Zalmai AFZALI, internal medical doctor in northeast virginia, had to finish a residence program in the United States after already finishing one in Afghanistan. He supports the new laws of states abandoning these requirements for doctors trained abroad.
Roya Qaemi
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Roya Qaemi
An increasing number of states have facilitated the training of doctors in other countries to obtain medical licenses, according to quarter supporters, could facilitate shortages of doctors in rural areas.
Changes involve residence programs – the supervised practical training experience that doctors must carry out after obtaining their medical diploma. Until recently, each state required doctors who finished a residence or similar training abroad to repeat the process in the United States before obtaining a complete medical license.
Since 2023, at least nine states have abandoned this requirement for certain doctors with international training, according to the Federation of State Medical Councils. More than a dozen other states are considering similar legislation.
About 26% of doctors training in the United States were born elsewhere, according to the Migration Policy Institute. They need federal visas to live in the United States, as well as state licenses to practice medicine.
Supporters of the new laws say that qualified doctors should not spend years undergoing a second training in residence. The opponents are concerned about patient safety and doubt that the change of license will facilitate the shortage of doctors.
The legislators of the Republican and Democratic States approved the idea at a time when many other immigration programs are attacked. They include Florida, Iowa, Idaho, Illinois, Louisiana, Massachusetts, Tennessee, Virginia and Wisconsin.
The changes come as President Trump moves to tighten many immigration rules, although He defended A federal H-1B visa program on which many foreign doctors count.
Supporters of the new licenses include Zalmai Afzali, an internal medical doctor who finished his medical studies and a residence program in Afghanistan before fleeing the Taliban and coming to the United States in 2001.
He said that most doctors trained elsewhere would be happy to work in rural areas or other poorly served areas.
“I would go anywhere as long as they have let me work,” said AFZALI, who now treats patients who live in rural areas and small cities in northeast virginia. “I failed to be a doctor. I missed what I did.”
It took 12 years in Afzali to obtain copies of his diploma and his transcription, the study of exams and the end of a three -year American residence program before being able to be entirely authorized to practice as a doctor in his new country.
But a National Health Organizations Commission wonders if the relaxation of residence requirements for doctors trained abroad would facilitate the shortage. Doctors in these programs could always deal with obstacles to licenses and employment, he wrote in a report that makes recommendations without taking a stand on such legislation.
Erin Fraher, professor of health policy at the University of North Carolina who advises the Commission and study the problemhave said that legislators who support changes predict that they will strengthen rural health personnel. But we do not know if it will happen, she said, because the programs are just beginning.
“I think the potential is there, but we have to see how it goes,” said Fraher.
Many draft state bills to facilitate residence requirements have been based on legislation model of the Cicero Institute, a conservative reflection group which sent representatives to testify to the legislatures after Offer such programs in 2020.
The new routes are only open to internationally trained doctors who meet certain conditions. Common requirements include work as a doctor for several years after graduating from a medical school and a residence program with rigor similar to those found in the United States
Even without having to finish an American residence, doctors trained abroad are faced with a complicated process to obtain a license. Applicants must face documents, including the implementation of insurance against professional faults and in certain states, they must find doctors who will supervise them. They must also take the standard examination in three parts that all doctors pass to become authorized in the United States
Those that are eligible receive a limited license to practice and can receive a complete license after several years.
AFZALI had trouble supporting his family while trying to get his medical license. His jobs included work in a department store for $ 7.25 per hour and chemotherapy administration for $ 20 an hour. AFZALI said that nurses in his last work had less training than him, but had won almost four times more.
“I don’t know how I did it,” he said. “I mean, you are really depressed.”
“Bad answer” to the shortage of rural doctors
About 10 of the laws or bills of the new path also oblige doctors to work for several years in a rural or poorly served area.
But declares without this requirement, Like TennesseeMay not see an impact on rural areas, researchers from the Harvard Medical School and Rand Corp. New England Journal of Medicine. In addition to including this condition, states could offer incentives to rural hospitals that are appropriate to hire doctors in the new training courses, they wrote.
Legislators, doctors and health organizations who oppose changes say that there are better ways to increase the number of rural doctors safely.
Barbara Parker is an authorized nurse and former republican legislative in Arizona, where the Legislative Assembly is considering a bill for at least the fourth consecutive year.
“It is a really poor response to the shortage of doctor,” said Parker, who voted against legislation last year.
Parker said that facilitate trained doctors abroad to practice in the United States, not ethically poache doctors from countries with greater health care needs. And she said that she doubts that all international residences are tied with those of the United States and are worried that the granting of licenses to the doctors who led there could cause poor care.
She also fears that hospitals are trying to save money by recruiting international trained doctors for people trained in the United States, the former will often accept a lower salary, said Parker.
“This is motivated by the greed of companies,” she said.
Parker said that in better ways to increase the number of rural doctors include increasing remuneration, widening loans for reimbursement programs for those who practice in rural areas and the creation of accelerated training for nurses and medical assistants wishing to become doctors.
Establish standards to protect patients
The advisory committee – recently trained by the Federation of State Medical Commissions, the Accreditation Council for Graduated Medical Education, and formatting, a non -profit organization that assesses international medical schools and their graduates – has published its recommendations to help legislators and medical advice ensure that these new ways are safe and effective.
The Commission and Fraher have said that state medical advice should collect data on new rules, such as the number of doctors participate, what their specialties are and where they are working once they have obtained their complete license. The results could be compared to other methods to mitigate the shortage of rural doctors, such as Adding residence programs in rural hospitals.
“What is the advantage of this particular path compared to the other levers they have?” Said Fraher.
The commission noted that if state medical advice can count on an external organization This assesses the strength of foreign medicine schools, there is no similar score for residence programs. Such an effort should be launched in mid-2010, said the Commission.
The group also said that states should demand that supervisor doctors assess participants before granting it a complete license.
AFZALI, the doctor of Afghanistan, said that certain primary care physicians trained at international level have more training than their American counterparts, as they had to practice procedures that are only carried out by specialists in the United States
But he agreed with the commission’s recommendation that states demand that doctors who have made residences abroad have supervision while they have a provisional license. This would help ensure patient safety while helping doctors to adapt to cultural differences and learn the technical side of the American health system, such as invoicing and electronic health files, the Commission wrote.
Fraher noted that doctors of programs with supervision requirements must find an experienced colleague over time and the interest of providing this surveillance in a health facility ready to hire them.
The Commission highlighted other potential obstacles, such as insurers for professional fault, perhaps refusing to cover doctors who obtain state licenses without finishing an American residence. The Commission and the American Board of Medical Specialties also underlined the question of specialized certification, which is managed by national organizations which have their own residence requirements.
Doctors who are not eligible to take exams of the board of directors could lose job possibilities, and patients may have concerns about their qualifications, The council wrote. But he said that a majority of his member councils would plan to certify these doctors if the states have added requirements she recommended.
Legislators’ plans to use these new license routes to increase the number of rural doctors will require that doctors trained abroad sail all of these obstacles and unknown, said Fraher.
“There are a lot of things that must happen to make it a reality,” she said.
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