How Immigrant Doctors Became America’s Next Generation of Nurses

A Florida university that helps physicians credentialed in their homelands train as nurses is adding much-needed diversity to the health care workforce — and caring for minority patients.

National Journal
Sophie Quinton
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Sophie Quinton
Feb. 20, 2014, 12:10 a.m.

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.

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