of patient outcomes between the groups is discussed in the article “When the Doctor Doesn’t Look Like You”. “Studies initially revealed that international graduates tended to score lower, while more recent research shows that they routinely outperform their peers on training exams in areas like internal medicine.” Recent data has also looked at patient outcomes between FTPs and US citizens who studied abroad. “Dividing the international medical graduates into those who were foreign-born and those who were American citizens who chose to study abroad, the researchers discovered that patients of foreign-born primary care physicians fared significantly better than patients of American primary care doctors who received their medical degrees either here or abroad.” The gist of the article was that board certification and continued medical eduction was the important indicator for patient well treatment, and did not, in fact, correlate with either foreign or US training of the doctors.

When the Doctor Doesn’t Look Like You. http://www.nytimes.com/2010/08/12/health/12chen.html?_r=0

Internationally Trained Doctors Well Positioned to recognize Ebola

Since the introduction of the first patient traveling from West Africa to the US with Ebola, hospitals and the CDC have been scrambling to train health providers in the recognition of and treatment for Ebola. The Texas hospital’s example shows that having someone in the ED who had a high index of suspicion for this African disease would have been helpful. Internationally Trained Doctors, especially those from Africa are assets of inestimable value in our new world order where there are no borders that diseases can’t cross. In addition, the electronic medical record system, where the information of the patient’s recent travel from West Africa was recorded, is no substitute for communication between healthcare providers.

Texas Hospital Could Face Probe over Handling of Ebola Patient as Records Released. http://www.foxnews.com/health/2014/10/11/texas-hospital-could-face-probe-over-handling-ebola-patient-as-records-released/

http://www.foxnews.com/health/2014/10/11/texas-hospital-could-face-probe-over-handling-ebola-patient-as-records-released/