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Bill seeks to clear path for health workers trained abroad

Supporters say people with health care expertise from abroad could ease Oregon's staffing shortages
A young woman with tan skin, dark brown hair stands in front of a window wearing a white shirt.
Dr. Win Kyin worked in primary care in Myanmar before fleeing the country, but she ran into roadblocks when she tried to get licensed to practice medicine in the U.S. Kyin pictured here on March 3 at the IRCO Pacific Islander and Asian Family Center. | JAKE THOMAS/THE LUND REPORT
March 9, 2023

When Dr. Win Kyin fled Myanmar’s military dictatorship in 2021, she left behind her home, her family and a medical career that now seems nearly impossible to regain.

Back home in the southeast Asian country, Kyin worked as a public health administrator and as a primary care doctor, treating patients for coughs, performing minor surgeries and making referrals to specialists. 

When the military took over, Kyin joined pro-democracy protests; later she barely escaped military arrest and came to the U.S. She quickly ran into roadblocks when she tried to get licensed to practice medicine in her new home, despite her medical degree and 12 years of experience. After arriving in Portland, Kyin took an entry-level position as a pharmacy technician at a Walgreens. She told The Lund Report she feels depressed at having lost her career but tries to focus on her future. 

“Because I have to survive here,” she said. “I have to rebuild my life again here.”

As Oregon struggles with shortages of health care workers seen across the country, lawmakers are taking note of the challenges facing people like Kyin. Senate Bill 849 seeks to create a clearer path for medical workers educated outside the country to get licensed in Oregon. The bill also appropriates $20 million in grants for nonprofits, educational institutions and employers who set up programs to help internationally educated people meet license training requirements. 

Bolstering Oregon’s pandemic-drained health care workforce has been one of the key issues of the current legislative session. Lawmakers are considering bills intended to expand the training of dental assistants and mental health workers, while enticing beleaguered nurses to stay in their jobs. 

State Sen. Kayse Jama, a Portland Democrat who is co-sponsoring the bill, said during a hearing last week that Oregon’s communities of migrants and refugees already supply 12% of the state’s workforce. He said helping workers from abroad overcome licensing barriers can help solve the state’s health care workforce challenges. 

Wearing a necklace with the Burmese words for “Spring Revolution,” referencing a series of 2021 protests against Myanmar’s military coup, Kyin said in an interview that the bill gives her hope that she and other doctors in exile will be able to continue their careers. 

“This is our passionate career,” she said. “We like to continue our career wherever we live.”

So far, the bill has sparked more than a dozen pieces of testimony in support, and none in opposition.

‘Brain waste’

State Sen. Michael Dembrow, a Portland Democrat and co-sponsor of the bill, described to a legislative committee last week the “brain waste” created by barriers to people from abroad getting licensed to pursue their careers.

“We have many professionals who had to come to this country for the safety of their families and have not been able to practice their professions,” he said. “They work as taxi drivers, grocery clerks, home health aides, CNAs when they could be serving their communities as nurses, physicians, psychologists and more. Why would they do that? Because they face barrier after barrier in getting re-credentialed.”

Jama, a former Somali refugee, told the committee that people who are new to the country often struggle with a lack of familiarity with the U.S. workforce system and what he called each state’s “unclear, inconsistent messages” on their licensing processes. 

The bill requires staff for the state’s professional licensing boards to publish clear guidance online regarding the licensing requirements for people educated outside the U.S. It also waives English proficiency exams for applicants who’ve already passed similar tests. Board staff, under the bill, must also receive “culturally responsive training” through the state Office of Immigrant and Refugee Advancement. 

The groups Oregon Business and Industry and Portland Business Alliance both support the legislation. 

In testimony submitted to the Senate Labor and Business Committee, the Portland Business Alliance pointed to a 2017 report finding that Oregon was home to 55,000 highly skilled people with at least a bachelor’s degree who were immigrants. It further found that these people working in low-skill jobs meant they were losing out $272.5 million in annual earnings and Oregon was forgoing $27.7 million state and local tax revenue.

‘An ongoing need’

The routes for people who have degrees from outside the country to get their license in Oregon varies by profession. 

The Oregon Nursing Board, for instance, requires international applicants for nurse licenses to show their education is equivalent to an accredited U.S. program and to verify practice hours. The board also allows five international agencies to provide documentation supporting their applications. 

Jama said some people from abroad need help navigating licensing requirements and other steps needed to get their credentials.  

Offering funding to help overcome barriers is a proven method to help connect trained people with “high demand jobs,” he told the Senate Labor and Business Committee last week. 

S.B. 849 would set up a grant program that nonprofits, colleges and employers can use to help people trained in other countries with requirements to become nurses, physicians, pharmacists, mental health workers and others. The money could be used to help people become proficient in English or technology, as well as to take courses to prepare for licensing exams. 

The Immigrant and Refugee Community Organization, a Portland-based nonprofit, oversaw a program beginning in 2018 to help foreign nurses meet requirements to get their licenses, according to testimony submitted by the group. 

The program was funded by a grant from Worksystems, the Portland area’s workforce development agency, that supported nurse credentialing with lab practice, clinical placements, career coaching and study for the National Council Licensure Examination. 

In 2018 and 2019, 30 out of 31 participants completed the program, 24 of which passed the examination and at least 20 received registered nurse jobs (employment tracking ended in 2020 when funding dried up). 

“Just from word of mouth, we have a wait list of 30 people who want to be licensed nurses,” Leisl Wehmueller, workforce and refugee services for the Immigrant and Refugee Community Organization, told The Lund Report. “It’s kind of an ongoing need.”

Despite the demand, she said her organization hasn’t been able to offer a similar program because of a lack of funding. Wehmueller said that the cost of helping each participant get their nurse license worked out to $26,000 to $36,000. 

‘A big investment in time and money’

The bill includes specific provisions for physicians from abroad seeking to regain their medical licenses. The Oregon Medical Board would be prohibited from placing limits on the amount of time an applicant has to complete the U.S. Medical Licensing Examination. 

The board would also be permitted to issue limited licenses to applicants allowing them to practice under the supervision of another physician if they’ve completed the U.S. Medical Licensing Examination requirements and are certified by the Educational Commission for Foreign Medical Graduates.

The Oregon Medical Board in 2019 issued a report mandated by the Legislature on the barriers that migrants and refugees face in becoming physicians. 

“International medical graduates are required to complete a three-year residency program to qualify for licensure; however, only a limited number of residency spots are available each year, and competition is high,” reads the report. 

Kyin now works as health services manager at the Immigrant and Refugee Community Organization and is studying at Oregon Health & Science University’s health care MBA program. 

She still wants to practice medicine again, and Kyin said the grant funding could help with language training and studying for the medical exam. But she faces what could be a bigger barrier. She considered studying to become a physician assistant but couldn’t apply for programs because Myanmar’s military government blocked the Myanmar Medical Council for releasing her university transcripts and endorsements. 

“I want to sit for the medical license exam again, but it is for me, a big investment in time and money,” she said. “And I struggle. I have no relatives here. And the first thing is I need a job.”

You can reach Jake at [email protected] or via Twitter @jakethomas2009.