Column: Improving Access to Quality Healthcare

Massachusetts is home to more than 32,000 primary care and specialist physicians, and many highly regarded hospitals and other healthcare providers. Nevertheless, many residents report difficulties accessing the care they need.

According to a recent survey by the Blue Cross Blue Shield of Massachusetts Foundation, among adults who had insurance for the entire previous year, 47% said they had experienced difficulty seeing a doctor. This was because they could not find a provider who accepted their insurance or was accepting new patients, or because they could not get an appointment as soon as needed. The severity of the problem varies by region in the state, and is particularly acute for primary care doctors.

This situation is likely to worsen in the years ahead since, according to the Association for American Medical College’s Center for Workforce Studies, the United States is expected to face a shortage of more than 130,000 physicians by 2025 and a deficit of 918,000 registered nurses by 2030.

One of the strategies we should be pursuing to close this gap and improve access to quality healthcare for all residents of the Commonwealth is to take better advantage of foreign-trained medical professionals. An estimated 12,000 Massachusetts residents are foreign-trained doctors, nurses, physical therapists, pharmacists, or other healthcare professionals. Unfortunately, more than 20% of these practitioners are unemployed or working in lower-skilled jobs that do not take full advantage of their talents and expertise. They face a number of barriers to working in their chosen professions in Massachusetts, including shortages of residency placements, limited access to information about licensure, complex and costly licensing requirements, and minimal hands-on clinical experience.

Marrying this pool of unused talent with a population in need of better access to services would help us to better meet our healthcare needs and expand opportunity at the same time. Research shows that foreign-trained clinicians are more likely to work in underserved areas; and, when they do, they can significantly improve health outcomes. Minority physicians and physicians of color also serve a disproportionate share of underserved populations, including patients with limited English skills. Research also suggests that greater diversity in the healthcare workforce, particularly better racial and cultural concordance, can improve clinical outcomes.

I first became aware of this issue as a result of conversations with a constituent who lives in Malden. Dr. Afsaneh Moradi came to Massachusetts in 2011 from Iran, where she had graduated from medical school and practiced as a primary care physician. She subsequently passed all three steps of the United States Medical Licensing Examination (USMLE). Unfortunately, although graduates of U.S. medical schools gain residency placements nine out of ten times, international medical school graduates who have successfully passed the USMLE are only placed at a rate of roughly five out of ten. Despite having graduated in the top 1% of her class and having already practiced medicine for seven years in her home country, as well as committing a lot of her time to volunteering and unpaid observerships, Dr. Moradi is still waiting to land a residency slot. Her life-saving talent remains under-utilized and her potential patients remain lacking for adequate access to quality healthcare.

To help address this problem I have filed An Act to Increase Access to Health Care in Underserved Areas of Massachusetts. This legislation would create an inter-agency commission to identify barriers to practice for foreign-trained medical professionals and ways to overcome these barriers, with the goal of directing their services especially to rural and underserved areas with the greatest need. The commission would identify state or national licensing regulations that pose unnecessary barriers to practice; recommend possible changes to state licensing requirements; and, develop guidelines for full or conditional licensing of foreign-trained health professionals.

For Dr. Moradi and others stuck in a similar situation, and for the many Massachusetts residents who need better access to care, I’m hopeful this bill will become law.