As the coronavirus pandemic continues to rip through the US, hard-hit areas have been facing doctor shortages, placing both patients and overworked health care workers at greater risk.

Thousands of foreign doctors who already have clinical experience and are waiting for a chance to practice medicine in the US could step in to help. But even before the current crisis, the immigration system, coupled with medical licensing requirements, have made it difficult for them to work in the US and go where theyre needed.

Graduates of foreign medical schools face the same certification requirements as any American graduate they have to pass their medical licensing exams and obtain a highly sought-after spot in a three- to seven-year residency program.

Many foreign students, though, have already completed years of training in their home countries before they seek US certification. That experience has little bearing on their admission into residency programs, where available spots are always fewer than the number of applicants, and graduates of US medical schools are given preference.

In 2020, about 40 percent of foreign medical school graduates didnt match with a residency program, compared to only 6 percent of American graduates. That means thousands of qualified doctors being effectively shut out of practicing medicine in the US. And if they want to try again next year, that comes with a hefty price tag: It can cost thousands of dollars to apply to residency programs.

Amid the pandemic, both New York and New Jersey have eased some of these licensing requirements so that foreign medical graduates can contribute to the coronavirus response. As the virus continues to spread to rural America, where there was already a shortage of doctors, other states may also have to relax their licensing requirements for foreign grads, or else face imminent shortages.

For S, an aspiring doctor from Canada who asked to be identified only by his first initial for fear of harming his residency applications, the decision to attend medical school abroad has put him at a disadvantage in finding a residency placement in both the US and his home country.

He had applied to Canadian medical schools but wasnt accepted into a single program. Thats not uncommon; medical school admissions are highly competitive in Canada the average acceptance rate is about 10 percent, compared to nearly 40 percent at US schools.

At the advice of his guidance counselor, S opted to attend medical school in the Caribbean instead, where dozens of programs now cater to students seeking to practice medicine in the US. He chose Saint James School of Medicine, spending about 16 months in class there before moving on to clinical rotations in the US. He worked in hospitals in Illinois, New Jersey, and rural Kentucky alongside US medical students and passed his medical licensing exams.

But when it came time to apply for residency programs in the US a process that costs between $10,000 to $12,000 a year for foreign medical students he couldnt get a placement. He has applied three years in a row with no luck, but he knows people who are still applying for the sixth or seventh year in a row. And practicing medicine in Canada, which also has a doctor shortage, isnt really an option either since hospital residency programs strongly favor Canadian medical school graduates.

Its kind of sad, because youre so close. You have your degree. You just need your foot in the door, he said. Especially with coronavirus, you really want to help. Youre in a situation where you have the training.

After he didnt match with a residency program this year, hes planning to work as a physicians assistant part-time and take up a flexible gig on the side, such as driving for Uber, to help pay off his student loans. He cant work at a hospital amid the pandemic, but hes been working with several volunteer organizations to aid coronavirus medical research.

Still, he feels hes capable of contributing so much more to the pandemic response, especially if he were placed at one of the rural hospitals where he did his clinical rotations, since many of them are facing doctor shortages and a lack of specialists. But instead, hes stuck in Canada.

I am one among many sitting on the sideline while this pandemic unravels, he said. I have years of training, experience, and medical knowledge but cant do anything but watch the situation unfold.

Even for foreign medical students who are already living in the US, finding a placement in a residency program can prove difficult.

Sana Javed, a foreign medical school graduate from Pakistan hoping to specialize in psychiatry, lives in Germantown, Tennessee, with her husband, a physician on an H-1B skilled worker visa. He was able to get a waiver for the requirement that he work in Pakistan for two years prior to applying for residency programs in the US because hes working in a medically underserved area at Le Bonheur Childrens Hospital in Memphis.

Javed can get a work permit through him, but she said she didnt match with a residency program this year, even though she has clinical experience in both the US and Pakistan.

She graduated from Nishtar Medical College & Hospital in Multan, Pakistan, in 2011 and worked for two-and-a-half years alongside doctors treating psychiatric patients examining their mental status, designing treatment plans, and counseling them and also volunteered at a military hospital. When she moved to the US in 2016, she worked for a few months as a clinical extern in a psychiatrists office in Troy, New York, and has been volunteering for a psychiatrist specializing in addiction medicine since.

Javed is planning to reapply for residency programs in the next application cycle. In the meantime, she is trying to accumulate more clinical experience in the US to improve her application, but the pandemic has made that difficult. Her clinical externship in Chicago that was supposed to start in March was canceled, but she has another one lined up in New York later this year.

She said the field of psychiatry is especially critical during a pandemic and that shes ready to contribute but because she doesnt have a placement in a residency program, her ability to do so is limited.

With this whole pandemic going on, there are many mental health issues emerging suicide rates and attempts are increasing, PTSD will be on the rise as we will be nearing the end of this pandemic, she said. I am hoping to contribute to the mental health of the people of the United States as much as possible now and even after matching into residency.

But even if she had more years of clinical experience, its not clear whether that would assure her a place in a residency program.

Rizwan Rabbani, who is from Pakistan but attended medical school in China, had over seven years of clinical experience under his belt when he applied to residency programs.

He went back to Pakistan after graduation for a one-year internship in internal medicine, surgery, and urology, and then to work as an internal medicine practitioner in a teaching hospital for five years where he instructed undergraduate medical students.

When he came to the US, he did an eight-month clinical rotation in cardiology at Mount Sinai Hospital in New York City and another six-month rotation in family medicine in Pensacola, Florida.

Nevertheless, he failed to match three years in a row. Every time, he had to spend thousands of dollars.

Its a money-making process, he said. They are making money every time you apply to one program.

He decided to move back to Pakistan instead, where hes currently working in the government coronavirus quarantine facilities at a teaching hospital in Lahore. Hes also hoping to practice in the UK instead, where he can start working immediately as a physician with the clinical experience he already has. But he also could have brought that experience to coronavirus patients in the US.

I would have contributed as a frontline doctor in US hospitals and with my experience and skills, would have been very beneficial, he said.

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Foreign doctors want to help fight the coronavirus. But the US health system stands in their way. - Vox.com