Dr. Muawia Obeid completed medical school in Russia and his residency in Jordan, where he practiced medicine for nine years. He worked as a general practitioner in rural areas, as an emergency room doctor in a trauma hospital, and in family medicine at a private medical center. In 2009, Dr. Obeid immigrated with his family to the United States where he expected to continue practicing medicine. But he soon discovered that in Colorado—even with the state’s severe physician shortages—systemic barriers would keep him from rejoining his profession. “I found myself with the prospect of completely starting over to even get my foot in the door,” he said.
Existing practices in Colorado do not recognize medical training and experience obtained outside of the U.S. Relicensing as a physician would require Dr. Obeid to repeat medical exams and his residency, a multi-year process that would cost tens of thousands of dollars. Moreover, in the past decade only 2.5 percent of Colorado’s residency slots have been awarded to international medical graduates (IMGs). Many residency programs will not accept candidates who completed medical school more than five years prior to their application; in Colorado, the cutoff is as low as two years.
Unable to continue his career as a physician, Dr. Obeid has worked as a phlebotomist, lab technician, and even career navigator to support his family. “The COVID crisis has only made it more frustrating to know that expertise among Colorado’s IMGs is being overlooked,” Dr. Obeid said.
Groundbreaking Legislation Tackles Systemic Barriers
Dr. Obeid is among the 2,000 internationally trained health care workers whose credentials are underutilized in Colorado, a state projected to have a shortfall of more than 2,400 physicians by 2030. Two-thirds of Colorado’s 64 counties currently report primary physician shortages. A bill introduced in January, aims at remedying this shortfall by reducing the barriers to entry to the field.
“The legislation comes in response to years of efforts to address physician shortages, but COVID-19 has provoked an urgent call to action,” said Mathew Mengesha, policy advocate at Spring Institute for Intercultural Learning, an IMPRINT member organization. “Colorado must tap all of the medical expertise available in our state. Up to 1,900 patients can be served for each additional physician added to our local workforce. We need IMGs’ experience and training to ensure that all Coloradans can access quality, responsive health care.”
WES, along with the International Rescue Committee (IRC) and Spring Institute, served in an advisory role to the Nurse-Physician Advisory Task Force for Colorado Healthcare (NPATCH), a group within the Colorado Department of Regulatory Agencies (DORA). Last year, at the request of Colorado Governor Jared Polis and a dozen state legislators, NPATCH drafted recommendations regarding the licensure of IMGs that helped shape HB22-1050.
The legislation creates opportunities for IMGs to demonstrate their qualifications to join Colorado’s health care workforce by:
- Opening a pathway that affords IMGs with international licensure and residencies access to full licensure in the U.S. HB22-1050 would establish a licensure process for IMGs who have not completed a U.S. residency program but meet other specified requirements, including holding a current or expired international medical license and successfully completing a board-approved competency assessment.
- Forming an assistance program to support IMGs’ navigation of the relicensing process. A new program, to be coordinated through a competitive grant process with the Colorado Department of Labor and Employment (CDLE), would review IMGs’ education, training, and experience and recommend next steps for rejoining the local health care workforce. The program would also offer technical support with credential evaluation, along with scholarships to defray the costs of the relicensing process.
- Creating a training program that supports IMG access to U.S. residency programs. In 2021, 5 percent of IMG applicants matched for residency in the U.S. compared with 92.7 percent of MD graduates of U.S. medical schools. Immigration status is also a factor in matching: The match rate of non-U.S. citizen IMGs was 5 percentage points lower than that of IMG applicants who were U.S. citizens. HB22-1050 would allow CDLE to provide funding to local medical schools and residency programs for the purpose of establishing a clinical readiness curriculum to support IMGs in the match process.
- Equalizing IMG residency requirements for medical licensing. To qualify for a medical license in Colorado, IMGs must have three years of clinical experience in a residency program, while U.S. medical school graduates are required to have only one year of experience. HB22-1050 would create parity in these requirements, stipulating one year of residency for all applicants.
“Strong communication between physicians and patients is the heart of good medicine,” said Victoria Francis, state advocacy officer at IRC. “IMGs can bring effective and appropriate communication to their practice that breaks down language barriers and supports patients of all backgrounds. Promoting a more inclusive health care workforce is an important step in fostering a healthier Colorado.”
A Model for Other States
Colorado is not the only state grappling with physician shortages, nor is it unique in having an opportunity to advance the workforce inclusion of internationally trained health workers. The Association of American Medical Colleges projects a shortfall of up to 139,000 physicians in the U.S. by 2033. At the same time, data from the Migration Policy Institute estimate that the international health credentials of 165,000 immigrants and refugees are underutilized in local workforces across the U.S.
Policymakers in several states are responding with reforms that focus on IMG workforce inclusion. In 2015, Minnesota appropriated funds to promote the licensure of IMGs who work in underresourced communities. More recently, in response to the COVID-19 pandemic, multiple states, including Colorado, enacted emergency orders to allow eligible health care professionals who hold international licenses to obtain temporary licenses to serve during the public health emergency. Last year, Washington State passed a law that provides limited licenses to eligible IMGs.
Check out the IMPRINT Policy Tracker for more information on federal and state policies aimed at removing economic mobility barriers impacting immigrants and refugees.
“Colorado’s bill continues nearly a decade of progress in recognizing the untapped talent of internationally trained doctors and forging opportunities for their inclusion in local workforces,” said Kit Taintor, Senior Advisor for New American Integration, at Colorado’s Office of the Governor. “HB22-1050 responds to the systemic nature of the barriers facing IMGs by proposing a comprehensive set of solutions. It’s a promising, innovative model for other states invested in addressing physician shortages and advancing equitable access to health care licensure.”