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

Foreign-trained healthcare professionals (FTHPs) play important roles in the delivery of health care in Minnesota and the US as a whole. The need for physicians and nurses, particularly among under-represented minorities, continues to grow. Minnesota has experienced an extraordinary acceleration in the arrival of refugees and immigrants from Africa, Asia, South America, and Eastern Europe. One consequence of this trend is a rapid growth of immigrant populations who – for a variety of cultural, political and historical reasons – may feel confused or threatened in Minnesota’s health care environment.  Addressing such community problems requires innovative approaches to counter obstacles and institutional barriers. For 13 years, Women’s Initiative for Self Empowerment (WISE), Inc., a 501 (c) (3) non-profit Organization, has been a vehicle for socio-economic empowerment of Asian, African and Latino immigrant women/girls in the Twin Cities Metropolitan Area, Minnesota. In 2004, WISE, in partnership with the African & American Friendship Association for Cooperation & Development (AAFACD), Inc. initiated a FTHP Licensure Program to empower and integrate these multiethnic FTHPs into the Minnesota workforce for self sufficiency. The main goals of the program were to organize and mobilize FTHPs to advocate with stakeholders for required system changes; provide FTHPs with mentorship, and scholarship for training and taking standardized licensure exams. The expected outcome of the initiative is to integrate FTHPs into Minnesota healthcare system to achieve socio-economic self sufficiency. The program is supervised by Dr. Wilhelmina Holder WISE Inc.’s Executive Director and is implemented by two full-time staff, a Program Coordinator from AAFACD who coordinates the employment development and licensure process, and a Program Advocate from WISE Inc. who leads the advocacy for system change and economic self sufficiency aspect of the Program. Funding for the Program’s operations and system change has come from local foundations (Headwaters for Justice, Park Nicollet and Women’s Foundation of Minnesota) and the state of MN (Department of Employment and Economic Development) and federal (US Department of Health & Human Services, Office of Refugee Resettlement) government grants. Since 2006, the Program budget has been about $150, 000.00 per year. The impact of this outcome will be, foreign trained professionals providing culturally appropriate health care to their communities thus decreasing the racial and ethnic gaps/disparities in Minnesota.

In 2005, the partnership successfully completed the Asset Mapping and Needs Assessment of FTHPs, funded partially by the sponsorship of a research assistant, and published by Center for Urban & Regional Affairs (CURA), University of Minnesota. This process identified the barriers, local resources, and opportunities to overcome obstacles for FTHPs in obtaining professional jobs. A database was complied from three sources of over 200 FTHP doctors and nurses desiring to practice in Minnesota. FTHPs have been organized to advocate changing or creating systems to remove the barriers to the licensure process. The findings apparently showed the need for use of FTHPs to fill the known shortage of health care workers in MN, and were supported by Ramsey County Workforce Investment Board’s 2005 Annual Report. Furthermore, a Bill proposed by Representative Karen Clarke for the appropriation of funding for the pilot project for the use of FTHCPs was enacted in June 2005 and an appropriation of $450, 000.00 was awarded to three organizations, AAFACD, Inc., International Institute of Minnesota (IIM), Inc., and the Workforce Center of Rochester, Inc., for the provision of scholarships for training, and exam fees for licensure. This program has reached over 125 FTHPs by convening task forces of stakeholders and FTHPs to advocate for changes to remove barriers in the licensure system; 80 doctors and nurses have enrolled in the educational program at Kaplan Medical for test preparation and other educational institutions to prepare for standard licensure exams; 35 have passed exams and participated in a mentorship program to assist FTHPs navigate the system and obtain local clinical experience and 15 have secured residencies.  Over 40 participants have completed English for Medical Professionals Studies at the Global Language Institute at the College of St. Scholastica.  On July 18 2008, AAFACD and WISE partnership conducted a Foreign Trained Healthcare Professional (FTHP) Forum, that brought together 80 participants, including 40 FTHPs (50% were females) and other stakeholders.  The forum was sponsored by Minnesota AIDS Training and Education Center (MATEC) and the Minnesota Department of Health, the Office of Multicultural and Minority Health (OMMH). The forum provided a great opportunity to reach new potential stakeholders worthy of collaboration to strengthen our program. Among them were: representatives from Bush Foundation, Blue Cross & blue Shield, Medtronic, Fairview Health Systems, St. Catherine and Minnesota Universities, the Nursing Association Board, the MN legislature (Rep. Karen Clark), and Welcome Back Institute from San Francisco, California.  St Paul Workforce Center has been offering resources for employment development and job placement, the Center for Cross Cultural Health in St. Paul led by its Executive Director Debra Rodgers has facilitated the advocacy training. 

Lessons learned/challenges overcome include:

·        There is the need to strengthen English proficiency, communication and self advocacy skills, especially for FTHPs with English as a second language. Prior exposure to the US clinical setting and technology-based training to prepare FTHPs for the licensure exams and make them more comfortable on the wards when they start practicing.

·        On-going funding to sustain the program is necessary.  Financial support in the form of scholarship funds is required to pay for preparation courses/studies toward taking standardize licensure examinations and for travel to sites for taking the requisite tests.  

·        An on-going comprehensive program that provides support and guidance through the licensure process, training and preparations for exams, mentorship and encouragement to remove the barriers to licensure and assist both doctors and nurses proceed as fast as possible is essential. Directing and mentoring doctors and nurses to the licensing process and to reach their goals rapidly adds to the success rate of passing the requisite tests. 

·        An on-going advocacy and cultural competency training program is being expanded to assist in understanding the complexities of diverse cultures and the US medical culture, as well as how foreign-trained professionals can work together to achieve common goals despite these differences. 

·        To get their licenses within a reasonable amount of time, some nurses have been referred to apply to Indiana or California to get their credentials accredited and to get permission to sit for their licensure examinations.  Once obtaining their Indiana or California licenses, they often apply for their licenses to be transferred to Minnesota to get their licenses in this state.  Many of these nurses did not return to Minnesota, representing a loss to the state’s medical workforce.

·        A general perception that foreign health workers are inferior in their practice results in bias in progressing to suitable jobs in health care.
·        Nurses arriving from war-torn countries often find it difficult to get transcripts in a timely manner, or even to get a transcript at all.