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FTC urged to study workforce barriers affecting immigrants, refugees

By Kathleen Murphy

Published on August 9, 2021 in Issue 1011

The Federal Trade Commission should examine the issues immigrants and refugees face when they attempt to rejoin their professions in the US, according to advocates for international medical graduates.

President Joe Biden wants the FTC to review unfair occupational licensing rules as part of a sweeping executive order on competition. Biden’s July order asked the agency to bar needless occupational licensing, without defining the scope. The review has potential implications for military spouses, returning citizens, formerly incarcerated people, plus immigrants and refugees.

While the order was a crucial first step, the FTC must look closer at restrictive occupational licensing and its impact on immigrants and refugees with international credentials, said Jacki Esposito. A director of US policy at World Education Services, Esposito leads the nonprofit’s Imprint Coalition, which works to open career paths for immigrants and refugees.

According to the Migration Policy Institute, more than 1 million college-educated immigrants are unemployed or working in unskilled jobs because they’re unable to make full use of their academic and professional credentials.

The Covid-19 pandemic underscored this urgency. While some states require citizenship as a condition for occupational licensing, Nevada and New Jersey let healthcare workers trained in other countries practice within their borders and help with the pandemic response. Other states have considered similar legislative fixes. The National Conference of State Legislatures says there’s “an increased appetite among legislators to examine state regulations to ensure existing licensing requirements are not unnecessarily keeping immigrant workers out of jobs.”

A Washington state law to provide limited licenses to eligible international medical graduates took effect July 25. It could help with a shortage: Washington needs 1,695 more primary care physicians by 2030. That’s 32 percent more than the state’s current number, reports the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.

Before the law’s enactment, Mohamed Khalif hit hard times when he tried to get recognition for his medical credentials. Khalif, founder of the Washington Academy for International Medical Graduates, returned to the state at age 25 with a medical degree and license from China. He’d also practiced medicine in Somalia.

But Washington law didn’t recognize international credentials, so the young doctor was required to repeat medical exams and graduate residency training. The complex, multi-year process costs tens of thousands of dollars.

“It was very hard for me. So I started as a security officer … while trying to find another job,” said Khalif who also worked in a pie factory.

“It was a difficult time,” he said. “But, you know, I think it taught me how to work hard, although sometimes it was depressing not being a doctor, and working in a pie factory, and not being able to help people with my skill. But … I think that experience helped me get to where I am right now and helping others, so no regrets at all.”

Certification exams

With medical education varying throughout the world, the Educational Commission for Foreign Medical Graduates began US certification programs in the 1950s. ECFMG is a 501(c)(3) nonprofit that verifies credentials and vouches for the readiness of international medical graduates (IMGs) to enter residency training. Any IMG who wants to train in a US-accredited residency program must be certified by the group.

Khalif has “a huge equity concern” with the certification exams because US doctors pay less for the tests directly from the National Board of Medical Examiners, while IMGs must go through ECFMG for certification at higher costs.

“And time and time after time again, we have not been heard. But it is a problem,” he said.

A spokesman for ECFMG said the higher fees support several initiatives, including resources to help IMGs orient to the US residency application process and healthcare system. The organization also has a multilingual staff to support interaction with more than 3,000 medical schools worldwide.

“The public can rely on ECFMG and its program of certification to ensure that IMGs entering our healthcare system have been thoroughly evaluated,” the spokesman said.

Task force

As more states have moved to examine licensing requirements, immigration advocates are calling for a fairness review, with an eye toward reducing underemployment nationally.

Immigrant advocacy groups are urging the FTC to create a task force akin to the Obama administration’s White House Task Force on New Americans. Similarly, during the first 15 months of the Trump administration, FTC Chair Maureen Ohlhausen established the Economic Liberty Task Force, which produced a report concluding states should make greater use of interstate compacts for license transfers. (See FTCWatch, No. 947, Oct. 1, 2018.)

“There is precedent for the FTC to engage in this,” Esposito said. “We would like to see states review their licensing laws and identify ways to open up pathways for people with international credentials. States I think need to be incentivized to do that, and I think one way to do that is to bring them together, share best practices and models, and start that conversation. I think the Biden administration can do that.”