During his first rotation in pediatrics as a medical student in Boston in the late 1960s, Dr. Deeb Salem came across a man performing janitorial work in one of the pediatric wards. Dr. Salem, now a cardiologist and professor of medicine at Tufts Medical School, asked around and learned that the man was in fact a doctor before coming to the U.S.
“He had fled Cuba when Castro came to power, but it was too hard for him to get licensed in the United States,” Salem recalled. Yet, despite the man’s inability to practice in Massachusetts, other medical students would often ask him questions regarding patient treatment. It seemed to Salem ridiculous that because of an onerous licensing procedure, an experienced older physician from another country could not simply go back to work in the U.S.
That is starting to change with the Mass Leads Act, an economic development bill, signed into law late last year by Massachusetts Governor Maura Healey. Inside this long and wide-ranging piece of legislation is the Physician Pathway Act (PPA), which amends a section of Massachusetts general laws to provide “an alternative pathway for physicians already licensed and practicing in another country.”
The PPA creates a pathway to full physician licensure for qualified internationally trained physicians. Those who qualify must dedicate at least three years of medical practice in a healthcare facility serving state residents with the greatest need in exchange for licensure. The PPA will also provide a mentorship alternative to residency requirements, since most internationally trained physicians will have already fulfilled those requirements in their home countries.
The PPA comes at a time of acute physician shortage in Massachusetts and throughout the country. In our state, 11 of 14 counties are designated as “health professional shortage areas.” These are areas in which there are 3,500 or more patients for every one provider. Given these numbers, it is unsurprising that 55% of Massachusetts physicians, as surveyed by the Cicero Institute, report experiencing burnout. Nearly a third of Massachusetts physicians surveyed intend to leave medicine by 2026, which will no doubt further strain the doctors who remain. The Cicero Institute projects that by 2030, the United States will face a shortage of about 120,000 physicians. Supply is falling, but demand for healthcare is only increasing, particularly given the aging population and the increase in chronic disease incidence.
The PPA will address acute physician shortages in Massachusetts by making the licensing procedure for foreign-trained doctors much easier. Among the proponents of the PPA is Dr. Salem, Chairman of Medicine Emeritus at Tufts Medical Center.
In 2021, then-governor Charlie Baker asked Dr. Salem to join a special commission to study physician shortages and physician licensing requirements. This became the Massachusetts Special Commission on Foreign-Trained Medical Professionals, which met throughout 2022 to produce policy recommendations to the state. The issues the commission worked on were personal for Dr. Salem: the child of Lebanese immigrants, he has worked with immigrant advocacy organizations such as the Asian American Civic Association for years. But the experience he had as a medical student also made a lasting impression on him and informed his work for the commission. He knew how residencies and licensing requirements can take years to fulfill and how doctors who had already gone through this process in their home countries may simply not have the time nor the energy to go through it again, particularly if they need to begin work immediately to support themselves and their families.
The special commission produced a report in 2022 recommending a range of administrative and legislative reforms, including the elimination of redundant licensing requirements and the development of the pathway to full licensure for foreign-trained physicians and dentists. The report also recommends creating a revolving loan program to provide interest-free loans to help defray the expenses that accompany the licensing process. The Massachusetts Joint Committee on Public Health favorably received the report, and the Physician Pathway Act was included in the Mass Leads Act that Governor Healey signed at the end of 2024. It may take as long as a year for the Physician Pathway program to be launched, according to the Massachusetts Immigrant and Refugee Advocacy Coalition (MIRA), an organization vital to the passage of the PPA.
The Massachusetts Board of Registration in Medicine still needs to develop regulations and partnerships with participating healthcare centers before the program can begin. Nonetheless, the most important step – the PPA’s passage into law – has now occurred, and Massachusetts will join several other states in reducing or eliminating costly and time-consuming requirements for internationally trained physicians.
“We’re really excited that the PPA passed. This is something that is much needed here, and it will help address the acute physician shortages in our underserved communities,” Maroni Minter, political director at MIRA, told the Sampan.
Minter described the process as one of bottom-up, community-oriented work “as something that a lot of the communities we work with have been advocating for.”
Among the numerous positive consequences of the PPA, beyond addressing physician shortages, is the potential to reduce stigma in healthcare. Minter points out that immigrants, people of color, and speakers of other languages than English may face barriers in healthcare. With the PPA, there is a greater possibility of being able to see a physician who speaks one’s language or understands one’s culture.
“There’s a trust that occurs when people can see a doctor who looks like them,” Minter said.
But there is still work to be done. Minter stresses the need for more outreach and education, citing the Tuition Equity Act, passed in 2023, as an example of a piece of legislation that many immigrants may not be aware of. The act gives immigrant students access to affordable education through standardizing financial aid and in-state tuition application processes.
“We want to get the word out…our hope is to have some community events, and to host some webinars and continue to educate people.”
MIRA is also looking toward other industries that may benefit from licensing reform for immigrants skilled in these industries, though as Minter notes, MIRA’s priority now is advocating for general immigration protection as the new Trump administration threatens even legal immigration.
For more information about the Physician Pathway Act, visit https://miracoalition.org/our-work/physicians-pathway-act/.
