The PA 166 (2022) LARA Task Force on Foreign Trained Medical Professional Licensing released its final report on licensing Foreign Trained Medical Professionals (FTMPs). The task force was composed of representatives from state government, higher education, and healthcare who considered foreign trained individuals seeking licensure in Michigan. No health care consumers independent of the Michigan health care establishment were included in the task force, a key omission typical of our state's narcissistic health care policy bureaucracy:
Michigan Task Force on Foreign Trained Medical Professional Licensing Releases Report and Recommendations
December 05, 2023
The Michigan Task Force on Foreign Trained Medical Professional Licensing has released its final report and recommendations.As mandated by Public Act 166 of 2022, representatives from state government, higher education, hospitals, and other professional associations were invited to meet with the Department of Licensing and Regulatory Affairs (LARA) to identify obstacles that prevent Foreign Trained Medical Professionals (FTMPs) from practicing in Michigan and create recommendations to improve the efficiency and effectiveness of the licensing process.
The final report and recommendations create a roadmap for Michigan to address the health care occupation gap while ensuring that highly qualified individuals have the ability to practice in Michigan at a level that is commensurate to their education and training.
The final report includes these recommendations:
- Expand acceptability of accredited credential evaluations from private entities
- Develop new transitional licensure pathways for FTMPs
- Create a state-run initiative to provide residency slots to FTMPs
- Dedicate a liaison within LARA to assist FTMPs and measure progress
- Fund a grant program to assist FTMPs with licensure and credential evaluation
- Rescind English language proficiency requirements
- Establish a Welcome Initiative in Michigan to support FTMPs
- Create and maintain skilled immigrant licensure guides in multiple languages
“Foreign Trained Medical Professionals have a key role to play in addressing Michigan’s health care workforce needs,” said LARA Acting Director, Marlon I. Brown. “These individuals comprise an underutilized talent pool of dentists, nurses, pharmacists, physical therapists, physicians, and other health care professionals who were trained in other countries but possess the experience and skills necessary to deliver quality health care services.”
The report's Executive Summary:
Foreign Trained Medical Professionals Have a Key Role to Play in Addressing Michigan’s Workforce NeedsA vibrant, prosperous Michigan economy requires a healthy population — both among residents and the workforce. With an aging population needing increased medical care, and hospitals and other providers across the state facing staffing shortages exacerbated by the COVID-19 pandemic, health care is an increasingly important economic driver. Unfortunately, Michigan has an acute shortage of, and growing need for, health care professionals at a time when its residents, and economy, need them more than ever.
Michigan is not alone in these challenges. States across the nation have begun aggressively turning to Foreign Trained Medical Professionals (FTMPs) to strengthen their workforce and address critical talent shortages. These individuals comprise an underutilized talent source of dentists, nurses, pharmacists, physical therapists, physicians, and other health care professionals who were trained in other countries but possess the experience and skills necessary to deliver quality health care services. However, FTMPs often face confusing, costly, and years-long regulatory and licensing processes that prevent many from practicing or force them into lower level jobs.
It is estimated that Michigan has approximately 6,000 immigrants with health-related degrees who are underemployed or unemployed. While that may sound like a relatively small number, most primary care physicians have up to 2,500 patients. Each time a physician or health care professional makes Michigan their home, thousands of Michiganders stand to benefit, as every single licensing decision has a major ripple effect on the community health professionals serve.
As mandated by Public Act 166 of 2022, the Department of Licensing and Regulatory Affairs (LARA) created the Michigan Task Force on Foreign Trained Medical Professional Licensing (Task Force) to provide proposals to reduce licensure barriers for medical professionals who are trained outside of the U.S.
Starting in the fall of 2022, representatives from state government, higher education, hospitals, and other professional associations were invited to meet with LARA to identify obstacles that prevent FTMPs from practicing in Michigan and create recommendations to improve the efficiency and effectiveness of the licensing process. At the forefront of the Task Force’s agenda was to consider what Michigan can do to ensure highly qualified individuals have the ability to practice in Michigan at a level that is commensurate to their education and training.
This report is the product of those meetings and provides policy recommendations to enhance the role FTMPs can play in addressing workforce shortages and creating a healthier, more prosperous Michigan.
The Task Force on Foreign Trained Medical Professional Licensing membership:
• Thadd Gormas - Executive Director, Michigan Academy of Physician Assistants
• Neema Katibai, JD - Manager of Government and Insurance Affairs, Michigan Dental Association
• Lauren LaPine, MPH - Senior Director of Legislative & Public Policy,
Michigan Health & Hospital Association
• Elizabeth Kutter - Senior Director, Government and Political Affairs,
Michigan Health & Hospital Association
• Farah Jalloul – Director of Professional Development & State Pharmacy Emergency Preparedness
Coordinator, Michigan Pharmacists Association
• Stacey Hettiger - Senior Director of Medical and Regulatory Policy, Michigan State Medical
Society
• Paige Recker, MHSA - Access to Care Manager, Michigan Center for Rural Health
• Sharif Krabti - Program Analyst, Office of Global Michigan, Michigan Department of Labor and
Economic Opportunity
• Glenn V. Dregansky, DO, FAAFP - Board Chair, Michigan Academy of Family Physicians
• Mia Murphy - Chief Policy Officer - Michigan Association of State Universities
• Bridget Leonard, DNP, MSN, MBA-HCM, RN, CRRN, NEA-BC -
President, American Nurses Association of Michigan
• Denise Hershey, PhD, FNP-BC – Past President, Michigan Council of Nurse Practitioners
• R. Taylor Scott, DO – Secretary and Treasurer, Michigan Osteopathic Association
• Rob LeFevre, JD - President, Michigan Independent Colleges and Universities
• Rachel Ruddock, MBA - Director of Workforce and Health Professions Training, Michigan
Primary Care AssociationThe LARA Support Staff
• Marlon Brown, DPA - Acting Director, Department of Licensing and Regulatory Affairs
• Courtney Pendleton - Deputy Director, Department of Licensing and Regulatory Affairs
• Amy Gumbrecht - Director, Bureau of Professional Licensing, Department of Licensing
and Regulatory Affairs
• Bryan Modelski, MPA - Deputy Director, Bureau of Professional Licensing, Department of
Licensing and Regulatory Affairs
• Richard Roselle, JD - Regulation Section Manager, Bureau of Professional Licensing, Department of
Licensing and Regulatory Affairs
• Neil DeSouza - Analyst, Office of Policy & Legislative Affairs, Department of Licensing and
Regulatory Affairs
Eliminate English competency?? That's really going to improve communication issues, frustration, and growing violence in healthcare settings.
FTMPs are not the only ones who "face confusing, costly, and years-long regulatory and licensing processes" for medical credentialing.
This opinion piece by an experienced physician lays out the problem. It is perpetuated in part by licensing boards like Michigan's BPLs within LARA.
Bold emphasis added by me.
https://www.medpagetoday.com/opinion/rural/109244
'Status Credentialus': The Case Against the Misery That Is Medical Credentialing
— This endless inefficiency is going to have a price sooner than anyone thinks
I have recently coined a new term for a terrible condition. This affliction can easily become an all-consuming source of misery for physicians. What is this terrible pathology, you may ask? I have diagnosed myself with "status credentialus."
As I near the end of my career and wish to ensure my place in the annals of medical history, I have decided to give it the eponymous title, "Leap's Credentialism."
Leap's Credentialism doesn't only afflict emergency physicians, but indeed any physician seeking to work anywhere. Now, every hospital or healthcare setting has its own set of requirements, rules, forms, and background checks. But this specific process particularly impacts those who do locums work. Indeed, there are physicians in every specialty who travel and work in different facilities, so this is a disease that reaches across geography and areas of expertise, from emergency physicians to neurosurgeons and everyone in the middle.
Its onset is truly insidious. I can only speak of what I know, but from my experience it begins for me and my colleagues around the nation when we are contacted about an "urgent" need in a hospital emergency department. It may be a call from a recruiter or an ad we receive via e-mail.
Then before long we discover that the need may be "urgent" but the process of credentialing is anything but. The CV is only the beginning and before long we're sending some other standard documents, such as copies of our medical school diploma, board certification, and merit badges like Advanced Cardiac Life Support, Pediatric Advanced Life Support, and Basic Life Support. Our state medical licenses and DEA soon follow. Fair enough.
But wait, there's more! In the last 6 to 12 months I have provided certificates of insurance for the past 5 years and have signed forms agreeing to background checks and credit checks. And I've had to pay for, and forward, my National Practitioner Database report, which of course is public record for anyone to look at, anytime. I have also pestered my co-workers and directors endlessly for letters of reference because you can never have too many of those.
I have verified my home addresses. I have sent my hospital case-logs, generated by the billing office of facilities where I have worked. For a recent job I was required to take the American Heart Association course on how to perform a stroke evaluation and generate an NIH Stroke Scale/Score. However, I made the mistake of only getting the certificate that said I took it and received the attendant 2 hours of CME.
Silly me, I didn't get the certificate without the CME, which was required to show that I had indeed taken the course. So, the locums company had to put me in touch with the American Heart Association, which then verified who I was and generated the proper certificate, which said that I took the course to do the thing that I had been doing all along well before the course. (That little episode nearly gave me status profanicus.)
To make things crazier, one facility has required that in order to do sedation, I must be board-certified in emergency medicine, take their sedation quiz, and also have a letter from a director stating that I do sedations.
I have worked in about 36 facilities over the course of my career to date. This apparently means that each and every one had to be contacted to verify that I am who I say I am. And all of us at one point or another have been asked to explain that 1-month break between medical school and residency, or betwixt residency and starting practice. (What sort of slacker physician doesn't work for a month, I ask you?)
At one point, a couple of minor variations appeared from facilities where I suppose two versions of my CV conflicted slightly on employment dates. It's easy to lose track over a career. This caused no end of consternation among the credentialing staff because this apparently hinted at deceit and danger.
"Dr. Leap, was it 2/15 to 2/18? Or was it 3/15 to 5/19?"
Or, more appropriately I might query, does it really matter?
We're now approaching 6 months of credentialing processes for some locums work. Meanwhile I still receive ads, weekly, for those sites with allegedly "urgent" needs.
Someone will tell me that these are insurance requirements or legal protections, or that it's all about safety or something like that. I get it. There are dangerous doctors out there, as well as scoundrels and those who aren't even physicians but are just good tricksters. The Lokisopens in a new tab or window of medical practice.
But this "status credentialus," this endless inefficiency, is going to have a price sooner than anyone thinks. Because we're running out of physicians, about half of whom in America are over the age of 50. Many others are leaving their jobs early to change careers or to retire as soon as possible.
The reasons are many, but we'll eventually be fresh out of doctors willing to do the work. I don't just mean the ever-more-difficult work of medicine, but the painful, all-consuming, and uncompensated work of credentialing. And if we should -- heaven forbid -- face another COVID-like crisis, we won't be able to wait half a year for doctors to go to work ... if doctors even remain.
As I contemplate the ridiculous amount of time I have spent on forms and emails, tests and verifications, a final thought occurs. All across the land, emergency departments hire new APPs right out of training programs and plop them down at computers right next to ours. I guess it's easier to credential people who haven't worked anywhere. What could go wrong, after all?
My case of Leap's Credentialism is improving as I move through the system. But I still get spontaneous eye-rolls, blurry vision from computer screens, fits of blind rage, and hand pain from typing explanations. (These are pathognomonic.)
If we want a healthy, functioning healthcare system in the future, someone is going to have to tackle this ridiculous process we've turned into an industry and impediment.
I fear that the only real treatment, or vaccination, for Leap's Credentialism will simply be to walk away from medicine. Pity that. Because people still need us at the bedside. And before long, our willingness and availability to provide care may be the only credential that matters.
Edwin Leap is a board-certified emergency physician who has been practicing for 30 years since finishing residency. He currently works as an emergency physician for WVU Hospitals in Princeton, West Virginia.
Michigan could dramatically simplify credentialing with simple interstate license reciprocity - not just for physicians, but for everyone required to obtain a healthcare license in our state.
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