Evolving Medical Licensing Laws Could Affect Hospice Workforce, Diversity Challenges

A rash of states are restructuring their medical licensing requirements to allow more trained clinicians from other countries to find employment in the United States. The trend is an aim to address prolific workforce shortages, including in hospice, but could also have impacts on improving diversity, equity and inclusion.

Some states have restructured medical licensing requirements for certain international medical graduates (IMGs) to allow more clinical professionals to work in the United States.

Driving a push for reform is the rising demand for end-of-life care amid widespread clinical shortages, according to Andy Siegel, chief business development officer of Virginia-based Goodwin Living. Seigel leads the nonprofit senior living and health care organization’s home- and community-based services, which include hospice.


“Dated or overly restrictive medical licensing requirements limit the ability of hospice organizations to access qualified providers with international medical degrees,” Siegel told Hospice News in an email. “Restructuring and updated medical licensing requirements are simply another pathway to expanding the talent pool and one we should embrace.”

Hospices nationwide are fighting for sparse resources of talented providers to meet the needs of a rapidly growing aging population with increasingly higher acuity levels, Siegel said. The changes in state laws could positively impact access to high quality providers among home-based hospice patients and their families, he stated.

“The more providers that hospices are able to utilize, and the more training programs there are to elevate their skillset in the United States and align them with U.S. standards, the better the outcomes will be for the patients receiving care and even more so the patients who need hospice care but for which their cities and states lack qualified providers,” Siegel said.


State laws in flux

A recent report from MedPage Today found that an estimated 15 states have either passed or considered enacting legislation that reduced or eliminated residency requirements for certain international medical graduates. These laws allow clinicians to seek alternative training and medical licensure in the United States.

The laws vary from state to state, but generally grant limited professional licenses permitting physicians from other countries to practice medicine in hospitals and outpatient settings after undergoing training in an approved medical school or college.

Tennessee and Illinois were among the first to enact some type of these laws. An Upwardly Global analysis dug into the Illinois policy changes, which created a permanent alternative pathway to medical licensure that replaced the residency requirement with two years of limited practice under the supervision of a licensed physician in an area of unmet need or with a provider that treats underserved populations.

These laws may be having an impact on improved clinical workforce recruitment and retention, according to Tamar Frolichstein-Appel, senior employment services lead at Upwardly Global, a national nonprofit organization that explores employment barriers among immigrants and refugees with international credentials.

“It comes from a space of realizing we have really big gaps and demand for more health care professionals in certain communities and specialties,” Frolichstein-Appel told Hospice News. “There’s acknowledgement that we need a different way to help folks who come to the United States with training and experience to join the medical field. They bring much medical and cultural knowledge and this opportunity to access talented people.”

Diversity impacts

Virginia is also among the states recently proposing changes to its existing medical licensing laws that, if enacted, would allow physicians from other countries to train and provide care in the state for a period of up to two years in hospitals and community-based settings.

The move could help alleviate physician shortages in rural and underserved communities. Evolving state laws like these also could allow more clinicians from diverse cultural and spiritual backgrounds to reach these communities, according to Siegel.

The laws open avenues for greater representation among interdisciplinary clinicians who are able to participate in supervised training and apply for licensure, he stated. Hospices could also improve upon developing more culturally aware care delivery approaches by having a diverse staff of clinicians from other countries, Seigel added.

“By virtue of creating pathways for IMGs to come to the United States and serve in these meaningful leadership roles, our organizations will be able to learn from the countries that these providers come from — not only in their best practices, but also learning from the richness of their culture,” Siegel said. “As we continue to try to enhance access to hospice care for everyone who is eligible, it should continue to be a priority for hospices to understand the entirety of the patients we serve.”

By virtue of creating pathways for IMGs to come to the United States and serve in these meaningful leadership roles, our organizations will be able to learn from the countries that these providers come from — not only in their best practices, but also learning from the richness of their culture.

— Andy Siegel, chief business development officer, Goodwin Living

International medical graduates make up 25% of the overall physician workforce in the United States health care system, reported Medical Licensing. Roughly 62% of IMGs have secured residency positions across the country last year, a rise from 44% in 2016, the report found.

A report from the Migration Policy Institute found that more than roughly 165,000 international medical graduates currently living in the United States are unemployed or underemployed immigrants and available to help minimize clinical workforce gaps.

International medical graduates are often individuals who are representative of some of the most underserved patient populations in the United States, said Avigail Ziv, Upwardly Global’s vice president of programs.

Opening career pathways for these medical professionals could help hospice providers to break down cultural and language barriers among underserved communities, Ziv said.

“Oftentimes in a medically underserved there are many immigrants and refugees based in these communities as well,” Ziv told Hospice News. “These laws aren’t something that is ‘nice’ to have,’ this is a must have if we really want to continue to serve the health care needs for this country and fill critical gaps in the health care industry to properly care for our communities of aging populations.”

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