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March 30 - April 5, 2001
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Siu’s story is typical of many foreign health professionals and students who come to this country only to discover that all their years of training and experience mean nothing. An intimidating re-certification process for nearly every field scares away highly-needed health care workers — often because of their poor English skills — and people such as Siu, a certified M.D., are left working as secretaries and taxi drivers.
With California’s ever-growing population, the shortage of health care workers is becoming a real crisis. For example, there is a minimum projected shortfall of 25,068 registered nurses (RNs) for the year 2006, according to a California Strategic Planning Committee for Nursing study. With an immigrant population growing exponentially, the lack of bilingual or culturally competent health workers at every level in effect equals poor health care for thousands of people.
• In December 1999, there were 247,138 RNs with active licenses in California. • By 2006, California will need 303,025 RNs, but is expected to have only 277,957. This leaves a minimum projected shortfall of 25,068. Source: California Strategic Planning Committee for Nursing Colleagues in Caring
But a recent $2 million grant to San Francisco colleges has created a program to bring these disenfranchised foreign health professionals back to their calling, and use them to fill in the gaping holes in California’s health care system. Titled “Welcome Back,” the program will establish a center that will do individual assessments of internationally trained health workers of any level of training and help guide them in the right direction, or place them in an environment where their skills can be utilized. It is set to open in February of 2002.
California’s Nursing Shortage
“I wanted to be a doctor my whole life.”
Siu was born in Hong Kong, but moved to Costa Rica with her family when she was barely five years old.
“Being immigrants to Costa Rica was very hard for me and my family at first, because none of us spoke Spanish,” Siu recalled.
Being so young, Siu picked up Spanish quickly and had to translate for her parents.
“It was different there because people only spoke Spanish, so if you didn’t pick up the language you were really in trouble,” Siu said.
Siu grew up in San Jose, Costa Rica, receiving all of her education there, and attended medical school at the Universidad Autonoma de Ciencias Medicas de Centro America.
“I wanted to be a doctor my whole life,” Siu said. “Healing people, taking care of them has always been something important to me. I guess it was like a hobby.”
After Siu finished medical school, she immigrated to the United States and moved in with her sister in San Leandro, Calif. Siu was fully trained to become a doctor and just needed to move on to the next step.
But moving to the United States from Costa Rica, Siu discovered that her English skills were not up to standard.
“I just never had to speak English there. It wasn’t part of my schooling, really,” Siu said. “I didn’t realize how difficult the language barrier was until I got sick.”
After coming down with a severe case of the flu and having a few frustrating experiences with non-Spanish-speaking doctors, Siu came to the Mission Neighborhood Health Clinic, where her sister worked.
Established in the 1970s, the Mission Neighborhood Health Center, located at 240 Shotwell Street, offers a range of services on a sliding scale to some 10,090 clients per year.
“It made such a difference coming here where I could talk to the doctors and have them talk back to me,” Siu said. “It made me really want to get back on track and continue my education.”
Siu enrolled in ESL classes and quickly picked up English. She began working at the Mission Neighborhood Health Clinic as an administrative assistant. She also decided to work at getting her United States medical certification so she could enter a residency program and start working as a doctor.
“The thing is that the test fees are like $700 or $800, and the courses for review are thousands of dollars,” Siu said.
Also, the tests and courses are not offered everywhere in the United States. Siu moved to Chicago to enroll in a review course, which emptied her bank account, plus she had to travel to take the test.
In 1998, Siu passed the USMLE and the English certification test. The medical licensing exam is the same for both foreign and domestically trained students — but that’s where the similarities seem to end. Most domestically trained medical students spend the first two years of medical school learning from books and in labs. The second two years are spent learning in clinical rotations. This hands-on experience in the United States health care system gives them an upper hand.
“Internships and externships are reserved for American students,” Siu said. “I cannot get these because of my background, and then it puts me at a great disadvantage because I have no real experience with patients. Without the experience of an internship, no residency program will touch me.”
Siu was able to observe a doctor at a Bay Area Veteran’s Hospital in exchange for 300 hours of volunteer work, but she said the experience was not equivalent to an internship.
“The doctor told me to sit in a corner and not touch any of his patients,” Siu said. “How am I supposed to learn anything that way?”
Since passing her USMLE, Siu has contacted over 25 hospitals in search of a residency program, all to no avail. She finds some aspects of the system ridiculous, like the fact that she has to renew her TOEFL or English certification test every two years, “like, I am going to forget how to speak English?” she wonders.
Fluent in Cantonese, Spanish and English, Siu is exactly the kind of health care professional who is needed in California, yet she is ready to turn her back on this line of work.
“I see how important it is to have doctors who can communicate,” Siu said. “It doesn’t matter if you are the best doctor in the world – if you can’t talk to your patients, you can’t really help them.”
“They are working as bank tellers or taxi drivers”
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Asked where the “Welcome Back” program originated, Pena replied, “From my head. It is [an idea] that has been cooking up there for many years.”
Pena said that the program stemmed from his own personal experiences as a health professional trained abroad and from his work at Mission Neighborhood Health center, where he needed to hire staff to develop services for the mainly Latin American population with which he was dealing.
“I really saw how difficult it was to hire individuals like social workers, nutritionists and doctors who were culturally competent and fluent in the language,” Pena said. “And on the other hand, there would be qualified people who would come applying for jobs who didn’t have their U.S. license.”
Pena has been working as the director of the San Francisco Bay Area Regional Health Occupations Resource Center (RHORC), run out of the John Adams campus of City College. This center’s purpose was to identify the needs of the health sector in terms of human resources and then use the training resources of the community college to help meet those needs. Through his work at RHORC, Pena discovered that the health sector generally lacks culturally competent staff to serve immigrant populations.
“The idea was that we have all these communities and within these communities there are people who have trained in their countries of origin and are now here — unemployed in the health field because they are working as bank tellers or taxi drivers,” Pena said. “Why don’t we find these individuals, find out what they have learned and see how we can help them by getting them into courses and trainings so they can reenter the health work force, and bring with them their knowledge of the culture, knowledge of the work and knowledge of how to relate to patients?”
California’s largest health care grants organization, the California Endowment, heard of Pena’s ideas and approached him in August of last year, asking him to submit a formal proposal.
The California Endowment gives about 200 to 400 million dollars in grants annually. They saw Pena’s ideas as an “innovative approach to addressing the shortage of health care professionals in California,” according to senior program officer Jai Lee Wong, and have invested a total of four million dollars in a statewide program.
Pena has no exact numbers for how many immigrant health care professionals may be out there. But within two days of a press conference held March 19 to announce the grant, Pena received 26 phone calls from people who were interested in the center.
“We need to see our immigrants and refugees as our assets. There are so many people out there who are trained as health professionals and are so passionate, but prevented from working,” Wong said. “We can help create the opportunities they need.”
“We are not talking about special treatment, but a way that does not deny everything these people already know”
The “Welcome Back” program aims to create a center that will allow internationally trained health workers to come in for initial assessments, which will be used to construct a series of career plans or alternatives.
“For example, if you are a trained psychologist from China and you are interested in staying in that field. We will tell you the process that you need to go through,” Pena said. “Or if you don’t want to go through all that, you feel like you are too old to go back to school, here are the alternatives. For each person there will be an individual assessment, an individual plan.”
The program is sponsored by the RHORC, but will be a partnership between City College and San Francisco State University, so students can be routed through programs at either institution. There is a parallel center opening in Los Angeles, and two planning grants for Fresno and San Diego. The San Francisco center will be headquarters for the state.
Pena is especially excited about the opportunities for people who may not want to go back and become a doctor or a nurse again, because he thinks they have other options and opportunities to help their communities. A series of seminars is already being offered at S.F. State called “Leadership in Health,” where people can learn to become administrators, advocates or lobbyists.
Linda Grohe, ´ean of health and P.E. at the John Adams campus of City College, emphasized the importance of routing people through technical programs that allow them to reenter the work force.
“We really want to get people back into their professions,” Grohe said. “We can give them the English that they need, and we tailor it to the health profession.”
Grohe said the programs at City College also work on introducing students to the American health care system and the health care culture.
“The health care culture is different in different places. People who come from Russia are not used to using disposable needles because of the shortage of supplies in their country,” Grohe explained. “But here we dispose of everything nowadays to make sure everything is fresh and sterile.”
At the John Adams campus students can train to be cardiovascular technicians, emergency medical technicians, vocational nurses, medical administrators or certified medical billers. Coursework for these vocations can be completed in two or three semesters. At the Phelan or Ocean campus, students can study to be RNs, x-ray technicians, community health workers or drug abuse counselors.
“After people start working in these programs for some time, we can talk about guiding them to State or to more specialized programs,” Grohe said. “The center can really introduce people to all the options that they have.”
The center’s first year of operation will be intensive planning and research. Doors will officially open in February of next year. “I am finding out how many are out there and what flavor,” Pena said. “I need to find out who they are, where they are coming from, and once I get a sense, then we can start developing programs that may be more appropriate to the needs that are out there.”
For example, if Pena finds the majority of students are nurses who want to go back into nursing, he will create a curriculum that will look very closely at transcripts and try and validate whatever is possible, so there can be a fast-track nursing program that ends with the state certification exam.
“We are not talking about special treatment, but a way that does not deny everything these people already know,” Pena said. “What we want to do is infuse the health workforce with a cadre of culturally diverse workers, so that everybody’s voices are heard.”
Siu believes that the “Welcome Back” center will be really beneficial for others who are in her position.
“Especially because people who trained to be doctors, that is all they know. They spent all their life learning to be a doctor and have no other skills,” Siu said. “That is why now they must take low-level jobs.”
Siu said that she is lucky because she had some computer skills, which helped her land a stable job. She plans to continue to try and land a residency program in the United States, and may go to the Center when it opens next year.
“I just really want people to know about the unfairness that is happening here,” Siu said. “There are so many nurses and doctors out there who could be helping. It really is a big problem.”
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