by Beth Blevins
A Minnesota program is aiming to tap the unused potential of international medical graduates who live in the state but can’t practice there.
The International Medical Graduate (IMG) Assistance Program, housed in the Minnesota Department of Health’s Office of Rural Health and Primary Care (ORHPC), evolved out of a nonprofit established by Yende Anderson, IMG Assistance Program Coordinator, and her parents more than ten years ago, while Anderson was in law school. “We noticed there were a lot of resources for immigrants in Minnesota already, but it was mostly for those who were low skilled,” Anderson said. “We saw that doctors in particular have significant barriers.”
It was while advocating for IMGs at the state legislature that Anderson met Mark Schoenbaum (then-director of ORHPC), who agreed to take on an IMG task force. As a result of the task force’s recommendations, the Minnesota Legislature established the IMG Assistance Program in 2015, and ORHPC selected Anderson to be its coordinator.
According to Anderson, the IMG Program is of special importance to Minnesota because the state is experiencing “a perfect storm” of a projected shortage of physicians along with an aging physician population. It would seem that employing IMGs who reside in the state to work in rural and underserved areas would be an easy solution to the problem, but it’s not that simple, Anderson explained. Even if someone has graduated from a medical school that is recognized in the United States or by the World Health Organization, they must pass a two-step licensing exam and complete U.S. medical residency, even if they’ve completed a residency elsewhere.
“This residency piece is where the barrier is,” Anderson said. “There’s not enough money for U.S. graduates to complete residency, so when you add international medical graduates, there’s even more demand for the available supply.” The cost of a residency runs around $150,000 per year per resident, she said.
In addition to limited residency positions, most IMGs also lack U.S. clinical experience, a prerequisite for residency. “One of the legitimate concerns we learned from the task force is that IMGs aren’t always familiar with the U.S. method of practicing medicine,” Anderson said. “It’s a team approach with the patients as well as the other physicians. They really need an opportunity to be in a clinic and become familiar with U.S. medical culture.” The IMG Assistance Program now offers clinical experience through a partnership with the University of Minnesota.
The cause of IMGs is personal for Anderson because her mother was an IMG who was never able to practice in the states. “My mom didn’t complete her residency in Canada (which would have allowed her to practice in the states) but went back home to Liberia to help,” Anderson said. But after she returned, her father, William R. Tolbert Jr., who was president of Liberia, was assassinated during a coup d’état, and the rest of the family was persecuted. Like many others, her mother fled her home country for the United States. In order to remain here, she had to maintain a student visa, so she studied Epidemiology at the University of Minnesota for seven years, despite having a Master’s in tropical medicine from the London School of Hygiene and Tropical Medicine.
By the time her mother finished her program, she had been out of medical school for over 20 years, too late to apply for a residency since most residency programs require that physicians have graduated within five years of application.
Minnesota stands out as the first state to implement a comprehensive program to integrate IMGs into the physician workforce, although at least three other states are in the process of planning a similar program, Anderson said. “We get calls from all over the country and we are happy to offer technical assistance.”
The IMG Assistance Program receives $1 million of state funding each year, with more than half of it going toward funding residencies, Anderson said. IMGs who accept a residency position funded by the program are required to pay $15,000 or ten percent of their annual salaries into a revolving account for five years, beginning in the second year of post-residency employment.
The program also is researching another pathway to licensing, called a skilled pathway, which is being done in Canada, Germany, and Australia as a national program that targets immigrant doctors. “IMGs complete a skills assessment and an exam and if they demonstrate competency, they’re able to practice medicine without completing a residency program,” Anderson said. “In Minnesota we run into issues of credentialing and insurance reimbursement that require board eligibility (which itself requires completing a residency program). So, we want to continue to investigate that route and figure out if this is a possibility.”
“This work is a wonderful example of collaboration,” said Teryl Eisinger, Executive Director, National Organization of State Offices of Rural Health. “A nonprofit organization with a mission to serve IMGs met up with a State Office of Rural Health (SORH) with policy expertise and together they’ve built an innovative program in the SORH to address workforce needs in rural areas.”