MIAMI — Isabel Barradas, 48, has been a doctor for 25 years. In her native Venezuela, she was an orthopedic surgeon and head of a hospital department, with expertise in physical rehabilitation. She speaks three languages and — since marrying an American and moving to South Florida more than a decade ago — is a U.S. citizen.
Barradas passed her U.S. medical licensing exams with flying colors. But she didn’t get a residency position in the specialty she loves. “Orthopedic surgery? Forget it. In this country, that is so elite,” Barradas says. Competition for the training positions required for medical licensure is fierce, and most go to seniors at U.S. medical schools. Barradas decided that the position she did get — internal medicine in Buffalo, N.Y. — wasn’t worth leaving her family in Miami for.
Thousands of foreign-educated doctors living in the U.S. would like to practice medicine here but don’t have the time, money or language skills to compete for and complete a residency. Miami’s Florida International University offers other options: accelerated programs leading to a bachelor’s and master’s of science in nursing which train foreign-educated doctors to be nurse practitioners. FIU’s programs both give internationally educated professionals an outlet for their skills and helps add much-needed diversity to the health care workforce.
The U.S. faces a dearth of 20,400 primary care physicians by 2025, according to federal statistics. The Association of American Medical Colleges projects a shortage of thousands of surgeons and other specialists too. While an aging population and health insurance expansion increase demand for health care services, medical schools and residency programs aren’t producing enough doctors to meet demand.
There are thousands of foreign-educated doctors living in the U.S. who have the expertise needed to address some of this growing need. Every year for the past decade, between 5,000 and 12,000 foreign-educated physicians who have passed their licensing exams apply for a residency position. Typically, about half get one, compared with more than 90 percent of U.S. medical school seniors who apply, according to data from the National Resident Matching Program.
International medical school graduates, like minority doctors, often go on to serve medically underserved populations. Graduates of international medical schools make up a quarter of U.S. office-based physicians, and are more likely than their U.S.-educated peers to treat minority patients, foreign-born patients, patients who speak little English and patients who qualify for Medicaid, according to a 2009 study from the Centers for Disease Control and Prevention.
Demand for highly trained nurses is also growing, particularly for nurses who speak more than one language and reflect the growing diversity of the U.S. population. If highly trained professionals like nurse practitioners and physician assistants were to take on more primary care responsibilities, the shortage of primary care doctors could be cut by more than two-thirds, according to the Health Resources and Services administration.
FIU introduced its accelerated nursing degree program in 2000, in response to pressure from underemployed Cuban doctors living in the area. The FEP-BSN/MSN program began as a bachelor’s degree program that prepared students to become registered nurses. In 2010, FIU added a master’s degree, and graduates of the full program can now find work as nurse practitioners — an advanced role that can include prescribing medicine and diagnosing patients. In Florida, nurse practitioners earn about $86,800 per year. Barradas hopes to find work with an orthopedic surgeon.
Isabel Barradas (left) and Mariana Luque, trained and credentialed as physicians in their native Venezuela and Colombia respectively, are nursing students at Florida International University. (Sophie Quinton)The program compresses six years of education into four, mostly by moving quickly through undergraduate-level material. English language learners get help with reading and writing academic papers, and courses are scheduled in the evenings or compressed into one day a week to fit the needs of working adults. For the past few years, the graduation rate has been close to 100 percent.
Despite its South Florida roots, the program has begun to attract students from all over the U.S. “I ask them, why don’t you just go to the accelerated program where you live? And it’s not the same for them,” says Maria Olenick, program director. “They choose to come here because they know that there are other people in the same situation.”
Most of the 200 doctors enrolled in FIU’s program this year are bilingual. About 39 percent are from Cuba, 28 percent are from Haiti, and 6 percent are from Colombia, with the rest hailing from Nigeria to Lithuania. Students are evenly split between men and women, and the average age is about 40. Applicants must be U.S. citizens or permanent residents.
Some doctors are initially reluctant to enter a nursing program, Olenick says, fearing loss of prestige, but usually the negative feelings don’t last. “What we’re hearing from them is that they’re actually really, really enjoy the role of nurse practitioner in the United States, because it’s more like the way they practiced in their home countries,” she says. American physicians tend to spend less time with patients and more time processing paperwork than their counterparts overseas. Barradas’ patients in Venezuela used to come by just to chat.
It’s not always easy for graduates of the accelerated degree program to find the kind of work they want, says Carlos Arias, chief operating officer of Access Healthcare. Although they’re armed with an advanced nursing degree and have medical training, graduates are often offered entry-level positions with low salaries. Arias, a Cuban-educated doctor himself, now heads a Florida independent practice association that has hired two graduates of FIU’s program to date.
Not all graduates choose to enter the workforce right away. The first class of nurse practitioners graduated last summer, and of 55 graduates 12 returned to FIU to enroll in a doctoral program. “We’re looking now at making the program a BSN to DNP program, because we have so many that are interested,” Olenick says of the doctoral program. “The way that nursing is moving, eventually a DNP will be required to practice as a nurse practitioner.”
For the foreign-educated physicians in the program, the doctorate offers another perk. As a graduate, you get to be titled Dr. again.
CORRECTION: An earlier version of this article misspelled the name of Carlos Arias. It also omitted the number of graduates who returned to FIU to enroll in a doctoral program. Twelve did.
The Underlying Condition: Increasing Diversity in Clinical Trials
Opinion: African-Americans, at 12 percent of the population, comprise only 5 percent of clinical-trial participants; the numbers for Hispanics are 16 percent and 1 percent. It’s time for that inequity to change, PhRMA’s CEO says.
- 1 Only the Margin Seems in Doubt in the Presidential Race
- 2 The Late-Breaking Democratic House Targets
- 3 Great Democratic Hopes Energize Quiet Faithful in Missouri
- 4 Comparing the 2016 House Map to 2008
- 5 Smart Ideas: Ken Bone Revealed a Serious Policy Divide, and Elizabeth Warren Seeks a Co-Presidency
What We're Following See More »
The protest over the construction of the Dakota Access Pipeline turned violent overnight as the police and National Guard sought to remove the protesters, surrounding them with assault vehicles and officers in riot gear. The law enforcement officers used pepper spray and fired bean bags for more than six hours. In response, the protesters "lit debris on fire and threw Molotov cocktails in retreat." One woman pulled out a gun and fired at officers, narrowly missing before being arrested. The protesters claim the pipeline would be constructed on land belonging to the Standing Rock Sioux Tribe.
The House has scheduled leadership votes for Nov. 15, the day after members return from their election recess. "Since mid-September, members of the House Freedom Caucus have weighed whether they should ask leadership to push back the elections so they can see how House Speaker Paul Ryan performs at the end of the year," but leaders don't seem inclined to grant their request.
Gross domestic product "expanded at a 2.9% annual clip from July through September. That’s a marked improvement from the first half of the year when the U.S. grew just barely over 1%." The robust numbers make it more likely that the Federal Reserve hikes interest rates at its next meeting.
"A federal jury on Thursday found Ammon Bundy, his brother Ryan Bundy and five co-defendants not guilty of conspiring to prevent federal employees from doing their jobs through intimidation, threat or force during the 41-day occupation of the Malheur National Wildlife Refuge. The Bundy brothers and occupiers Jeff Banta and David Fry also were found not guilty of having guns in a federal facility." In a strange "coda" to the decision, Bundy's attorney Marcus Mumford was tackled and tasered by marshals in the courtroom as he argued that Bundy should be free to go.
Hillary Clinton is eyeing Vice President Joe Biden to be her secretary of state, and her campaign is trying to figure out the best way to broach the idea with Biden. Biden has a lifetime of foreign policy experience, serving as chairman of the Senate Foreign Relations Committee; he can also put eight years as vice president on his foreign policy resume. Biden has previously stated that he would not work in a Clinton administration, so it might be a tough sell for the Clinton camp.