Globalization meets the healthcare workforce: Training, recruitment, and integration for health professionals

The San Francisco Welcome Back Center (SF WBC) was established in 2001 in partnership between San Francisco State University and City College of San Francisco. Its purpose is to contribute to the efforts of increased cultural competency, language access in health, and the overall diversification of the health workforce by integrating immigrant health professionals into the health workforce. The initial objective of the Welcome Back Initiative was to identify internationally trained health professionals living in the U.S., ascertain if they were utilizing their education and skills in the health sector, and learn of the barriers they were facing to practicing their profession.  The underlying assumption on which the program was structured has proven to be correct:  there are large numbers of immigrants in the U.S. who are foreign trained health professionals but are not working in the health sector.  Furthermore, there are many foreign-trained health professionals who are working as taxi drivers or maintenance workers and living below the poverty level because of their inability to attain licenses to work in the U.S. health sector. Since the program’s inception, over 8,200 foreign trained health professionals have been identified and assisted through our centers.  Forty-seven percent of program participants are from Latin American countries and 28% are from countries in Asia and the Pacific Islands, 10 % from Russia and the former Soviet Republics, and 4% from Africa. Data collected by the centers demonstrates that 66% of identified foreign trained health professionals are not working in the health sector at all.  Furthermore, of the 34% who are working in the health sector, the vast majority are underemployed i.e. physicians and nurses working as nurse aides and dentists working as dental assistants.  Results of the needs assessment also demonstrated that approximately 40% of our participants lack the necessary English language skills to function effectively in the health sector. The SF WBC is the lead site of the Welcome Back Initiative, which currently includes additional sites in Los Angeles, San Diego, Boston, MA, and Providence, RI. The SF WBC has developed a toolkit to guide the replication of the model and is currently working with other sites around the country interested in establishing new Welcome Back centers. Each center is independently funded and staffing patterns vary but typically include a center director, case managers, a research associate, and an office manager.
In the seven years since it started, the Welcome Back Initiative has developed a successful model to work with internationally trained health professionals to assist them in the process of re-integration to the health sector. The model of service builds on the participants’ training and strengths, provides guidance, and has created curricula and activities to support their efforts. The program’s approach to developing a career strategy with the participants starts by understanding where they are in the spectrum of options available to them. This flexible pathways approach is a non-linear, non-“one-size-fits-all” service model featuring a menu of options and participant flow pathways. Participants have different needs at different points in time and to be successful, the program was required to be flexible. Typically, early steps in this process include setting both short-term and long-term goals. For example, if a person’s long-term goal was to obtain a nursing license, she might begin by enrolling in a phlebotomy course. Upon completion of the course, she could obtain a job in the health sector and thus improve her familiarity with the US health workplace.  At the same time, she could be enrolled in a customized English as a Second Language program and have started the process for obtaining her transcripts from her country of origin. On a monthly basis, she would meet with the educational case managers to check in on the status of the entire process, obtain information about upcoming events, for example an interviewing skills workshop.
Program outcomes demonstrate the effectiveness of the model.  Participants are moving in a positive direction along four pathways: 1) re-entering the health workforce, 2) applying their skills and knowledge to a related health profession, 3) assuming leadership roles in the health sector, or 4) obtaining licensure in their original professions.   As of July 2008, 1,685 validated their foreign credentials with U.S. credentialing entities, 1,071 passed licensing exams in a myriad of health professions, 549 entered new careers in health, 959 obtained new employment in the health sector in the U.S. for the first time, 644 advanced in their careers, and 59 internationally trained medical doctors have been accepted into residency programs.
Perhaps the biggest challenge the program faces is its sustainability. To sustain the program different funding strategies are being explored, including  non-categorical funding streams to address emerging issues, private and public entities, sponsorships of individual elements of the program, fee-for-service, sliding scale to program participants for licensure study groups or other classes; and 6) contributions and support from alumni.  The appropriate mix of these strategies along with continued support from institutional partners will help sustain the model.