FOREIGN-TRAINED
PHYSICIAN TASK FORCE
Meeting #1
July 30, 2014
Task Force charge
• Overall charge: To develop strategies to integrate
refugee and asylee physicians into the Minnesota health
care delivery system.
• Recommendations due to the Commissioner of Health
and the Legislature by January 15, 2015.
• 2014 Minnesota Session Laws, Chapter 228, Article 5,
Section 12
Specific charges
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Analyze demographic information of current medical providers
compared to the population of the state.
Identify, to the extent possible, foreign-trained physicians living
in Minnesota who are refugees or asylees and interested in
meeting the requirements to enter medical practice or other health
careers.
Identify costs and barriers associated with integrating foreigntrained physicians into the state workforce.
Explore alternative roles and professions for foreign trained
physicians who are unable to practice as physicians in the
Minnesota health care system.
Identify possible funding sources to integrate foreign-trained
physicians into the state workforce as physicians or other health
professionals.
Proposed ground rules
• Make decisions by consensus whenever
possible, majority voting when/if necessary.
• Share responsibility for developing quality
recommendations.
• Engage in constructive, honest discussion.
• Listen actively and keep an open mind.
• One speaker at a time.
• Others?
Proposed timeline
Terminology
Language in session law
“Foreign-trained
physicians”
Possible alternatives
Immigrant IMGs (international
medical graduates)
• To distinguish this group from J-1 and other
nonimmigrant visa IMGs.
• To distinguish from U.S. citizens who trained
overseas, who are also IMGs.
Refugee and asylee
physicians
Other language/terms to
discuss?
All immigrant physicians
• Not limited to refugees/asylees
Work on Charge #1
• See presentation of DRAFT initial analysis by MDH staff.
• Discussion: Questions, additional information/analyses
needed?
Work on Charge #2: Survey
• Content of the online survey:
• Training and professional information.
• Demographic information.
• Interest in meeting the requirements to enter medical practice or other
health careers in MN.
• Interest in exploring alternative professions – e.g., PA or NP.
• Other possible solutions for integrating these docs into health care system.
• Timing: Survey open July 21 to August 11 (or longer, tbd).
• Participants: Invitations sent to 240+ contacts from New
Americans Alliance for Development (NAAD) plus those
identified through other networking (e.g., refugee resettlement
agencies and other community-based organizations).
Work on Charge #3: Initial thoughts from TF
On costs and barriers
• "Recency" of graduation issue: Many residency programs won't take docs who graduated from
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medical school more than 3-5 years ago.
Residency programs seem to be afraid FTPs are too old or that the program won’t be perceived
as rigorous enough if they accept more. They also worry that U.S. grads won't have a shot.
There’s no pathway for people who have been out of med school to take medical courses again,
even if money was no issue. Perhaps we could offer a refresher year/rotation, or different
prerequisites.
There’s a growing problem in the capacity of residency programs: U.S. medical enrollments are
growing, but the cap on GME slots means they’re not keeping pace with that growth. And most
of the growth in residency slots funded outside GME is in specialties, not primary care.
The testing fees, books and training costs to become licensed are huge barriers.
Most also need living costs while they are doing research and/or studying for the exams.
Residency matching fees are another cost. Individuals are encouraged to apply to as many as
possible, and some max out several credit cards to increase their chances of matching.
Education for retraining.
For PA programs, there are 3 major variables: (1) language; (2) prerequisite requirements, which
are sometimes complicated by difficulties getting (or translating) transcripts from other countries;
and (3) the cost of tuition.
Work on Charge #4: Initial thoughts from TF
On alternative professions
• The PA/nursing schools require the doctors to go back to the beginning, starting from scratch.
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They say their hands are tied because of national credentialing requirements.
I haven't met a single internationally trained individual who is interested in other fields…. It
seems after all this effort and several years of denial and thousands of dollars, they are not
willing to look into others. If we are able to encourage them toward these areas, the largest
barriers will remain getting the proper license and starting from "scratch" in this area of training.
Nursing could work. I’ve known foreign-born physicians in RN nursing programs.
Perhaps career exploration could be encouraged, so each person could choose a program that
fits their personality and style.
There are so many long-term care needs…perhaps something could be developed in that field
for those interested in working with the elderly.
I think that PA is a very feasible option. We need more diversity in the provider population and
the roles and training models between MD and PA are similar. We need to find ways to
streamline the process of preparing for admission, getting through programs, and lowering cost.
I'd like to see a customized training for both PAs and APRNs.
The APRN/PA path would be good for people who don't pass the USLMEs. I worry otherwise this
will become the main pathway IIMGs are directed to/expected to take.
Another alternative route is pharmaceutical companies, which have hired some of these doctors.
Work on Charge #5: Initial thoughts from TF
On possible funding sources
• Grants from large health care organizations that provide residency programs.
• Workforce Development organizations and funding sources such the Workforce Investment Act,
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although they are not specifically designated for these populations.
HealthForce Minnesota (has small grants that have assisted in such areas), or foundations.
For alternative pathways, could we allow the option of testing out of certain courses and not
charging tuition for those courses successfully passed on paper; but instead, requiring those
students to audit the course without paying? Auditing while requiring that all course requirements
be met would ensure preparation while lowering the overall cost of education.
Set up a public-private Rural/Urban Underserved Residency Track that operates outside the
Match system and is open to both IMGs and USMGs - a revolving program that would pay for
residency slots (residents pay part of it to help sustain it) and doctors would agree to serve a
number of years in shortage areas.
The State, perhaps with additional support from partners, could once again fund a program like
the Preparation for Residency Program (PRP), plus residency slots.
Corporate-sponsored (or other sponsored) residencies - e.g., a Target residency, a Medtronic
residency. Could work with banks, health institutions or insurance companies.
Health insurers are another possibility; it's in their interest to have more of these docs available.
Federal-level funding: Residencies shouldn't be tied just to Medicare. Should involve funding
from the Dept of Education, workforce development, health & human services.
Proposed framework: Pathway DRAFT
Work on Charges #3-5
Additional input that should be brought to table
• Speakers?
• Research/analyses?
• Other?
Next steps
• Additional analyses on current licensed
workforce (Charge #1).
• Results from survey (Charge #2).
• More detailed discussion of barriers and
alternative pathways (Charges #3-5).
• Other work identified/requested during meeting.
• MDH staff will be available post-meeting to
discuss additional ideas, questions or requests.