UCLA program helps foreign doctors practice in U.S.

UCLA program helps foreign doctors practice in U.S.
By Jim Steinberg, San Bernardino Sun and Susan Abram, Los Angeles Daily News
POSTED: 06/02/14, 6:24 PM PDT | UPDATED: 49 SECS AGO

"There is such a need for family physicians and this program is so
exciting. We need doctors who know the language, the culture, and who
understand their patients from the cradle to the grave." — Dr. Michelle
Bholat, executive director of UCLA's International Medical Graduate Program
As a resident physician in Havana, Hamlet Garcia Peña was trained to
heal and even perform delicate eye surgery if needed.

But after he came to the United States, Garcia Peña worked with his
hands to remove lead and asbestos from old rooftops and pack boxes into
trucks, as well as assisting nurses in a home for people with mental
illness. At one point, he even sold cars in the San Gabriel Valley.

"I came here to be a doctor. I always had that on my mind," Garcia Peña
, 33, said recently. "But I didn't have the time to study or the money
to buy the books."

Garcia Peña is one of thousands of doctors born and trained in foreign
countries who come to the United States, hoping to continue practicing
medicine here. But instead of practicing medicine, many end up in
low-paying jobs hoping to save enough money to take exams, compete for
residencies and eventually, if they make it, become a doctor in the U.S.
Some never achieve their dreams.

The issue was troubling to doctors Michelle Bholat and Patrick Dowling
from UCLA's Department of Family Medicine. Here were trained physicians
such as Garcia Peña who were unable to practice in a country facing a
shortage of 91,500 primary care physicians by 2020, according to a
figure by the American Association of Medical Colleges.

The shortage is especially acute among Latino physicians, who represent
5.5 percent of all doctors nationwide, and 5.2 percent in California, a
state that needs their language skills and cultural knowledge the most.

Dr. Roger Hadley, dean of the Loma Linda University College of Medicine,
said California governing bodies are reluctant "to unleash a license to
examine" unless the applicant can be thoroughly vetted.

It is difficult to evaluate what is being taught at many foreign medical
schools — and what level of competency is required for the materials
taught, he said.

Also, medical students in the U.S. are subject to extensive background
investigations, he said.

Issues regarding a foreign doctor's past are difficult to research in a
foreign country.

Lack of new residency programs are a key reason that there is a doctor
shortage, especially in the realm of primary care physicians, said Dr.
G. Richard Olds, founding dean of the UC Riverside School of Medicine.

"It is a lot easier to start a medical school" than develop new
residency programs, Olds said.

The UCLA program offers no net gain to the number of trained physicians,
Olds said.

In 2007, Bholat and Dowling developed the UCLA International Medical
Graduate Program. The goal is to help bilingual, bicultural physicians
from Latin American countries complete exams and residency in family
medicine for free. In exchange, the doctors then practice in underserved
communities. In California, 35 percent of the state's 13 million Latinos
reside in areas that not only need physicians, but need ones that
understand them.

"There is such a need for family physicians and this program is so
exciting," Bholat said. "We need doctors who know the language, the
culture, and who understand their patients from the cradle to the grave."

Such a program is needed, especially now, when many obstacles work
against foreign physicians hoping to become American doctors, experts
say. In addition to travel expenses, each U.S. Medical Licensure Exam is
expensive — the Step I exam, the first in the series, costs $580, but
will likely rise next year to $590. And residencies are scarce and
competitive, with U.S.-born medical students most likely to be
considered first. All those factors and others may be deterring foreign
doctors, according to a recent report by the National Resident Matching
Program.

The UCR medical school model addresses the lack of Spanish speaking
physicians in remote areas of the Inland Empire by drawing medical
students with ties to the region, Olds said.

The number of active applicants who were non-U.S. citizen
students/graduates of international medical schools declined from 7,568
in 2013 to 7,334 this year.

"The conventional wisdom seems to be that IMGs (international medical
graduates) are better off in the home countries than previously was the
case," said Mona Signer, executive director for the matching program.

Several other factors are squeezing international physicians out of the
residency process, said John Boulet, vice president of research and data
resources for the Foundation for Advancement of International Medical
Education and Research. The group was founded by the Educational
Commission for Foreign Medical Graduates, the organization that
certifies international medical graduates, making them ready to compete
for residencies.

"The American dream isn't free," Boulet said. "It's a big chunk of
change to make that leap."

The squeeze on international doctors is likely to tighten further.
American medical schools, including osteopathic schools are expanding
and accepting more students. In addition, more American students are
attending Caribbean medical schools. And at the same time, federally
funded residency training positions were capped by Congress in 1997 to
26,000 spots. It's not enough for American medical students, let alone
international ones, Boulet and others said.

Also, the primary care shortage is being shored up with more clinics
using nurse practitioners and physician assistants, Boulet added.

All those factors make the UCLA program that much more needed, Boulet said.

"To me that's a great program," Boulet said. "It's unique in the
cultural aspects. We need Spanish-speaking doctors, but what happens is
that it's very difficult for someone whose second language is English to
pass the exams."

The UCLA program is competitive as well, Bholat said. Those who apply
must be recent graduates from a medical school recognized by the Medical
Board of California. The candidate must be bilingual in English and in
Spanish who has preferably lived in a Latin American country. The
program also accepts recently graduated physicians who have been out of
medical school for no more than 5 years. The program only accepts U.S.
citizens or permanent residents. It does not assist applicants in
acquiring the visa status needed for eligibility.

So far, 81 students have been placed in residencies — at least 10 of
them in Riverside County, and several across Southern California,
including Pomona, Loma Linda and Fontana. In the current class, some
doctors from Mexico said they are grateful for the opportunity to
practice in the United States.

For some, the process will take about seven years, but many in the
recent class said it was worth it.

"To be a doctor in the United States has been a passion," said Dr.
Aichel Nateras, 29, who graduated from Universidad Autonoma de Baja
California. "Not everybody has a chance to complete their goals."

Dr. Alanna Chig, 28, who graduated from the same university, agreed.
Both are studying to complete their medical exams.

"We're very fortunate to have this program," she said. "In the long run,
I'd like to serve the underserved community. I liked treating people who
may not have the resources for care."

Garcia Peña, who has been in the program longer, has already passed his
exams and has started his residency at Pomona Valley Hospital Medical
Center, where he will work for three years, then go on to practice
family medicine at a clinic for another three years.

The road to residency was difficult, he said; from Cuba to South
America, Kentucky to Los Angeles, earning $11 an hour at various jobs.

But the struggle was and will be worth it, Garcia Pena said.

"If I'm going to do this, I'm going to do this for something," he said.
"Life in Cuba is hard. That's why when you come to the United States you
feel so grateful."

Source: UCLA program helps foreign doctors practice in U.S. -
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