World Refugee Day: Renew efforts to integrate refugee physicians into our health care system

World Refugee Day: Renew efforts to integrate refugee physicians into our health care system
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When my grandmother fled Nazi Germany, the only employment she could get, at first, was scrubbing floors and dusting blinds in private homes and office buildings. It was only after a few years of this work that she was able to re-establish herself in her prior career — as a dentist. 

This was nearly 80 years ago, but the obstacles my grandmother had to overcome, as a health care professional-turned-refugee, are not unique to her place or time. To this day, many doctors, nurses, and dentists fleeing dangerous conditions in their home countries find themselves underemployed in their countries of asylum. We see MDs driving cabs, RNs washing dishes, PhDs running cash registers — their deeper skills unused, their potential contributions to society untapped. 

Saturday, June 20th is World Refugee Day, and an opportunity to think about the many refugee physicians who do not have the option of returning to their home country, and who — like my grandmother — often find themselves working in low-skilled jobs to make ends meet while waiting to get a job that uses their skills, or getting into training programs to re-establish their previous careers. 

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As my colleagues and I discussed in a recent article, the difficulty in integrating these physicians into the host country’s health system represents a missed opportunity not only for the refugee physicians themselves, but for the host country’s own health care system, especially in countries or areas with documented physician shortages, or a high proportion of immigrant or refugee populations.    

The issue has come front and center during the current COVID-19 pandemic — when so many countries are facing an urgent need for health workers at the frontlines, as doctors and nurses fall ill or have to quarantine themselves, creating workforce shortages. In response, several countries, including the  U.S., relaxed some of the very stringent restrictions in order to fast-track certain refugee health professionals into the health system. 

Initiatives sprung up in Germany, home to more than 10,000 Syrian refugees who are also health professionals, and in Spain, France and Ireland. In the UK, foreign-trained doctors have responded to a call to join the NHS to tackle the pandemic, but many ended up working only in medical support roles. 

The UN High Commissioner for Refugees, Filippo Grandi, praised these efforts and called for more countries to implement such emergency measures, saying “refugees with proven professional competencies are ready to step in and contribute, if allowed to, under the supervision of certified health professionals. In this way, they can show their solidarity, and give back to the communities sheltering them."

In the  U.S., the governors of a few states — Colorado, New Jersey, New York — have signed orders allowing foreign trained and licensed and refugee health professionals to aid in COVID-19 related activities, but generally only as support personnel and not as full-fledged physicians. 

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This is certainly encouraging, but only a first step. According to the Migration Policy Institute, there are more than 165,000 refugees and immigrants in the  U.S. who have medical training but are unable to work in their field due to credentialing and licensing rules.

Refugees have a long and very successful history of making economic and cultural contributions to their new communities, and integration in the health care system predates the COVID-19 pandemic. How can we support them to resume their professional lives and identities? 

Refugee and asylee physicians who want to practice medicine in the  U.S. must undergo a time, labor, and financially intensive process. This includes eligibility confirmation, passing multiple tests and exams, applying for and completing residency programs (even if they’ve worked as doctors in their home country for decades), and applying for licensure. Indeed, it is necessary to ensure the best and most consistent quality of care, but many argue that the process is too long, too expensive and even demeaning to doctors who have years of advanced clinical skills. A recent study showed that patients in  U.S. hospitals treated by international medical graduates had lower mortality rates than those treated by  U.S. graduates.

The integration will require concerted efforts from multiple stakeholders: state and federal health authorities, medical association, private entities, non-profits organization and higher education institutions. As my colleagues and I document in another article, there are multiple efforts underway in the  U.S. to facilitate such training and integration, but most of these programs are very small in scale and seem as disjointed as our health care system itself. 

What is clear is that the  U.S. lags behind other countries in boosting efforts to recognize the training of refugee health professionals and to find more streamlined ways to harness their knowledge, talents, language and lifesaving skills to benefit our communities.  

We could start by creating a task force with a broad range of stakeholders including refugee doctors themselves; we need to collect accurate data on the number of refugee physicians, their demographics and current specialties; we should examine successful state-based solutions, review certification requirements, and consider the creation of special training incentives for residency programs that are geographically or specialty-focused, and based on local population needs. We could also create clinical observerships and internships specifically tailored to refugee health professionals. 

Opportunities to strengthen preliminary job opportunities (and prevent refugee doctors from entering the less-skilled workforce) may include the creation of programs that recruit them into the system in other roles, such as scribes or medical translators. Such opportunities would provide them with early exposure to the system as they prepare for their training requirements. Any solutions should also address the extreme financial burden of the process of licensing exams, with plans put in place for a more centralized scholarship and need-based grant or stipend system. 

A global crisis such as the COVID-19 pandemic has given us the perfect opportunity to re-examine how our health care system operates and what needs to happen for it to function more efficiently and equitably. As we re-imagine our broken system, we must consider how to harness the knowledge and skills of refugee health professionals. 

Ranit Mishori, M.D., professor of Family Medicine at Georgetown University School of Medicine and director of her department’s Global Health Initiatives. She is also a senior medical Advisor for Physicians for Human Rights.