As an anesthesiologist in Moscow, Aleksandra Prasolova always heard the United States had some of the world’s greatest hospitals.
“I wanted to work with the best and really to learn from the best,” she said.
That’s why Dr. Prasolova said she gave up a comfortable career three years ago to join family living in Brooklyn. At age 35, and without a medical degree from the U.S., she knew she’d have to start all over again. Her foreign degree would have to be certified and she’d need to pass two grueling exams, a notoriously tough process that could take several years and cost thousands of dollars. After that, she’d have to apply for a three-year residency at a hospital.
But shortly after moving here, she heard from other immigrants about how that final step, getting matched with a hospital, would be the hardest part. They told her first-hand stories.
“Like look at me, I passed all the exams and I couldn’t match for eight years,” she recalled. “I couldn’t match for seven years, I couldn’t match for five years… Do not make my mistakes.”
Dr. Prasolova took the warnings to heart and set her sights on becoming a nurse first, because the process was faster. She earned a nursing degree online last year from a university in Russia that partnered with a school in New York, because she said it was much cheaper than an American degree, which could cost more than $40,000.
But that meant an evaluation agency would have to determine whether her foreign nursing degree matches standards used by different states before she can even go for a nursing license. She sent her academic credentials last summer and was still waiting for approval this month.
“I think I’m almost ready to give up,” she said.
Now 37, Dr. Prasolova is also unemployed. A few years ago, she’d gotten credentialed to work as a clinical medical assistant to pay her bills, and had moved from an office job to teaching at about $35 an hour part time. But the school where she taught had to cancel her class this month because of the COVID-19 pandemic.
Now, during a public health crisis, Dr. Prasolova is among almost 1.2 million adults with medical degrees who are considered underemployed, according to the Migration Policy Institute. They’re trained as nurses, doctors or therapists but they’re often in low-paying jobs outside their field, working in restaurants or as home health aides. Nationally, MPI found a quarter of them are immigrants. But in New York City, senior policy analyst Jeanne Batalova said the figure is much higher: 55 percent and more than 60 percent in the Bronx and Queens.
“New York City is a very attractive place to live and work,” she explained, and a popular destination for immigrants. “So there is a natural competition for the number of spaces that are available in hospitals and clinics in the city,” she added.
Competition is part of the reason they’re underemployed. As Dr. Prasolova learned, hospitals in New York usually choose residents who were trained in the U.S.—sixty percent of the 16,000 underemployed immigrants in New York City earned their degrees back home. Many don’t have the English skills to pass a highly technical test. Then there’s the time commitment and cost.
These immigrants are typically refugees, asylees, and those who were sponsored by relatives. Batalova said only a small percentage are undocumented. Though 16,000 isn’t a big number in a city of more than eight million people, she said these underemployed residents should be put to better use. “Immigrants bring important language and culture skills that could be very helpful at the time of an epidemic,” she explained, especially given that almost 40 percent of New Yorkers are foreign born.
It’s a population that also wants to help right now, said Jina Krause-Vilmar, CEO of Upwardly Global, which counsels under-employed immigrants on how to get the jobs they were trained to do or to pursue other careers in health care.
“We surveyed our internationally-trained health care professionals,” she said. “Ninety-three percent said that they want to serve in this moment regardless of the risks to themselves. I think that that’s incredibly powerful.”
Powerful, she said, because it shows how many are in what she called “survival” jobs that might not even exist right now because of the pandemic.
Upwardly Global encouraged Dr. Prasolova to volunteer right now, but the Russian immigrant said she tried a couple of hospitals that never replied. There are limits to the kind of volunteer work that can be done without a medical license, which is why some immigrants are offering their skills at COVID-19 testing sites.
New Jersey allowed foreign-trained doctors to get temporary licenses during the pandemic and so has Nevada. But New York hasn’t done that. Governor Cuomo signed an executive order that only shortens the residency requirement from three years to one for immigrant doctors.
At Northwell Health, which runs 23 hospitals in the region, Senior Vice President and Chief Academic Officer Dr. Andrew Yacht said that’s a good first step but he said there’s still more to do.
“In the time of COVID there are great needs for all levels of care,” he said. “I think the state of New York and New Jersey are going a long way but could certainly be more creative working with health systems and hospitals to try to match up those needs.”
The United States already relies heavily on immigrants in its healthcare industry, and more than a quarter of all doctors were born abroad. But even those already licensed in the U.S. face limits, too, in terms of where they can work.
This week, Aleksandra Prasolova was finally approved to take the licensing test to become a nurse. But because of logistical hurdles caused by the pandemic, she doesn't know when she’ll be able to sit for the test. And her foreign credentials were only approved for North Carolina. She also chose to have her degree evaluated for Florida and Arizona. She selected these states because she thought the process would be faster for them than for New York.
Dr. Prasolova said she understands why foreign degrees need to be examined closely and doesn’t want states cutting corners on licensing. That’s why she thinks changes need to be made that will last beyond the pandemic.
“The crisis we experience right now just revealed the process that’s been broken for years,” she said.
Beth Fertig is a senior reporter covering immigration, courts, and legal affairs at WNYC. You can follow her on Twitter at @bethfertig.