Back to Table of Contents | April 2010

Pulse

Willing and Able to Work

Wilhelmina Holder, M.D., knows the frustration of being a physician and not being able to practice medicine. A public health practitioner from Liberia who earned her medical degree from McGill University in Canada, Holder came to Minnesota in August of 1985 to do a fellowship at the University of Minnesota’s Hubert H. Humphrey Institute of Public Affairs, intending to return to her home country the following year. But a coup attempt in Liberia in October of that year and the human rights abuses, corruption, increased ethnic tension, and civil war that followed it stopped her. “Taking my children back would have been a disaster,” she recalls.

Holder ended up staying in Minnesota. She began work toward a master’s degree in epidemiology while raising her son and three daughters; but she really wanted to practice preventive medicine. “I had my green card and was working in the community and saw the need,” she says. She knew getting licensed in Minnesota would require passing the U.S. Medical Licensing Examination (USMLE) and going through residency. With the financial help of a Bush Medical Fellowship, she began studying for Step 1 of the exam, which tests on the sciences that are basic to medicine, in 1997. But she became discouraged when she discovered matching with a residency program would be unlikely. “I had been out of medical school for 25 years,” she recalls.

In the meantime, she was meeting more and more people like herself—physicians, attorneys, engineers, teachers, nurses, who had come to the United States as immigrants, refugees, or asylees and were working as nursing assistants, taxi drivers, or parking lot attendants. Holder decided that instead of pursuing her own medical career, she would use her energy to help other professionals in her situation.

Along with her husband, who had been an attorney in Liberia, and their daughter, also an attorney, Holder founded the St. Paul-based African and American Friendship Association for Cooperation and Development (AAFACD) in 2002. With a $25,000 federal grant, she set out on a mission to get foreign-trained physicians and other professionals back doing what they were trained to do.

Hidden Talent

Along with applying for grant money to assist newcomers, Holder tries to connect them with others who may be able to help. Her determination and passion come through as she tells about meeting with leaders from the University of Minnesota, local foundations, the Minnesota Legislature— anyone who will listen to her argument for what these physicians and others can contribute to Minnesota.

Although there is no registry of nonpracticing foreign-trained physicians in Minnesota (not to be confused with international medical graduates who come here for residencies and fellowships straight out of medical school and, in some cases, stay to practice), a recent event hosted by the AAFACD, the Women’s Initiative for Self Empowerment (WISE), and the International Institute of Minnesota drew approximately 60 doctors from Iraq, Bhutan, and other countries in Asia and Africa. “These are bilingual and trilingual physicians who can provide health services in the community and who can train and assist U.S. physicians in understanding their culture,” says Holder, who now volunteers with AAFACD and is executive director of WISE.

On a Tuesday afternoon in March, Holder brought together three physicians the AAFACD has worked with to share their stories. Jameelah Hassoon tells how she practiced anesthesiology in Iraq and Jordan before coming to the United States last year as a refugee. She recently began taking a Kaplan course to prepare for the USMLE. “Psychologically, I’m slightly depressed from this situation,” she explains. “I was a doctor there, now I have to start again. I’m not young … I have 27 years of experience as an anesthesiologist. In my country, I worked in many different hospitals and administered anesthesia to people of all ages, even neonates, which is very difficult. I just want to have a chance to work here in a hospital.”

Alla Campbell practiced internal medicine at a hospital in Petrozavodsk, Russia, and served as one of two physicians at a 50-bed hospital near the Arctic Circle before coming here four years ago. Campbell passed Steps 1 and 2 of the USMLE, got clinical experience at HealthPartners’ Center for International Health and the University of Minnesota, and this year attempted to match with a residency program. She did not. Now, she says she’ll study for Step 3 of the USMLE, which is usually taken during residency and continue to work as a nursing assistant at North Memorial Residential Hospice. “I saw a lot of my peers not matching the first year but be more successful the next year,” she says. “So I’m not ready to give up after all my hard work, and I’m looking forward to the next Match season to try my fortune again.”

Mimi Oo, a general practitioner from Burma, immigrated to the United States in 1986 and came to Minnesota in 1992. She found work as a research clinician with the University of Minnesota’s Berman Center for Clinical Research, then took time off to care for her son, who was diagnosed with autism, and study for the USMLE. She completed Steps 1 and 2 and became certified by the Educational Commission for Foreign Medical Graduates, which verifies that graduates of foreign medical schools are ready to enter postgraduate training in the United States. “But I couldn’t apply to residency right away because of my son,” she says. By the time she started applying in 2001, the rules had changed. “They wanted someone who graduated from medical school within the last five years,” she says. “The other thing they said was that I didn’t have any U.S. clinical experience.” In 2004, Oo stopped applying. “I didn’t have any more money, and I had to look after my son and family.” Today, she works as a phlebotomist at St. Joseph’s Hospital, an interpreter at the Center for Victims of Torture, and as a personal care attendant. She gets frustrated when she meets refugees from the Karen state in Burma who could benefit from being cared for by a physician who speaks their language, understands their culture, and is aware of their health needs.

Big Hurdles

Hassoon’s, Campbell’s, and Oo’s stories illustrate some of the challenges foreign-trained physicians face when trying to practice in the United States. Carol DaBruzzi, who runs a nursing assistant training program for immigrants at the International Institute in St. Paul, has tried to help physicians who show up in her office looking for a way to get back into practice. She found that many didn’t have the money to prepare for and take the USMLE, which tests them on concepts learned in medical school and requires proficiency in English. The Kaplan preparation course costs between $12,000 and $18,000, she says. The cost of the USMLE is about $3,000 for all three parts. In addition, there’s the cost of travel to testing sites.

Then there’s study time, which can consume eight to 10 hours a day. “We found that people could not work and do this intensive study. So they’d have to give something up. Unfortunately, many times they gave up studying,” DaBruzzi says.

Another difficulty is getting clinical experience in the United States, a requirement for foreign medical graduates wanting to get into residency programs. “These individuals have to find this themselves, and they don’t know any doctors in America,” she says. “Plus, it’s really hard for hospitals to want to provide that kind of experience because of concern over litigation.”

Those who do pass the USMLE and get the necessary experience then must apply to and in some cases be interviewed by residency programs, many of which are unlikely to consider foreign medical graduates who have been out of school more than five years. “They could be all over the United States,” says DaBruzzi, who tells of a man from Nepal who bought a Greyhound bus pass to get to interviews in Texas, New York City, and Ohio. (He got the residency in New York.)

Options Needed

DaBruzzi and Holder have been as tenacious as the physicians they are trying to help. In 2006, the AAFACD, International Institute, and Workforce Development, a job-placement organization in Rochester, received a one-year $450,000 state grant to encourage licensure of foreign-trained health professionals. By paying for their review courses, books, exams, and travel, Holder says the AAFACD was able to help 50 physicians and 18 nurses. The other organizations helped many more.

Holder has since secured funding from private foundations and the federal Office of Refugee Resettlement to help people who meet the government’s definition of a refugee or asylee. DaBruzzi has been able to get people discounts on Kaplan courses. But she can’t help them pay the fees. “One of the hardest things for me is to sit here and see these individuals have to go to jobs that are far beneath their skill level,” she says.

Recently, Holder has been exploring ways to retrain physicians to work as nurse practitioners, mental health practitioners, public health specialists, and clinical laboratory technologists. She has asked leaders at the University of Minnesota School of Nursing what it would take for doctors to become nurse practitioners or, in the case of Hassoon, a nurse anesthetist. She also has worked with leaders from the Academic Health Center on increasing the number of residency slots for foreign-trained physicians and getting them into clinical settings where they can observe or gain experience. She remains determined. “A system has to be created to get people back into practice,” she says.—Kim Kiser