Forced to flee Myanmar because of political persecution, Win Mar Lar Kyin eventually resettled in Oregon, leaving her family behind.
Since then systemic barriers, including the lack of recognition of international credentials, have prevented Win from resuming her career as a primary care physician—despite having 12 years of experience practicing medicine in Myanmar.
“With my experience not being recognized, I had to relinquish my hope to continue working as a doctor,” said Win. Despite her desire to contribute to Oregon’s health care workforce, she has been prevented from working as a physician or applying to any medical programs in the state. The Myanmar government did not issue any official documents for medical graduates because of the country conditions, and without an official transcript, Win is not eligible to take the United States Medical Licensing Examination (USMLE).
To support her family, Win worked as a customer service associate and pharmacy technician at Walgreens. She is now employed as the health care services manager of the Immigrant and Refugee Community Organization (IRCO), helping Oregon’s immigrants and refugees to access health and social services.
Health Care Shortages in Oregon
Limited proof of academic credentials is one of many challenges that international medical graduates (IMGs) like Win face. Even IMGs with access to their transcripts are often prevented from obtaining licensure in the U.S. unless they redo their training. Systemic barriers, such as the lack of credential recognition and limited access to U.S. residency programs, drive the severe underemployment of immigrant and refugee doctors trained abroad. In 2022, IMGs had a residency match rate of 58.1 percent compared with 92.9 percent for U.S. medical graduates.
There is an urgent need to address health care shortages in Oregon. As of December, 14 of the state’s 36 counties have been designated Health Professional Shortage Areas by the Health Resources and Services Administration (HRSA)—a formal recognition that there were not enough primary care workers in those counties to address the needs of their residents.
“The growing demand for health care workers in Oregon is striking With 1.3 million Oregonians approaching retirement age in the next decade, Oregon will need more workers to fill critical labor shortages in health care and other key industries.”—Rich André, senior policy advisor for state and local initiatives at the American Immigration Council
Research has shown that the need for licensed practical nurses in the state increased by 97.7 percent, dentists by 40 percent, and registered nurses by 9.9 percent from 2018 to 2022. Data from the Oregon Longitudinal Data Collaborative stated that Oregon’s nursing programs produced the third fewest graduates per capita in the U.S. as of 2020.
Internationally trained immigrants and refugees like Win are essential to meeting this demand. Oregon is home to more than 430,000 immigrants, with immigrant workers making up 22 percent of the state’s physicians and 5 percent of its nursing workforce. According to a report by Migration Policy Institute, there are approximately 8,000 immigrant adults (ages 25 to 64) with health-related undergraduate degrees who can help respond to the state’s health care labor shortage.
“To respond to the state’s health care needs and remain competitive, Oregon must implement policies that can attract and retain immigrant and refugee workers,” said Rich.
SB 849: A Promising Solution to Workforce Inclusion
Oregon’s proposed legislation, SB 849, is a critical step toward a more inclusive and accessible health care workforce. If enacted, the bill would create a new type of limited license for internationally trained immigrants and refugees to practice under the supervision of a fully licensed physician. A first of its kind, this limited license could be renewed indefinitely, effectively allowing IMGs to resume their professions without having to repeat their training.
“Washington has benefited from the work of internationally trained immigrants and refugees,” said IMPRINT steering committee member and founder of the Washington Academy for International Medical Graduates, Mohamed Khalif. “IMGs have brought their unique perspectives and in-demand skills to treat diverse patients in Washington.” Mohamed was a key leader in the effort to develop pathways for internationally trained immigrants and refugees to practice in the state of Washington and nationally. He successfully championed the passage of HB 1129, a bill that has helped IMGs find commensurate employment and address health care shortages in the state.
In addition to expanding pathways to licensure, SB 849 would ensure that applicants who meet English proficiency standards in another state are not required to retake exams in Oregon and would remove the existing requirement to pass the USMLE in seven years. Currently, twelve other states, including California, Florida, Hawaii, Maryland, New York, and Pennsylvania, have no time limitations on completing the test.
“There are many international medical graduates who are primary care physicians, obstetricians, gynecologists, physiatrists, and public health specialists,” said Win. “They had to leave everything behind and resettle in the U.S. SB 849 is an important step to help us resume our careers in Oregon while improving access and quality of health care services across all corners of the state.”
An Innovative Approach to Community-Based Support
In addition to creating opportunities for IMGs to practice, SB 849 would launch the Internationally Educated Workforce Reentry Grant Program to provide financial support to non-profit organizations, post-secondary educational institutions, and industry-specific employers.
SB 849 will help build the capacity of service providers to offer career resources to internationally trained workers in five eligible professions, including nursing, medicine, and teaching. This support can include tuition, training, and a living wage while pursuing training and credentials in the U.S.
In 2020, a study by the Nonprofit Association of Oregon, Portland State University’s Nonprofit Institute, Mercy Corps Northwest, and Oregon Voluntary Organizations Active in Disaster found that a large number of organizations in Oregon experienced financial and capacity challenges: 56 percent of the 490 non-profit leaders surveyed expressed concerns that their organizations will not be able to maintain their current levels of service; 54 percent reported losses in earned income, with losing more than half of their earned income as a result of the economic strain caused by the COVID-19 pandemic.
A Critical Moment for Reform
On March 14, 2022, SB 849 passed the Oregon Senate Committee on Labor and Business with unanimous support. The bill is now being referred to the Ways and Means Committee.
“The Senate must pass SB 849 as it has immense potential for immigrant, refugee and U.S. born internationally trained medical school graduates who are based in Oregon to contribute to the health care workforce and diminish the gap in health care access for patients in medically underserved areas,” said Faarina Khan, an Oregon-based family medicine resident physician who graduated from Dow International Medical College in Pakistan.
“This is a very important initiative to improve health equity and minimize health disparities by nurturing a diverse health workforce that can provide culturally specific health care services for communities across the U.S.” – Win
By 2034, the U.S. will face a deficit of up to 124,000 physicians, including a shortage of between 17,800 and 48,000 primary care physicians. With SB 849, Oregon is opening pathways to practice for IMGs, ensuring that Oregonians benefit from the diverse experiences of immigrant and refugee health workers—and serving as an important model for states across the U.S.
Check out IMPRINT Policy Tracker to learn more about Oregon’s SB 849 and other state and federal policies aimed at reducing barriers to employment for immigrants and refugees with international credentials.