Physician Pathway Act, co-sponsored by Amherst rep, may help ease physician shortage

Doctor with stethoscope isolated on white

Doctor with stethoscope isolated on white Zoonar/N.Okhitin

By Jiashan Zheng

Boston University Statehouse Program

Published: 05-14-2024 4:49 PM

When she fled to the United States amid Haiti’s political turmoil, Dr. Marie Jacques envisioned continuing her work. However, upon claiming asylum in 2019, she encountered the harsh realities of the Massachusetts medical licensing system.

“As a physician, no matter where you studied, you always had the skillset but still needed to take a long exam to access the system,” said Jacques, a Haitian-trained physician who now works as a contact tracer in the Department of Public Health while navigating her path to requalification.

“In the meantime, this country has a lot of problems finding physicians. We are here with the knowledge but cannot work as physicians.”

The Physician Pathway Act, gaining traction in the Legislature, could untangle some red tape for internationally trained physicians like Jacques.

Aimed at addressing the critical shortage of health care professionals in underserved communities, the bill introduced by Sen. Jason Lewis, D-Winchester, and Reps. Jack Patrick Lewis, D-Framingham, and Mindy Domb, D-Amherst, would allow internationally trained physicians to waive their residency after they pass the United States Medical Licensing Examination.

“I felt depressed because COVID hit soon after I came in September 2019.” Jacques said, “You have knowledge and could help, but you could not even work as a nursing assistant in this country.”

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By 2025, the state is expected to see 25% of its physicians leave practice, according to Maroni Minter, the political director at Massachusetts Immigrant and Refugee Advocacy Coalition.

According to Minter, rural and low-income residents in the state especially faced severe physician shortages.

“Just to put things into perspective,” Minter said, “nearly 40% of our physicians practice in Suffolk County, which has just 11% of the population.”

“One of the concerns that people have in the past is that this pathway will displace current doctors who are trained in the United States for those same positions,” said Dr. Noemi Custodia-Lora, a member of the Foreign-Trained Medical Professionals Commission in Massachusetts. “The answer is no, because there is a big shortage.”

According to Custodia-Lora, foreign-trained medical doctors can help to meet the demand in low-income places where there is a concentration of low-income communities.

Rep. Jim Hawkins, D-Attleboro, who endorsed the bill, said the turmoil surrounding various Steward hospitals in Bristol County is causing the understaffed health system to face more challenges.

“The act represents an opportunity to fill critical gaps in our health care system with doctors who are already trained and eager to serve,” Hawkins said.

Under current Massachusetts licensure requirements, internationally trained physicians like Jacques must pass the United States Medical Licensing Examination and complete a residency program, the duration of which can vary depending on their chosen specialty.

“Because of the current pathways for internationally trained physicians to get licensed,” Rep. Lewis said. “Many of them are no longer practicing medicine.”

Lewis said many medical professionals from places like Afghanistan and Iran now take jobs like Uber drivers to make a living.

“I would want us to create some very clear pathways,” Lewis said, “So that in addition to the opportunity to drive taxis, they can continue devoting themselves to practicing medicine.”

Custodia-Lora said that with the current obstacles to ITPs obtaining their license, she couldn’t remember ever meeting a medical doctor who has gone through the process.

She said the process, including exams and residency, potentially costs between $8,000 and $32,000, which could be an immense financial burden for ITPs.

“A lot of time, people think that most immigrants that arrived in the United States don’t have a level of education,” said Custodia-Lora. “While in reality, there are many professional immigrants that come to this county where their credentials are being seen as not valid, which in a way eroded their self-esteem.”

“A dozen other states have already passed the law,” Minter said, “if we don’t pass this law, there is a chance that we will be losing all of these folks who are currently in Massachusetts and willing to provide their services.”

More ITPs in the state may also help immigrant community with an influx of physicians that have the relevant experience, cultural, and linguistic connections, Lewis said.

Patients in immigrant communities would be able to get access to physicians who speak their language and share the same cultural background.

Custodia-Lora said the commission is now working to provide recommendations on helping ITPs with their current language barriers.

The recommendations may include English classes for health professionals and English proficiency exams that are based on competencies, as opposed to reading and writing exams.

Custodia-Lora said the commission is also looking into helping doctors to access communities that share the same language.

“You will have doctors whose English is limited, and they might be speaking Spanish,” Custodia-Lora said, “but in a community where most of the people are Hispanic, they will be able to communicate with them in a better way.”

Jacques is now working on her USMLE test while taking care of her newborn son and 1-year-old daughter.

To become a doctor in the United States, she still has to take three tests and have a two-year, three-year, or five-year residency based on the specialty she chooses. She was hoping that with the Physician Pathway Act, she could skip residency.

For her, like many trained medical professionals who arrived in the United States for a better life and opportunity, her American dream is to get her license and become a physician.

“Taking care of two kids and studying simultaneously is difficult,” Jacques said. “But (my) mum said if you want something, you must work for it. That’s why I know it’s not easy but it’s worth it.”

Jiashan Zheng writes for the Gazette from the Boston University State House Program.