Washington creates new pathway for international medical graduates

For the hundreds of Washington State professionals who received their medical training abroad, and who are trying to navigate the complicated and expensive process to getting certified in the U.S., a new state program provides a pathway to practice.

The roughly 600 members of the Washington Academy for International Medical Graduates (WAIMG) are mostly immigrant and refugee doctors who were trained abroad, and who are trying to practice in the U.S. The process to do so can take years, includes a three-part paid test, and requires competing for and landing a residency as part of the highly-competitive Match process.

 

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After the passage of SB 5846 in 2019, the International Medical Graduate Work Group was formed by the Washington Medical Commission. In May, Gov. Jay Inslee signed a bill which created a two-year medical license, with the option for one renewal, for international medical graduates to get clinical experience under licensed doctors sponsored by hospitals and clinics. This recent experience is something which many residency programs look for in applicants.

The program is administered by the Washington Medical Commission, which began accepting applications in October.

As of early November, Micah Matthews, deputy executive and legislative director for the Commission, said they had only received two applications.

“It’s about getting clinical experience and having those physicians oversee what the (international medical graduates) are doing and assess it, and give a good letter of recommendation about their clinical skills,” Matthews said.

Matthews said they will be monitoring how many international medical graduates who use the two-year medical license program go on to land residency positions. They’ll also be watching how the licenses are used by physicians of varying ages. For example, an international medical graduate in their 50s may be less interested in going on to a residency program after their license expires.

That hesitancy over what comes after the license expires is a problem that Matthews said international medical graduates have been discussing. There have been questions as to whether it would be more viable to create a permanent pathway to practicing through the program.

Matthews said there’s concern from the state about creating a two-tier system, where international medical graduates who use the program, but don’t end up landing a residency and becoming board certified, could be stuck earning less than fully-accredited doctors.

It’s a concern that Dr. Mohamed Khalif, founder of the WAIMG, said he’s hearing too. But for Khalif, the potential benefits of creating a permanent pathway through the program outweigh the cons.

“The state is essentially telling that immigrant doctor after two years, you have to go back to doing Uber. You have to go back to doing McDonald’s again,” Khalif said.

Khalif said the license was intended to be a pathway to employment. But the lack of residency positions, and a low acceptance rate for internationally trained doctors compared to domestic students, is a persistent problem.

During the 2021 National Resident Matching Program, the nationwide match rate for non-U.S. citizen international medical graduates was 54.8%. For U.S. citizen international medical graduates, the match rate was higher, at 59.5%. However, these rates are significantly lower than the 92.8% match rate for U.S. senior students.

For both U.S. citizen and non-citizen international medical graduates, internal medicine was the most sought-after residency, followed by family medicine and pediatrics.

Given the difficulty landing residency positions, Khalif said the state should consider extending these licenses at least until a residency is secured, or create a pathway for doctors working under the license to fulfill accreditation requirements through that work.

But the first steps should be getting people into the program, practicing again, and then addressing the questions about creating and extending those pathways, Khalif said.

I think this is a first step. Rome was not built in a day, I understand their concern, but the people that they’re talking about right now are making $12 an hour at McDonalds and Starbucks and Uber. I think this gives them a step towards what a physician assistant or nurse practitioner is making, like a mid-level provider, and to improve their career that way.”

Khalif said major medical universities, where many medical students complete residencies, could put more emphasis on accepting international medical graduates as well.

There are also concerns about whether insurance companies and Medicaid will reimburse clinics for services provided by international medical graduates through the two-year license program, Khalif said. He’s in the process of trying to speak with Washington’s Health Care Authority and the Office of the Insurance Commissioner to figure out how to proceed.

“The truth is nobody’s going to hire these doctors if Medicaid-managed care companies don’t want to pay them, and right now we don’t know why that is,” Khalif said. “If it’s maybe their own policies, or maybe it’s something in the law that prohibits that.”

Despite the challenges, international medical graduate doctors could help fill a doctor shortage, and provide culturally informed care, Matthews said, which can improve health outcomes.

According to an Association of American Medical Colleges report from June, the U.S. could have an estimated shortage of between 37,800 and 124,000 physicians by 2034, including shortages in both primary and specialty care.

“When you start talking about cultural background, something as basic as my doctor looks like me, or understands what I’m going through, or have gone through having common cultural experiences, and something as essential as being able to speak the language,” Matthews said.

But even with the bills and work Washington has done to create pathways for international medical graduates, Khalif said many physicians in the WAIMG are beginning to wonder whether it will work. Some 20 physicians recently left for another state to search for residency positions or to work as scribes or medical assistants to get their foot in the door.

“I think there’s a lot of people saying it’s taking three years, and still nobody’s working,” Khalif said. “So a lot of people feel that uncertainty, but a lot of people are hopeful as well. So we have that mixed type of environment, especially with this license to see how it goes.”

At the same time, Khalif said he’s been receiving significant attention from legislators in other states, asking about what Washington is doing, especially after a recent article in Time magazine came out on the program.

And in Washington State, Rep. Adam Smith’s office reached out as well, as they’re working on a bill to provide funding for states who are working on international medical graduate issues. There are also many employers who are willing to work with international medical graduates.

“There’s a lot of support, but I think we have a lot of work to do as well,” Khalif said.