Massachusetts’ untapped pool of foreign health care professionals

The state should do more to ease the licensing of foreign-trained doctors, nurses, and medical assistants to serve in the pandemic and beyond.

Jorge Carias, a physician with 26 years of experience from El Salvador, testifies at a State House hearing in late 2017 on proposed legislation to support foreign-educated doctors.
Jorge Carias, a physician with 26 years of experience from El Salvador, testifies at a State House hearing in late 2017 on proposed legislation to support foreign-educated doctors.MIRA Coalition/Handout

Dr. Jorge Carias moved to Massachusetts in early 2017, after working for 26 years as a general surgeon at a large public hospital in El Salvador. Now, with the coronavirus raging in his new home and harming Latino communities disproportionately, the 58-year-old could be on the front lines, using his medical training to save lives.

Instead, the Somerville resident is working as a certified nursing assistant — helping with some COVID-19 patients: checking their vital signs and assisting them with routine activities like taking showers and eating. “I feel underutilized, like I’m being held back,” said Carias. “I know I have a lot more to contribute if only I were given the chance.”


Long before the coronavirus pandemic hit, there was already a critical need for medical personnel in underserved communities — and overly burdensome requirements for foreign-trained medical professionals who could be filling the gaps. Now states like Massachusetts, New Jersey, and New York are taking emergency measures to ease the strain put on front-line health care workers during the crisis. Those measures are steps in the right direction, but they need to go further. And when the crisis abates, there should not be a return to unnecessary rules that prevented professionals like Carias from meeting the state’s needs. The Legislature should permanently remove barriers that prevent highly skilled immigrants from practicing here.

To get a medical license from the state, international medical graduates like Carias must complete three years of US residency training at a local hospital — one more year than is required for US medical graduates. And applicants must complete the residency program, highly competitive positions that are hard to win, within five years of graduating from medical school; Carias graduated in 1990.

Carias is one of approximately 3,000 foreign-educated doctors, nurses, dentists, and other health care professionals in Massachusetts who are either underemployed or unemployed. A report from a 2014 state task force shows that physicians with foreign degrees are five times more likely to be underemployed than those with an American education. Nationally, the number of unlicensed doctors educated abroad is around 65,000. There are an estimated 260,000 underutilized immigrants and refugees with undergraduate degrees in health-related fields.


Governor Charlie Baker recently signed executive orders aimed at easing some of the challenges the crisis has put on the medical workforce, including issuing a temporary guideline to allow some foreign-trained physicians to get a state medical license faster. This expedited measure will be valid for the duration of the state of emergency enacted by Baker due to the coronavirus.

But advocates of international medical graduates contend it doesn’t go nearly far enough. “Baker’s order does almost nothing,” said Dr. Robert Marlin, of the Lowell Community Health Center and a longtime advocate of integrating foreign-trained doctors into our workforce.

Indeed, all the order did was get rid of the requirement of an extra year of residence to obtain a medical license. And the temporary policy only helps international physicians who are early in their career, according to state Representative Mindy Domb, who along with more than 40 legislators sent a letter to Baker earlier this month urging him to provide temporary licenses to health care staff educated abroad. Baker’s order also applies only to doctors, ignoring other much-needed front-line workers like nurses and medical assistants.


According to the Baker administration, the board of medicine approved 114 full licenses last week; of those, four went to international medical graduates who would not have been issued a license without the executive order.

How to unlock the potential of experienced foreign-trained health professionals is not an issue that the pandemic suddenly exposed. In late 2014, a task force created by then-Governor Deval Patrick’s administration issued policy recommendations to fast-track the relicensing of foreign-trained health care professionals into the workforce — such as increasing residency slots for international graduates, extending limited or temporary licensing to more foreign-educated professionals, and allowing some of them to practice here under the supervision of a licensed professional.

Fast forward to last summer, when the legislature established a commission . . . to study the issue again.

“The idea is to put this on the agenda in Massachusetts and come up with concrete recommendations to how we can assimilate these very talented people, not just doctors, and give them a pathway, recognizing that they still have to demonstrate their skills,” said Senator Jason Lewis. Most of the members of the commission have been appointed and have not met, but Lewis said he still expects them to issue a report by July of next year.

But other states have led the way, from offering a one-stop-shop for foreign-educated professionals with detailed guidance on steps needed to obtain health care licenses (something Massachusetts doesn’t currently offer) to modifying licensure requirements. Minnesota even funds and sets aside medical residency slots for international medical graduates. “We don’t have to reinvent the wheel,” Lewis said.


At a time when some communities in the United States face an alarming shortage of doctors and other health care workers like pharmacists, medical assistants, nurses, and dentists, states need to relax arbitrary restrictions for foreign professionals as much as they safely can. The coronavirus crisis should be a wake-up call: Those rules don’t just hurt doctors like Carias who are kept from practicing; they also hurt the public that’s deprived of the care they could provide.

Editorials represent the views of the Boston Globe Editorial Board. Follow us on Twitter at @GlobeOpinion.