It seems like a no-brainer.
On the one hand, Vermont - and especially Windham County - has a dire shortage of medical practitioners. General practitioners are especially needed. Also, nurses, phlebotomists, X-ray technicians, dentists, hygienists, and a whole host of other medical professionals.
On the other hand, Vermont - and especially Windham County - is a welcoming place for immigrants. And some of them are medical professionals.
It seems like a problem with an obvious solution. But nothing is uncomplicated when it comes to medicine.
Let's start with doctors. The process of converting a medical degree earned outside the United States into one that would allow someone to work here is long, tedious, expensive, and sometimes - at least when it comes to finding a residency - close to impossible.
Recognizing this, state Sen. Wendy Harrison, D–Windham County, has just introduced a bill, S.263, which would start to make the process less onerous.
"The intent of the bill is to identify opportunities to utilize graduates of international medical schools living here our the state to improve Vermonters' access to primary health care as well as the lives of those graduates and their families," Harrison said when introducing the bill to the Senate Health and Welfare Committee on Jan. 31.
"It proposes two actions: one, the beginning of a long-term solution and the other, to make short-term progress," she said.
First, S.263 proposes that the Legislature form a one-year working group to study how to simplify the process of accrediting qualified foreign medical professionals to practice in the United States. The group would work under the auspices of the Department of Public Health's Board of Medical Practice.
In addition, it suggests that $50,000 be appropriated in FY2025 to "reimburse international medical school graduates for all or a portion of the costs of books, study materials and software needed to become licenses to practice medicine in Vermont."
Meeting the needs of a diverse community
Harrison credits NAACP of Windham County's Health Justice Subcommittee for alerting her to the problems that international doctors face in trying to practice here.
The organization, which promotes and supports the BIPOC community, became involved in this issue when its subcommittee began investigating whether the health needs of people of color in U.S. were being met.
Then its focus widened to looking at a variety of health outcomes in general.
Diana Wahle is a founding member of the subcommittee. In the past year, she has led its work group as it focuses on diverse workforce development in health care.
"We started learning about stubborn regulations that make the path to U.S. credentialing unrealistic and unattainable," Wahle said. "Most of the work group members are internationally trained professionals who have experience with these challenges. As a team, we work closely with Sen. Harrison and fully support S.263."
Meanwhile, several issues have emerged in the general landscape of health care in Vermont: Demographics have changed, the population is shrinking, and general practitioners who want a rural practice are rare, Wahle said.
"So it's really sad to see barriers put up to keep physicians out who do not reflect the same culture or have the same racial background," Wahle said.
She called the shortage of practitioners "just the tip of the iceberg" and cited "a crying need for nurses, [licensed nursing assistants], and people at all levels of the profession."
"The hope is the working group will target physicians to start, because that's something that's very workable, but then evolve into dealing with every level of health care, and the possibilities for streamlining people who are internationally trained to enter more easily into the Vermont workforce," Wahle said.
As a potential model, Tennessee has just passed Senate Bill 1451, which goes into effect in June and smoothes the pathway for international medical professionals by issuing temporary licenses to international medical school graduates who have demonstrated competency, completed a three-year postgraduate training program in their country, or "otherwise practiced as a medical professional performing the duties of a physician for at least three of the last five years outside the United States."
An applicant must also submit evidence of education, training, and employment offers in Tennessee.
The law also creates a pathway for a permanent license after two years under a temporary license.
A doctor who can't practice
Dr. Candice Taylor-Diallo is from Trinidad and Tobago. She got her medical degree from the University of the West Indies in Jamaica and practiced at home in Trinidad and Tobago before marrying and coming to live in Brattleboro.
"I knew that I wouldn't be able to practice immediately," said Taylor-Diallo, United Way of Windham County's community health equity grant coordinator, who came here in 2021 at the height of Covid. "So there were a lot of barriers during that particular time," she said.
But she learned that "it's going to be a long, expensive process in order for me to practice," Taylor-Diallo said.
First, she had to get her green card (the Permanent Resident Card, which allows foreigners to live and work in the United States) and become established in Brattleboro. Then she took the job with United Way.
"The process to get licensing or credentialing for medical practitioners, you have to begin at the very beginning," Taylor-Diallo said. "You have to do the [U.S. Medical Licensing Exams]. These exams are quite expensive, maybe around $2,000 or so apiece."
To pass the exam, "you have to study for a lengthy period of time," she continued. "Essentially, you're repeating medical school, if you want to think of it like that. Because step one would be the foundational classes that I would have studied for the first two years in medicine."
Step two would involve the more clinical aspects of medicine.
"That would have been the last three years of my medical school, compared with the last two years of the medical school program in the United States," Taylor-Diallo said.
That makes a five-year program - often one year longer than a path in this country for an aspiring doctor - for someone who already has a medical degree.
"We spent three years in the hospital doing hands-on work, and two years in the classroom. Whereas the program in the United States is two years or so in the classrooms and the other two years in the hospitals, if I understand that correctly. And at each step, there's an exam. When you come here, you have to repeat those exams."
Then there is a residency requirement. According to Harrison, "It's expensive and has very limited capacity."
Taylor-Diallo agrees.
"That's a whole other set of hurdles for somebody to go through as well, because there would be a certain amount of residency spots," Taylor said. "And they hold immigrants, physicians, to so much higher standards than the American ones."
There are significant differences in how medicine is practiced in different countries, Taylor-Diallo said.
"Everything here is more technologically advanced," she said. "So those systems, and with insurance, those are the areas where it's a bit more challenging for us. But not necessarily the actual dealing with patients."
As a person of color, Taylor-Diallo would add an important aspect of diversity to the medical system here. In general, many studies show that BIPOC people have shorter life expectancies.
In addition, studies show that "stark racial disparities in maternal and infant health in the U.S. have persisted for decades despite continued advancements in medical care," according to KFF.
And while the BIPOC community experiences mental health issues at the same rate as white communities, BIPOC people are less likely to seek medical help.
"There really is nobody that they feel comfortable, with whom they could seek care," said Taylor-Diallo, who calls the bill "an important step."
"There's a lot that people don't know and don't particularly understand," she continued. "But I think we're in at least the beginning stages of putting things in place to encourage more diversity and more people to come.
"If we are trying to bring more people to Vermont to practice - not just in medicine, but in general, to increase the workforce and the diversity as well - this is a good opportunity," Taylor-Diallo added.
Hospitals need doctors
Aware of the Tennessee bill, Christopher Dougherty, the CEO and president of Brattleboro Memorial Hospital, is a strong supporter of Harrison and S.263.
"I believe that our responsibility is to find ways to safely create the most clinicians we possibly can," Dougherty said. "How do we do it so that we can maximize the supply of physicians in Vermont, yet also maintain the high quality that Vermont is known for?"
His answer: "We've got to find innovative ways. The question becomes a balance of supply and quality. How can you guarantee the quality? Senator Harrison's bill is to do a study, creating a working group, which is, I think, a great first step."
Some people believe the quality of medical care will be diminished if Vermont allows immigrant practitioners to practice here, Dougherty said. But he disagrees.
"There's criteria," he said, noting the safeguards and processes defined in the new Tennessee law. "It's not just, 'Oh, I'm a doctor from somewhere.'"
And, he said, "there might even be some evaluation of the work that you're doing."
Licensing immigrant practions aids in the economic development of the community as well as in its overall health, Dougherty said.
"A physician, when she starts working as a physician, she's generating more income," Dougherty said. "She's paying more taxes into the community. She's buying more in the community. She's able to help generate more economic growth in the community. And I can tell you, this community needs more economic growth. I would assume everywhere else in Vermont does, too."
When evaluating S.263, the question for the Legislature should not be whether we should do it, but how we should do it, Dougherty said.
"Maybe it's just primary care, or maybe it's some certain specialty care as well," he said. "Maybe there's limitations that need to be put in place. I think the medical world needs to weigh in on some of that."
But he thinks that it should "be a question of, How do we make this work to increase the supply of clinicians in the state of Vermont? Because we're never going to catch up."
"I think if we keep at the same pace, we're just going to get further and further behind in terms of our physician-to-population ratio," Dougherty said - and because of the aging population, "the needs are increasing more rapidly than the supply is increasing."
"Somehow we have to figure out ways to increase the supply," Dougherty said. "I think this is a great opportunity to do so."
This News item by Joyce Marcel was written for The Commons.