Colorado Groups Work to Make it Easier for International Medical Graduates to Work in Health Care

This article was originally published in The Denver Post.

Three years ago, after multiple visits to emergency rooms and her OBGYN office, a patient who was dealing with severe pain and no diagnosis sought out Wafa Elejmi for advice.

Elejmi, who was working as a clinical researcher in Denver, was not a practicing doctor in Colorado but had OBGYN residency experience after graduating from medical school in Libya. Someone the patient knew had recommended she reach out to Elejmi when she was at her wit’s end.

After 10 minutes of listening to the patient talk about her symptoms — vaginal bleeding and hemorrhagic cysts in her pelvis, pain and insomnia — Elejmi gave her opinion: The patient had an incomplete bilateral oophorectomy. Basically, she still had ovarian tissue in her body, despite having had her ovaries removed at least a year earlier, and it was causing problems with the hormonal replacement therapy she was taking. It took advocacy by the patient and three more doctors looking at her ultrasound before they confirmed what Elejmi had told her.

“We are trained to use our knowledge and skills more than rely on machines,” Elejmi said. “That is a strength we can add to this healthcare system is accurate diagnosis. Then machines can confirm our diagnosis and not vice versa.”

Although Elejmi was born in Greeley, she spent most of her life in Libya, minus a few years in the UK, so that’s where she did her medical schooling, before moving back to Colorado in November 2007. She wasn’t prepared for the hurdles she would face as an international medical graduate trying to practice medicine in the state — the process is not only lengthy and costly, but it requires these graduates (from approved schools) to complete three years of post-graduate clinical training in the state to get licensed to practice, competing for limited residency spots. U.S. graduates only have to complete one year.

Earlier this year, Colorado Democratic lawmakers asked the Nurse-Physician Advisory Task Force for Colorado Health Care within the Colorado Department of Regulatory Agencies to make recommendations for how to make the process easier for the estimated more than 2,000 Coloradans who earned medical degrees and were licensed in other countries so they could join Colorado’s workforce of physicians. The group released a list of three main recommendations, including six proposals that would require legislative action or approval by the Colorado Medical Board.

Those recommendations include allowing physicians who had an active medical license in another country to qualify for a Colorado license by successfully completing a competency assessment; international medical graduates who haven’t qualified for an active license in another country being able to apply for internships to practice in a clinical setting and match for residency; and increasing the residency slots and earmarking spots for qualified international medical graduates.

“NPATCH’s recommendations regarding the licensure pathways available to International Medical Graduates (IMGs) could position Colorado to benefit from underutilized medical expertise in our communities,” said Lee Rasizer, a spokesperson for the Colorado Department of Regulatory Agencies, in an email. “In the longer term, successful implementation could attract medical expertise from a wider range and potentially help to mitigate healthcare shortages.”

In April of last year, Gov. Jared Polis signed an executive order that temporarily changed some licensing requirements for medical professionals, including for international medical graduates who could become eligible for temporary licenses under certain conditions through May 31, 2022. This was independent of the NPATCH recommendations and was meant to help with the high demand for medical professionals with rising COVID case counts.

But only two international medical graduates were able to get their temporary licenses and only one currently practices with it, according to Carrie Miller, program manager for the Spring Institute’s Colorado Welcome Back program. The organization helps internationally trained health care professionals establish careers in the health care industry in Colorado.

Problems came up involving malpractice insurance, but it also became clear too many barriers to entry still existed for those who earned medical degrees outside the United States.

Those barriers often include time and cost — many professionals end up having to take other jobs to support their families more quickly, and residency programs in the state don’t accept anyone who graduated more than three years prior, said Victoria Francis, state advocacy officer for the International Rescue Committee.

“Even if you were a surgeon running a hospital in another country, you come to Colorado and you don’t have the opportunity to go back to a medical residency unless you move out of state, so there’s just a whole host of reasons why it’s really hard for these individuals to put their skills to work in Colorado,” Francis said.

Lawahiz Abbas, an international medical graduate from Sudan, who moved to Colorado in 2012 to join her family after seeking asylum, knew she would have to start from the beginning to pursue a medical career. But first, she needed time to adjust to her new country — learn the language, culture and its systems.

When she was ready to join the physician ranks, she kept bumping into obstacles. She decided to pursue other pathways, while continuing to work toward her license. She’s worked as a medical interpreter and with refugee programs at health care centers. She’s studying for a master’s degree in public health.

“I’m not going to stop trying,” Abbas said. “I hope they can do something to make it easier because there are so many international medical graduates in Colorado. They are really qualified and really trained.”

Miller was part of the advisory panel helping provide information for the NPATCH recommendations, and she said during her research, she found that over the past decade in Colorado, only 2.5% of all residency slots were given to international medical graduates.

Elejmi is one of those graduates. After moving back to the U.S., she studied again, passed the first required exam and did medical rotations with physicians. She said she was treated like a colleague because of the amount of experience and knowledge she brought with her.

Still, despite the recommendations she received and how many applications she put in, she couldn’t get matched for a residency program.

Now, Elejmi works as a clinical researcher for the Rocky Mountain Cancer Centers in Aurora and also serves as a consultant for the Colorado Welcome Back program to share her experiences.

“I didn’t have a plan B,” she said. “I needed to fulfill that passion.”

Rep. Naquetta Ricks, a Democrat from Aurora, plans to introduce legislation next year that would implement some of NPATCH’s recommendations, including finding a way to help international medical graduates get into residency programs in the state. She also wants to look at some type of reciprocity for people who have practiced medicine in other countries to find pathways to practice in Colorado, potentially modeling a program after what other states like Minnesota are doing. Part of the bill that’s still being drafted may also include requirements for these graduates to work in areas of the state that are underserved.

“Considering the shortage of the medical workforce right now, including doctors, nurses, CNAs, we need to ensure that people who come here with medical degrees have an opportunity to work in our society to do what they’ve been trained to do,” Ricks said.

Elejmi is advocating for these changes as she continues to apply and keep up with her medical skills, remaining undeterred.

“I do what I do because I’m passionate about helping people and what better way than to help people stay healthy to continue their journey in life to fulfill their purpose,” she said. “I have so much to give.”