Last month’s Supreme Court ruling on the Affordable Care Act ensures that more and more Americans will have access to affordable health care. While increased access to healthc are is good news, the increased demand for services raises a larger problem looming in our future.
The Colorado Department of Labor and Employment estimates that by 2023, Colorado will need an additional 24,387 health-are practitioners. This represents a roughly 29 percent increase in the number of doctors, surgeons, nurses, dentists, pharmacists and other health care practitioners needed to keep Coloradans healthy.
Access to health care for more Americans, combined with the “silver tsunami” of aging baby boomers, means that Colorado, like many states, will continue to struggle to find enough qualified health care professionals to fill these positions.
Part of the answer to this growing problem can be found in a readily available, eager and currently under-utilized population already living in Colorado. Nearly one in 10 Coloradans is foreign-born, and of this population, about 26 percent have a bachelor’s degree or higher. Yet, high-skilled and well-educated immigrants have the highest rate of underemployment nation-wide. This means we have experienced doctors driving cabs and nurses ringing up groceries. This skilled population is here legally, and about one-third are already naturalized U.S. citizens.
While there are pathways for most health care professionals to become recertified in their given professions, there are more barriers to licensure than solutions. Many highly skilled immigrants drop out of the process, not because of deficient skills or poor training but because of how long these pathways take, how much they cost, and the bias against international training.
Internationally trained doctors need to complete a residency before they can become licensed here, even though they have already completed residencies in their home countries. Matching to residency is a highly competitive process. This year, there were more than 40,000 applicants for the 27,293 first-year positions. And because many residency programs do not consider the applications of International Medical Graduates (IMGs), only about 49 percent of IMGs were successful in finding residencies, compared to 94 percent of U.S. medical school graduates.
Moreover, a doctor with over 10 years’ experience has fewer choices than a new graduate because many programs have requirements limiting the time since graduation. So actual experience practicing medicine, counterintuitively, hurts IMGs.
These numbers don’t include those who can’t make it through the process to apply For many, the costs to apply for residency are too great. The U.S. Medical Licensing Exams cost a minimum of $4,500 for the applications, tests and fees. The cost of flights and accommodation for the Step 2 exam and residency interviews also need to be factored in.
U.S. medical students typically take these tests while they are in medical school, but IMGs need to study on their own for eight to 12 hours per day to get competitive scores. The length, difficulty and cost of the whole process forces people into tough decisions over whether they can afford to take the time and expense to reclaim their careers or whether they must simply find a job to pay the bills.
Internationally trained health-care professionals should not be given a license automatically. But the current system discourages even the most qualified and experienced individuals from re-entering a field for which there is enormous need.
Many experts, and now policymakers, are attempting to find better ways to tap this talent. The Access to Health Workforce Integration Act introduced by Rep. Lucille Roybal-Allard of California in June would be a significant step to reducing barriers for highly skilled immigrants to reclaim their careers if passed. Colorado congressional representatives should support this bill and local legislators should ease the requirements for medical licensure regulated by the state.
Colorado has the opportunity to create reasonable and thorough standards to get the best and brightest of internationally trained healthcare professionals and put them to work. Let’s not wait until our shortage of healthcare workers reaches crisis levels before we act.
Benjamin Harris is program manager of the Colorado Welcome Back Center, providing guidance to internationally trained medical professionals.
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