Since childhood, Abdilahi Ali Mohamoud has wanted to be a doctor, influenced by the dire state of health care in Somalia amid a decades-long civil war.
After studying medicine in China for five years, doing a clerkship in India for a year and then practicing medicine in his native Somalia, Mohamoud had his sights set on coming to the United States.
“My goal was always to be able to get the highest [level of] education possible,” he said. “I didn’t feel like there was any other better place than the U.S., and pursuing the dream of training here and hopefully practicing here and getting the best knowledge that I can.”
Mohamoud, 31, passed the necessary exams and was matched into a residency program at Hennepin Health in Minneapolis.
But for many international medical school graduates, the bar of entry — the yearslong process to become licensed to practice in the United States — is too high.
Now a bill in the Minnesota Legislature — authored by Minneapolis DFL Rep. Anquam Mahamoud in the House and Edina DFL Sen. Alice Mann, a doctor, in the Senate — aims to make that process easier by providing an alternate path for international medical school graduates who meet certain requirements.
Lawmakers and advocates hope the changes would lessen barriers to practicing medicine in Minnesota for immigrant physicians and address shortages in underserved areas, while still ensuring a high level of quality of care.
Barriers to entry
Before international medical graduates can come to the United States to practice medicine, they must pass the U.S. Medical Licensing Examination, then be matched into a residency program in the United States or a similarly accredited program, which includes some facilities in Canada.
After a year of general practice in Somalia, Mohamoud journeyed to Turkey, where the exam was being administered, to prepare for and then take the exam. Mohamoud estimated that process has cost him $15,000 to $20,000.
“There’s a lot of challenges in preparing for the USMLE exams,” Mohamoud said. “There’s no guarantee of coming [to the United States] even after you pass, and it doesn’t guarantee you a residency, so unless you really commit to it, it’s very hard.”
Under current Minnesota licensing laws, physicians are required to have graduated from medical school and then go through a residency program accredited in the United States before becoming licensed to practice as a physician. That second requirement is where many international medical graduates experience challenges, said Dave Renner, the Minnesota Medical Association’s director of advocacy.
“The challenge with some international medical grads is that they go through medical school — many times they’re also practicing for a number of years in other countries — but they have not gone through an accredited residency program,” Renner said. “They come to the United States, they want to get licensed here and they, in a sense, have to start over and go back through a residency program, which is a minimum of three years of supervised practice, before they can get a full license.”
However, Renner said, the potential concern with reducing the requirements for foreign medical graduates to gain a U.S. license is ensuring that a high level of quality of care will be maintained. Since medical schools across the world are not uniform in their curriculums, the three-year residency requirement in the United States is meant to ensure a standard level of competence.
The compromise proposed by the legislation is a two-year limited license issued by the state Board of Medical Practice. In order to qualify for the limited license, an international medical graduate would have to have practiced medicine in another country for at least five of the last 12 years.
The two years, as well as the exams the graduates take before even coming to the United States, establish a foundation of medical knowledge while providing another route to practicing medicine, said Dr. Meghan Walsh, chief academic and research officer at Hennepin Healthcare.
Walsh said she gets hundreds of requests from international medical students asking to come to Hennepin Health to gain clinical experience through observation. The proposed alternate pathway will loosen up that bottleneck, she said.
“Instead of traveling all over the country trying to get one-month observerships, you do two years through this pathway, you get a provisional license … and then you apply for residency,” Walsh said.
Diversifying the workforce
The number of licensed physicians across Minnesota has been steadily growing each year, and the workforce’s demographics have also become more diverse, with more women and people of color going into medicine than in prior decades.
Despite those gains, a 2019 report from the Minnesota Department of Health’s Office of Rural Health and Primary Care showed that about 76% of all physicians in Minnesota were white. Just 2.6% were Black, 1.9% were Hispanic and 0.2% were Indigenous.
Another problem is that fewer physicians are going into primary care, and even fewer opt to work in parts of the state that need doctors the most.
“The challenge we have is a maldistribution, both of geography … and specialties,” Renner said. “Where we are seeing shortages are usually in rural and underserved urban areas, and in primary care.”
The bill aims to address those issues by requiring physicians who are granted the new limited license to practice in a rural area or underserved urban community.
The goal is to bolster the ranks of physicians at clinics and hospitals that need it. And like Mohamoud’s placement at Hennepin Health, which serves the largest Somali community in the nation, another benefit could be having physicians serve the communities to which they belong.
“One of the things that drew me to this place is the opportunity to help Somali patients,” he said. “I am able to speak the language and kind of navigate the culture, see where patients are coming from and what is meaningful to them.”
The legislation was laid over in committee in both the House and Senate, and slipped into the chambers’ respective health omnibus budget bills. Following an incomplete legislative session that ended without a two-year budget being passed, both chambers are waiting for Gov. Tim Walz to call a special session.
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