Opinion: Colorado’s medical residencies are less welcoming to international graduates than the rest of the U.S.

Recently, tens of thousands of medical school graduates got career-defining, life-altering news. Every March on “Match Day,” medical school graduates learn about their U.S. residency placements, in-depth postgraduate training programs, where they’ll hone clinical skills and focus on a medical specialty.

It’s a celebratory time for many, but for others, including me, it’s a heartbreaking reminder that training, skills, monetary investments, and dedication to the medical field don’t always lead to a triumphant Match Day, let alone to careers contributing to our full potential in a workforce that sorely needs us.

To be clear, Match Day results are only part of the picture of a would-be doctor’s ability to compete and perform in a field with rightfully high quality standards. In my case, I excelled through medical school and was on my way to a promising career – but I’m also one of at least hundreds of Coloradans who went to medical school outside the U.S or Canada, making me an international medical graduate. 

My circumstances are somewhat unique: I was born in Greeley but lived in Libya from childhood through early adulthood, including my time in medical school, until family ties brought me back to Colorado. Many of my fellow international medical graduates are refugees, asylees, Special Immigrant Visa recipients, and other immigrants.

Whatever circumstances brought us to Colorado, every international medical graduate I know is poised to contribute advanced skills in the local healthcare workforce, if given the proper chance. Meanwhile, Colorado faces a shortage of 2,400 physicians by 2030, part of the national shortfall of up to 124 ,000 physicians projected by 2034 according to the American Association of Medical Colleges.. 

International medical graduates like me are qualified to help fill that gap. As the youngest student in my medical school cohort, I thrived during hands-on training in cardiac intensive care, obstetrics and gynecology, and community-based preventative medicine. I returned to my birthplace of Colorado intending to continue caring for patients, but soon learned that processes for medical licensure are extremely challenging, if not impossible, for lots of international graduates. Although my medical school credentials are verified by the Educational Commission for Foreign Medical Graduates, getting licensed to practice here meant repeating rigorous exams and re-starting residency.

With significant time and financial resources, I’ve persisted. I’ve passed all three steps of the U.S. Medical Licensing Exam, completed numerous U.S. clinical experiences, and built a network with local physicians who recognize me as a colleague. I’m a clinical cancer researcher in Denver, helping deliver new life-saving therapies that give patients vital treatment options, longevity, and hope. Yet, despite my diligence, proven acumen, and many accomplishments, I’ve faced repeated rejections trying to match to a U.S. residency program.

I’m not alone. 

International medical graduates consistently match to residency at significantly lower rates than our U.S.-educated peers. On Match Day 2022, the first-year residency match rate for U.S. MD graduates was 93% versus only 60% among international graduates. And while international graduates obtained 22% of residency slots filled nationally in 2021, they filled only 4% of those in Colorado. 

Frustratingly, many residency programs won’t accept candidates who completed medical school more than five years ago; in Colorado, that cutoff is as low as two years, depending on the residency program. Some programs go as far as automatically filtering out international graduates—our applications aren’t even considered. Barriers persist despite the fact that many international graduates already have completed a residency program abroad or have even practiced medicine extensively outside the U.S. 

In the face of all this, I have reason to look forward: a bill, HB22-1050, is advancing in the Colorado General Assembly that will build on successes in states like Minnesota and Washington in better recognizing international medical graduates’ training, and improving opportunities for us to establish ourselves as licensed doctors.

Importantly, HB22-1050 does not create any new, unique, or alternative medical licensure pathways for international medical graduates, yet it is trailblazing in proposing measures to leverage our education and experience in matching to U.S. residencies and navigating the existing licensure process. Provisions include the creation of a clinical readiness program where international graduates can refine skills preparing for residency, a training and technical assistance program to improve workforce integration, and measures ensuring equitable licensing requirements.

Through HB22-1050, Colorado can bolster livelihoods by tapping into an existing, underutilized pool of talent while helping to counter physician shortages. We can also offer a model for other states in building a more inclusive, equitable health system for all. That is why the Nurse-Physician Advisory Task Force for Colorado Healthcare generated recommendations that informed this legislation and more than 30 organizations, including the Colorado Medical Society, endorse this bill. 

The General Assembly should pass and fully fund HB22-1050 without delay and give international medical graduates a better chance to finally have a happy Match Day — and, ultimately, return to our life’s work giving back to our community by practicing medicine. For now, we’re all missing out. 

---

Wafa El-ejmi, of Denver, is a clinical researcher. She is a consultant to Spring Institute for Intercultural Learning, a partner of World Education Services’ #UntappedTalent campaign.

---