Ghislaine Bola moved to Maine from the Democratic Republic of the Congo in 2015. Before then, she’d been a practicing physician for five years.
In Maine she’s a medical assistant — which demands less education and training than her role as a physician in the Congo. To practice as a physician here, the state requires U.S. and state-based exams and residency. Her foreign training doesn’t meet the requirements.
The efforts to meet U.S. physician requirements would cost Bola time and money, neither of which she has in abundance. She only recently got the money to take nursing classes at Southern Maine Community College.
But Bola, with more than 15 years of experience and education in the Congo, wants to do more.
“I don’t want what I have as a gift to be wasted,” she said. “I’d like to go back as close as possible to who I was.”
Foreign-trained health professionals encounter similar barriers after immigrating to the U.S., even as the country — Maine included — faces a serious healthcare workforce shortage.
To many, immigrants are an untapped workforce. Maine had more than 47,000 immigrants in 2018, according to the American Immigration Council.
At the Migration Policy Institute in Maine, researchers conducted a study in 2020 that found foreign-trained professionals were struggling to re-enter the workforce throughout the U.S.
“It is extremely important to effectively use people who are already in the workforce,” said Jeanne Batalova, an MPI researcher who co-authored the report, adding that this will maximize their potential, talents and skills.
Practicing medicine in Maine requires varying degrees of training, education and cost, depending on the role. To be a physician, a foreign-trained doctor at a minimum must take the U.S. medical licensing exam and complete a residency.
While seeming like simple steps, they are anything but, and most immigrants arriving in Maine aren’t aware of the challenges they may face.
The New Mainers Resource Center has worked since its founding in 2013 to provide immigrants from diverse professional backgrounds with the knowledge and limited funding where available to help them reclaim their professions. Their clients include foreign-trained health professionals such as Bola.
“I was very naïve about what it would take to bring about change or address their issues,” said Sally Sutton, the NMRC program coordinator. “We’re still nowhere near doing what needs to be done.”
Every immigrant’s story is different, Sutton said, but a common issue is the language barrier, and for undocumented immigrants, access to documents required for practice is also a concern. To combat the language barrier, Portland Adult Education — which includes NMRC — has English language learning services.
But even after an immigrant learns the language, Sutton said many face financial deterrents.
“The only thing that’s holding them back is they don’t have a way to pay for school,” Sutton said, adding that the cost for physicians can be thousands of dollars.
For this reason, as well as the amount of time it might take to study for the licensing exam, many turn to roles in the medical field that have less stringent licensing requirements.
“Just because you’ve been a doctor doesn’t mean it’s going to be easy, and maybe you can’t be a doctor again,” Sutton said. “They could be putting a lot of eggs in one basket that might not ever come through.”
There’s also tough competition to get selected for a medical residency. There aren’t many spots open, and foreign-trained professionals who may not have studied recently could be set back.
“You’re going to compete with American medical graduates who are just freshly coming from university and have priority,” said David Ngala, a medical resident in Portland and an immigrant from the Congo.
Ngala spent seven years searching and studying before finding his residency position. Following advice from NMRC, he stayed in the medical field during his studies for the exam, working as a phlebotomist, drawing blood from patients and donors, despite having been a physician back home.
Although he struggled to become a resident, Ngala said it’s possible to achieve. It just might take time, money and effort.
“It’s doable,” he said. “I say that to everybody, and you just have to put down some time and sacrifice to go after it.”
He added that one of the best things the state can do is provide literature to help immigrants understand the process.
If becoming a physician doesn’t work out, he said there are other roles, such as a physician’s assistant, a nurse or an advanced practitioner that will still allow foreign-trained professionals to contribute.
In Bola’s case, financial constraints and age barriers pushed her to pursue nursing over a physician’s career. But she said she’s more than happy to be contribute where she can.
“I’m doing what I can. As long as I’m still in healthcare, that’s fine for me,” she said. “I’m helping people; that is my first goal in life.”
Erik Steele, the Maine Medical Association president, said proper training cannot be sacrificed to remove barriers for foreign-trained physicians.
“While on the one hand we’re really supportive of the idea of well-trained foreign physicians being able to practice in Maine, we can’t have that happen at the cost of the quality of care,” Steele said.
For now, Steele said MMA is not actively recruiting physicians in Maine who have foreign training, although the organization does believe practitioners need to be diverse. All aspects of the physician workforce are “a very substantial concern to us.”
At the same time, Bola, Ngala and Sutton said there is more Maine can do for foreign-trained health professionals. Providing scholarships or other means of financing for education is a priority, but access to resources and opportunities is also on the list.
Rep. Kristen Cloutier (D-Lewiston) is pushing state legislation to establish a commission dedicated to addressing the needs of foreign-trained workers in the state, including health professionals. If approved, the commission would report on how to move forward with legislation.
She said removing barriers to employment access for foreign-trained health professionals is a “win-win” because they can support their families, and the state can rely on them in a time of need.
“We have a real shortage of folks in healthcare,” Cloutier said. “We have a shortage of folks who speak folks’ native languages and healthcare, and so it seems like a good time for us to be sort of taking the initiative here.”
Colorado, Massachusetts, Oregon and Washington are considering similar legislation. Colorado’s bill directly pertains to removing barriers related to licensure.
The University of Southern Maine has its own education efforts advocating for foreign-trained professionals.
Brenda Petersen, the associate dean for the School of Nursing, said she has been working since the summer to help strengthen and build a platform for multi-language learners within the school. But it’s likely to be fall at the earliest before something is released.
“We’re really in a point of development,” she said, adding that this should help the school “be successful in ensuring that the nurses who are caring for others look like the people they are caring for.”