Three Senate bills and one doctor

Months-long waits to see a doctor of any specialty, even as an established patient, have become the norm. Being fortunate enough to have a primary care doctor at all is too commonly the exception. 

A solution 

Our state recognized an unused physician resource in our midst. Washington is the national leader in integrating International Medical Graduates (IMGs are physicians educated in countries other than the U.S. and Canada) into our health care system.  

Through the extraordinary vision of the Washington Medical Commission (WMC is a state agency that licenses doctors), which partnered with the Washington Legislature, we have Senate Bill 5846. SB 5846 liberalized options for full licensure to IMGs to practice in our state. 

Only one other state, Tennessee, has such a pathway for IMG licensure and it has one IMG currently practicing. Since SB 5846 passed in 2019 and was activated in 2021, we have 40 IMG physicians practicing as full-fledged physicians with a Clinical Experience license. 

The U.S. has made it historically difficult for foreign-trained physicians to gain licensure. They must pass rigorous examinations, and then complete a medical residency (residency is the three to seven years doctors spend in clinical training after four years of medical school) in the U.S., no matter what field or level of competence they had in their home country. 

We have a shortage of residency positions in our state. This matters because physicians usually stay where they do their residency. Even IMGs who pass the rigorous qualification requirements, and are willing to retrain, cannot get a residency position here.  

Senate Bills 5118, 5226 and 5185 

These three new bills are being considered to expand and strengthen our IMG licensure program.   

SB 5118 extends the opportunity for IMGs currently practicing to stay for up to eight years (rather than four in the older bill). It establishes strict clinical competency and English language proficiency, plus standards for clinical supervision.  

SB 5226 provides guidelines and provisions to create medical residency slots in Washington, specifically for IMGs only in fields grossly underserved: family practice, internal medicine, pediatrics, psychiatry, ob/gyn and general surgery. All of Washington’s residency programs support this bill. At the moment, this is the only pathway for them to gain permanent full licensure. That is unless SB 5185 passes.  

SB 5185 delineates six pathways for IMGs to gain licensure in this state. One is a hardship waiver for physician refugees who have no access to educational records. These pathways lead to full licensure without time limitation, thus allowing them to stay and serve indefinitely. It offers a viable alternative to the strict U.S. medical residency training requirement.  

At last week’s state Senate hearing, I witnessed moving testimony of IMGs grateful to be working as physicians in our state, some of whom were eminent specialists in their home countries. Most are caring for our most vulnerable, the elderly, including a psychiatrist helping the mentally ill.  

International physicians have left their home countries for a variety of reasons, some fleeing wars as refugees. Once here, insurmountable barriers prevented them from practicing as doctors. 

These physicians agree to no shortage of compromises to have the privilege to practice here. In these times of physician shortages causing endless health care issues for everyone, these bills and a little compromise (of rigidity, not rigor on our part), provide an answer.  

Meet Dr. Achashman Berihun: Thurston County’s one and only IMG  

At Olympic Crest Coffee Roasters in Lacey, I had the privilege of meeting Dr. Berihun.  

She grew up in rural Ethiopia, where her parents are farmers. Inspired to apply herself to learning by an encouraging teacher and a memorably negative experience when she needed health care in the eighth grade, she decided to become a doctor.  

In Ethiopia, medical school is completed in six years after high school, the equivalent of an accelerated medical curriculum.  

After medical school and licensure, she practiced general medicine for three years after which she entered a three-year internal medicine residency to expand her knowledge and skills.  

Halfway through her residency, an opportunity to apply for the visa lottery to Washington presented itself and she went for it. Her goal in doing so was to expand her medical knowledge and skill beyond what was available in her country.  

After winning the lottery in 2017, she, her husband and son left Ethiopia and moved to the Seattle area. Little did she know the barriers she would face to practice medicine here.  

She immediately took and easily passed the required medical competency exams, stymied only by the English proficiency requirement. Needing to support her family and improve her English skills, she worked as a cashier at Seatac, a medical assistant, and a research coordinator.  In the meantime, she had her second child and discovered too much time had passed for her to qualify for any residencies in the U.S.  

Not to be deterred  

Having passed all her competencies, she interviewed in June 2023 and was accepted into the Limited Medical License Clinical Experience program with Pacific Medical Group (Pacific Medical Specialty Group, LLC). It was a life-transforming event. The program asked her to work in Olympia and the family gladly moved to Lacey soon after acceptance.  

Dr. Berihun (with the help of her single physician assistant) cares for a rotating group of 200 patients at three rehabilitation facilities: Panorama, Roulan and Regency Olympia.  

Her patients are complex and recently discharged from the hospital. They stay at those facilities for therapy and needed medical support to be ready to go home. Most are elderly with a laundry list of medical conditions and medications. That includes strokes, heart attacks, infections, diabetes, cancer and weakness after hospitalization to name a few. Many of these conditions are co-occurring. 

Her supervising physician and senior program colleagues are available to support her by phone at any time of day or night. Together her larger team shares weekend and night emergency calls. None of their patients are ever without a physician available. 

Her program has mandatory monthly educational dinners with her 16 colleagues and their preceptors for case presentations, discussions and lectures from specialists. She looks forward to these educational, collegial and inspiring evenings.  

Dr. Berihun has come to love caring for elders. Learning about their lives, she has gained a deep appreciation for her patients and the humbling aspects of aging. For her, it is not only challenging and interesting work, but also a privilege. If laws are passed to allow her to continue to practice, she intends to continue in the field of geriatrics and stay in Lacey. With the passage of SB 5118 and SB 5185, she may very well be able to do just that.  

Benefits of having IMGs 

• IMGs have the opportunity to practice their profession, one in which they have invested enormous time and commitment before immigration.
• For our state, it is a path to solve the physician shortage right away, while some of our own are in the long training process to become doctors. Many of those students may opt to choose residencies and practice out of state with few choosing primary care specialties. The IMGs are willing and anxious to do what it takes to get back to their calling as physicians. 
• As for economic benefits, physician access and availability avoid repeated emergency department visits, hospitalization, unnecessary tests and specialty referrals.  
• For safety, continuity of care prevents relapses and mistakes in handoffs. The rehabilitation facilities and their staff feel supported in caring for their complex patients. 
• For patients and all of us, like it or not, we will need health care some time in our lives. IMGs reduce stress for patients who can regain trust and confidence in doctors and the health care system. 

Please contact the Washington Legislature in support of SB 5118, SB 5226 and SB 5185. It will allow Dr. Berihun to stay and bring more people like her to our county! 

Debra L. Glasser, M.D. is a retired internal medicine physician in Olympia. Got a question for her? Write drdebra@theJOLTnews.com