Bloomberg Law
April 13, 2020, 5:40 PM

Immigrants With Foreign Medical Training Untapped in Virus Fight

Genevieve Douglas
Genevieve Douglas

There’s one way hospitals across the U.S. could meet the surging need for more medical professionals to fight Covid-19: tapping the pool of immigrants and refugees with foreign medical training.

Thousands of people who come to the U.S. through family reunification, seeking asylum, or as a refugee feel pressure to immediately find work, and jobs in their chosen medical field aren’t an option because of the time and cost it would take to meet U.S. licensing requirements. But as the coronavirus cripples the health-care system in some parts of the country, providers are looking for fast ways to respond.

A Migration Policy Institute analysis of U.S. Census Bureau data found that over 260,000 immigrants and refugees with undergraduate degrees in health-related fields are either underemployed in low-paying jobs that require significantly less education or are out of work.

Doctors in their home countries come to the U.S. and give up their ability to practice medicine, taking what the U.S. considers menial labor or leave the workforce altogether, said Elora Mukherjee, professor of law at Columbia University and director of its Immigrants’ Rights Clinic. “It’s a loss for both them as individuals and also for our American health system, especially at this moment when Covid-19 is wrecking the ability of medical professionals to provide care to thousands and thousands of people.”

States will largely be responsible for solutions to remove barriers for foreign-trained medical professionals, as each state sets its own licensing requirements. MPI found that more than 60% of underemployed immigrants and refugees live in states that are among the top 10 experiencing the highest number of coronavirus cases: California, Florida, Texas, New Jersey, and Illinois.

“We’re in a time of such uncertainty, depending on where the curve tips,” this could be a pool of workers that states are willing to make a dramatic change to current systems for, Mukherjee said.

States Taking the Lead

The Centers for Medicare & Medicaid Services has relaxed state licensing restrictions so doctors can practice where their services are needed most, and retired physicians and nearly graduated medical students have been called into service.

“It takes a long time to navigate the licensing systems, and our experience studying the various barriers shows the requirements vary greatly across states and occupations, and it’s quite difficult to figure out what you need to do to qualify and pass the necessary requirements,” said Jeanne Batalova, senior policy analyst at MPI and co-author of the research. “There is room for creative views and thinking about this population, and for many people it’s a calling they have and that’s why they entered the health field.”

Some states already have started to relax requirements in the hope that more doctors will be able to help treat Covid-19 patients. New Jersey’s governor signed an executive order April 1 that will allow the state to issue licenses to physicians if they’re in good standing in their country of origin and have at least five years’ experience and have practiced in the last five years.

Utah Gov. Gary Herbert (R) signed legislation March 30 that allows internationally trained doctors to qualify for state licenses as long as they obtained their licenses from certain countries that are considered the most consistent with the training in the U.S., including the U.K., Australia, New Zealand, South Africa, Switzerland, Hong Kong, and Singapore.

And in New York, Gov. Andrew Cuomo (D) issued an executive order allowing international medical graduates to practice without a license as long as they have had at least one year of residency.

The only option is for states to take the lead, said Greg Siskind, an attorney who specializes in physician immigration. This crisis has shown that prior thinking on foreign-trained physicians and health-care workers may not be the best path forward, he said. Making it easier for doctors with training outside of the U.S. to practice “would be something that would be good in the near-term for dealing with this crisis, but potentially in the long-term as well.”

This is yet another argument for going to a merit-based system to help address these shortages, said Ira Mehlman, a spokesman for the Federation for American Immigration Reform. “In 2020, in the midst of this pandemic, medical professionals are at a premium, and five years from now we might need some other professional qualifications in another field.

“The system should have some flexibility to look at the appropriate needs of the country, and adjust our admissions accordingly,” said Mehlman, whose organization supports lower immigration levels.

While the American Medical Association didn’t immediately respond to a request for comment, the organization sent a letter to the heads of the Department of Homeland Security and the State Department in support of policies that would allow international medical graduates “the support they need from the Administration to provide health care to those patients battling COVID-19.”

Will Agencies Follow Suit?

State action in response to the pandemic could be the impetus for some kind of national license for medicine, Siskind said.

Despite states’ flexibility, U.S. Citizenship and Immigration Services still has immigration rules in place that would likely present challenges.

The agency requires a foreign-trained doctor to have a physician license in hand and all three parts of the Medical Licensing Examination passed before approval to practice, Siskind said. “It slows down doctors from being where they need to be.”

Political pressure is building for the agency to make changes, however. Sixty-five members of the House, led by Reps. Tony Cardenas (D-Calif.) and Zoe Lofgren (D-Calif.), sent USCIS a letter April 6 calling on the agency to expedite adjudications, visa processing, and work authorizations for foreign-born health-care guestworkers, and to relax restrictions on where those medical professionals can practice.

But those actions won’t likely address immigrants and refugees with foreign training already in the U.S.

“We’re not the only country whose residency programs produce good doctors, and that’s basically the assumption in our system right now,” Siskind said. “It’s probably true that we have the best teaching hospitals in the world, and that’s why so many doctors want to come here, but that is not to say that other countries are not competent to train good doctors.”

To contact the reporter on this story: Genevieve Douglas in Washington at

To contact the editors responsible for this story: Martha Mueller Neff at; Karl Hardy at