When Michael Scott pitched potential investors for The Michael Scott Paper Company, he introduced his team. “From his humble beginnings as a prominent surgeon,” Scott says of Vikram, an Indian employee at his company, “he risked it all to become the most successful telemarketer in the lipophedrine industry.” If you watch The Office, you might have chuckled at that line and moved on with your day. But the problem is very real: Doctors relocate to America and can’t easily begin to practice, even if their training lines up with American training.

This issue is even more problematic during the pandemic when medical professionals have been stretched thin. Fortunately, new legislation in Missouri could fundamentally change the way the state treats foreign-trained doctors. If it passes, it will be a model for the nation.

During the pandemic, executive orders in New YorkNew Jersey, and Massachusetts allowed immigrant doctors and foreign medical school graduates to work to varying degrees for a brief period. The move was vital while medical professionals were in short supply and a poorly understood virus run rampant. But all states ought to take a lesson from these three and permanently allow foreign doctors to work here.

Once COVID-19 ends, America will still face a daunting and growing shortage of physicians, even compared to other countries. One report in the past few months detailed that “the number of practicing physicians per person in the United States is lower than in just about any other developed country.”

And the shortage is self-inflicted. Robert Orr, poverty and welfare policy associate at the Niskanen Center, wrote in the report that “from 1980 to the early 2000s, the prevailing wisdom was that the number of physicians within the U.S. ought to be reduced.” A report from the Council on Graduate Medical Education, which is governed by the Federal Advisory Committee Act, reads, “Additional funding [for the Graduate Medical Education (GME) program] would not be in the public interest since it could contribute to a continuing surplus of physicians.” Orr describes how deliberate actions were taken to reduce the attractiveness of the profession for prospective students. There was even a voluntary moratorium on new medical schools. His report also found that America is behind other countries on training physicians and having foreign-trained physicians work here.

The latter is no wonder — doctors who immigrate to the U.S. must trudge through a duplication licensing process that can last more than a decade. As a report from the Cicero Institute explains, they start from the same place as those who just finished medical school in America — if they’re lucky. Residencies are a required part of the process but are too scarce for the demand. In 2020, while just under 94% of U.S. medical school graduates were matched with residencies, just 61% of foreign doctors could say the same. In part, that’s because the system favors American medical school graduates. Expanding residency slots clearly needs to be one part of the approach.

But there is another, simpler way to allow foreign doctors to come to the United States and serve patients: just let them. That’s exactly what Missouri state Rep. Derek Grier is trying to do. He recently introduced House Bill 1211, which would allow physicians trained in other countries to work in the U.S. if certain conditions are met.

The criteria in the bill is simple. Among other programs, the physician must have graduated from an international medical program that provided “substantially similar” training to that required to practice in Missouri, be in good standing with their country’s licensing board, and have completed their residency in a qualified international medical program. Applicants need to provide evidence of their training. Furthermore, it allows international medical programs to apply for accreditation with the Missouri Board of Healing Arts, the board that oversees doctors.

In an op-ed, Grier describes the current state of affairs as “a man-made crisis,” adding that “there are thousands of highly-trained physicians throughout the country who are stuck in jobs far below their skill level.” His legislation provides them a pathway out of underemployment.

And the extent of underemployment here is unsettling. A Migration Policy Institute report found that “263,000 immigrants and refugees with undergraduate degrees in health-related fields are either relegated to low-paying jobs that require significantly less education or are out of work.” That is a lot of potential to waste during the best of times and especially during the worst.

In 2019, Arizona became the first state to enact universal licensing recognition so that those who moved to Arizona could transfer in their occupational licenses. Other states quickly began enacting similar laws. Missouri’s proposed legislation has the same potential to become a model — and even a challenge — to other states to expand the ability for those trained outside the country to work in their trained profession. Vikram was just a character on a sitcom. But his dilemma is real.

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