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State budget cuts out help for immigrant doctors to regain profession

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Dr. Liban Farah, Dr. Jibril Elabe
Dr. Liban Farah and Dr. Jibril Elabe practiced medicine in Somali for several years before fleeing the civil war. When they got to the U.S., their lack of residency experience made it impossible for them to continue working as doctors. A state-funded program at the U of M helped them qualify for residency assignments. The program's funds were zeroed out in the state budget agreement.
MPR Photo/Lorna Benson

A state-funded program that helps immigrant doctors qualify to practice in Minnesota has become a casualty of the state budget agreement.

It shut down after lawmakers eliminated funding for the $150,000 program during last-minute negotiations last month.

Unless the program's funding is restored, its legacy will be the three doctors from Somalia who, after years of professional limbo, were finally able to begin residency training, a difficult proposition for immigrant doctors who received their training years ago.

"I knew that there was some obstacles," said Dr. Jibril Elabe, a Somali doctor who came to the United States 11 years ago. "But I never thought they would be so hard and it will take so long to overcome." 

Elabe was in his early 30s when he fled Somalia's civil war. With a medical degree and eight years of intense field experience to his credit, he hoped he would be able to continue his career in his new home in Minnesota. Now, 44, Elabe is finally getting his chance.

It's not a simple thing for doctors served by the program to work as a doctor in the United States, even if they have been a practicing physician elsewhere for many years.

Dr. Liban Farah discovered that his 10 years spent delivering babies and treating gunshot victims in Somalia didn't matter to Minnesota providers.

"Every place that you go they will ask you, when did you graduate? And I graduated a long time ago," Farah said. "Then they will say to you, 'Do you have experience in the United States?' How can I get a United States experience if they don't give the opportunity to practice here? So it was a difficult time for me."

Dr. Will Nicholson
Dr. Will Nicholson helped train the group of three Somali doctors who had been unable to qualify for residency programs. "You have these people who, many of them could be qualified to do this job with just a little bit of extra training," Nicholson said. "You desperately need people to do this job. Why not get them out in the game?"
MPR Photo/Lorna Benson

Most U.S. hospitals and clinics require physicians to complete a residency program before they will hire them. Residency programs typically will only accept doctors who have graduated within the last five years.

That made qualifying for a residency seemingly impossible for Farah, 45, who had graduated from medical school in 1989. While he searched for a way to get around the rules, he took whatever work he could find.

"I did everything, everything that you can imagine, from driving taxi to working as an interpreter or doing some other jobs to support me and my family," he said. 

Eventually, Farah, Elabe and some other out-of-work Somali doctors convinced state lawmakers to help them. In 2010, the Legislature gave the University of Minnesota $150,000 to set up an intensive, seven-month training program that would help the doctors meet the qualifications for a U.S. residency program.

Farah, Elabe and Liban Hired, another Somali doctor, were selected for the first class, which began last December. 

In seven months, the program instructed them on how the U.S. health care system works, including insurance billing and electronic record-keeping. They also worked three-month rotations in a hospital and a clinic.

"By cutting our funding, they've saved a dime and lost a dollar."

Elabe said the experience showed him how different health care is between the United States and Somalia, where he dealt mostly with urgent problems. He said he had never followed a consistent protocol when taking a patient's medical history or performing a routine wellness exam until he came to the U.S.

"Everybody knows how to do that and if you don't do it, they will look at you," Elabe said. "Even if you're (otherwise) doing the right thing, you will look strange. So that was one of the things that we benefited from that program." 

Dr. Will Nicholson, a U of M professor who helped teach the inaugural class of immigrant physicians, said Minnesota needs doctors like Elabe and Farah who are willing to treat under-served and immigrant communities.

"Many of them could be qualified to do this job with just a little bit of extra training," Nicholson said. "You desperately need people to do this job. Why not get them out in the game? To tackle some of the health care problems Minnesota is facing we need all hands on deck."

An estimated 200 foreign-trained doctors living in Minnesota face similar barriers to becoming a practicing physician. The University of Minnesota program was their best hope for reviving their career. But now that there's no money for the program that possibility has dimmed considerably.

That's a shame, Nicholson said, because re-training foreign doctors is much more cost-effective than training a new student.

"By cutting our funding, they've saved a dime and lost a dollar," he said. "I wouldn't want to be a lawmaker, but my guess is if they had the time to listen to what we did and look at the math, they probably would have done something different. It's unfortunate that politics has to play out in these sort of last-minute, midnight kind of deals."

The three Somali doctors who graduated from the U of M's program must still finish three-year residencies. After that, they're required to work for one year in an underserved Minnesota community.