In Uzbekistan, Dora was a well-respected oncologist with more than 25 years of experience taking care of cancer patients.
In the United States, she was told that her medical license would not be accepted, that her English was too poor to work with patients. She was encouraged to get a job in a cafeteria or as a housekeeper.
“That was a big humiliation for me because nobody had ever said those bad words to me. After that, I was depressed, I cried a lot,” Dora told The Daily Progress.
Dora, who asked to use a different name to conceal her identity, found employment at a large-scale, chain grocery store in Charlottesville. Yet, as a former physician once in charge of an entire medical department, the job is “horrible for me.”
U.S. Sen. Tim Kaine speaks at the CODE Building in downtown Charlottesville during a campaign rally as the Virginia Democrat makes a bid for a third term, Thursday, April 4, 2024.
“I’m not a satisfied person,” she said. “It’s terrible for me.”
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Despite the rejections she has faced time and again since she, her husband and their four children immigrated to the U.S. three years ago, Dora is still trying to find a way back to the career she sees as her calling.
“I enjoy my work,” she said. “I really want to work at the hospital here, because almost all my life, I helped my patients, and I can do it. I have a lot of medical knowledge, and I have a huge experience, but … I can’t speak English very well.”
Last summer, Dora spent two months studying in an EMT training program but decided to drop out before the final exam because she didn’t think she would be able to complete the test in the allotted time as she still “couldn’t think in English.”
Though Dora often feels alone and isolated, statistically, she is far from it.
According to the Migration Policy Institute, 2 million immigrants with a college degree are currently unemployed or underemployed in the U.S. Of those individuals, roughly 270,000 hold health-related degrees but are either working below their level of training or not involved in health care at all.
From Dora’s, and others’, perspective, this population could play a role in addressing the shortage of workers that has plagued the U.S. health care industry in recent years, especially after the pandemic burned out many in the field. Studies show that, over the next several years, the country could have a shortage of almost 30,000 nurse practitioners and 122,000 physicians.
“I don’t say, ‘Oh, I should work as a doctor,’” Dora said. “I understand it’s impossible right now, and it’s a different system. But this problem should be observed, and they should think about it, because it’s a very big problem and a lot of immigrant doctors live here.”
Today, Dora is enrolled at Thomas Jefferson Adult Career Education, a branch of Piedmont Virginia Community College in Charlottesville, where she takes English classes as well as some prerequisite medical courses online through the community college. The center provides English language learning and General Education Development, or GED, courses, completely free of charge to more than 800 individuals, many of them immigrants.
It was in one of these classrooms where, one morning last month, Dora had a chance to bring her case to a higher power: U.S. Sen. Tim Kaine.
The Virginia Democrat, now running for a third term, visited the adult education center to hear from those who stand to benefit from his Jumpstart Our Businesses by Supporting Students, or JOBS, Act, proposed legislation that would expand access to federal grants to those seeking high-quality, short-term job training programs.
As he was touring the facility, Kaine dropped in on a few of the classes to speak with students, one of whom was Dora, eager to share some of her suggestions with the senator. She shared her story with Kaine and inquired about the possibility of a special program for foreign doctors that would streamline the current process to work in the U.S.
Though he was there to discuss other initiatives, Kaine told The Daily Progress that, after his tour, his conversations with Dora and several other students, who expressed similar frustrations, challenged “me to think harder about that.”
Two weeks later, he proposed the Welcome Back to the Healthcare Workforce Act, proposed legislation that would fund a grant program helping internationally educated health care professionals obtain their certifications; connect them with the local resources providing the necessary prerequisite medical and English language learning classes; and develop mentoring and “culturally competent career counseling opportunities.”
“I think the need for it is even getting stronger and stronger,” Kaine told The Daily Progress on April 9, just after his office revealed the text of the bill. “The Piedmont Community College program I visited, I thought, was a really innovative way to address and help this class of people who really want to be health care providers.”
Democratic Virginia Sen. Tim Kaine assists a student with her English exercises at Piedmont Virginia Community College’s Thomas Jefferson Adult Career Education facility in Charlottesville on Monday, March 25, 2024.
‘You feel helpless because you cannot give’
Though it is just now making its way to the Senate floor for the first time, Kaine first began putting the bill together shortly after the pandemic roiled the health care industry. He said the focus on tapping foreign medical professionals was inspired by someone working on a health care fellowship on loan in his office who pointed out there was a significant number of qualified workers unable to practice due to licensing and other barriers.
For internationally educated health care workers to continue practicing in the U.S., it’s not as simple as closing one clinic in Central Asia and opening another in Central Virginia. First, they must reach a level of fluency in English that not only allows them to converse with patients and colleagues, but also to comprehend more complex medical jargon.
That is only Step 1. Next, they are often required to take prerequisite science classes, such as anatomy and biology, study for and pass multiple medical licensing exams, obtain credential evaluations and, often, repeat a residency program, which typically lasts upward of three years.
“If you need to take residency, it’s a big problem for foreign doctors,” said Dora. “It’s a hard path for immigrants. It’s a long way for immigrant doctors because my experience isn’t enough.”
Over the past few years, as the industry continued to struggle with an inadequate number of personnel across the country, Kaine said that the Welcome Back to the Healthcare Workforce Act has managed to accumulate endorsements from more than 50 groups, which the senator referred to as “a real United Nations of NGOs, workforce, health care and pro-immigrant organizations.”
Given this enthusiasm as well as the widespread bipartisan support for such legislation, Kaine is optimistic about the bill’s chances in Congress this year.
“I think there’s a good chance we’re going to take up the general topic of the health care workforce shortages,” he said. “And if we do, I’m going to do all I can to get this bill included in that package, and I think I have a high likelihood of doing that.”
When Jules Semikenke heard of Kaine’s efforts, he was grateful that someone was willing to take a step to assist immigrants with medical backgrounds like himself and his wife Stella.
“I think it will be very helpful also to the patients, to the staff members to have more support,” he told The Daily Progress. “We’ll really be excited and happy to give what we know and give our best for the country and for the health care teams.”
Jules Semikenke came to Charlottesville in 2011 to escape political unrest in his home country, the Democratic Republic of the Congo, where he worked as a general practitioner. Stella Semikenke, a dermatologist, was able to follow him across the Atlantic 10 years later.
Though they first arrived in the U.S. with hopes of finding better opportunities, Stella Semikenke, who spoke to The Daily Progress with her husband translating, now finds herself asking, “Was this a good move?”
“She definitely is frustrated. Every day she tells me that she feels worthless,” said Jules Semikenke. “Because everything she knows, she cannot give anything, she cannot help in any way. You feel helpless because you cannot give.”
Stella Semikenke is a classmate of Dora’s at the adult education center where she works to improve her English, but she is unable to do anything with her medical degree. Her husband said that she still stays in touch with her patients back in the Democratic Republic of the Congo, reads every dermatology-related book she can find and has even tuned in to some online dermatology conferences held in Canada where the attendees spoke French, the official language of the Congo.
“It’s something we cannot live without, even if we do other things because we have to survive, there’s still that passion that we have with helping patients,” Jules Semikenke said.
When he first arrived in the States, the only employment Jules Semikenke was able to find was with a housekeeping service and truck company, jobs that undermined not only his qualifications and skill, but also his sense of worth.
Jules and Stella Semikenke both worked in health care back in the Democratic Republic of the Congo. When they moved to the U.S., multiple barriers to entry prevented them from continuing their careers.
“At some points in my life, I was depressed here, clinically depressed,” he said. “Working as housekeeping. … Obviously now I’ve been here a little longer, and I try to see what I can do, but there’s still that sometimes it’s still there. I don’t want to say, ‘I was — I was something,’ living in the past kind of.”
Jules Semikenke did not want to live in the past, did not want to wallow in despair, so he applied himself. He started studying to become a certified nursing assistant, or CNA, so he could find some way back into a hospital. In 2016, he was able to begin working as nursing assistant at the University of Virginia, where he took advantage of the health system’s benefits to enroll in Piedmont Virginia Community College. In 2020, he graduated as a registered nurse.
Even though he enjoys being able to interact with patients now, Jules Semikenke said he still feels limited, knowing that he has more to offer to those in his care.
“I thought it was going to be easier than how it is,” said Jules Semikenke. “I knew it was going to take a little bit of patience and figuring out if there’s anything I can do. But, of course, I didn’t expect to start the way I started. It’s been now 12 years.”
The University of Virginia Health System is anchored by UVa Medical Center in Charlottesville.
Bridging cultural and medical divides
Even without the federal government’s endorsement, some hospital systems have already implemented measures on their own to ease the transition for people like Jules Semikenke and Dora.
Kathy Baker has served as the chief nursing officer at UVa Health since 2021 and holds over 25 years of experience in the health care field. She told The Daily Progress that while language and educational differences do present some challenges to foreign health care providers, she has found that the transition to working in an entirely different cultural environment can be just as formidable an obstacle, if not greater in some cases. This difficulty to adjust has been particularly evident when training newcomers to use the health system’s electronic health records, an online version of a patient’s medical history that practically all U.S. hospitals and clinics adopted close to a decade ago.
“It’s a new world for many of our internationally trained nurses to work in a more digital environment with the level of automation we have in the U.S.,” said Baker.
“So, the biggest hardships are adapting to the culture of health care teams as well as … in the U.S., we really are focused on the work of the entire disciplinary team and collaborating to work with a shared understanding. That’s a big hurdle for nurses who may have worked in a more hierarchical-focused system with different expectations,” she added.
Jules Semikenke agreed with Baker’s observation, saying he has encountered many foreign medical workers who chose to leave their profession behind in the U.S. because they were “paralyzed by the complexity of the system.”
To ease this assimilation process, Baker said that UVa Health has connected international nurses who are more established both in the hospital and Charlottesville area with new arrivals to help them get acclimated both inside and outside of work. The program is an undertaking the hospital did on its own, but Kaine’s bill would provide additional resources and community partnerships to further expand the initiative.
Such a mentorship network has proven beneficial, and UVa Health has made an effort over the past several years to specifically recruit foreign medical professionals from countries “with an excess of nurses who struggle to find employment,” according to Baker. Last year, the health system hired 35 international nurses to fill a shortage of health care workers in Charlottesville, though Baker said hiring internationally trained nurses is only “a piece of the puzzle.”
“The whole puzzle is good, healthy work environments and focusing on our new graduates,” she said. “[Kaine’s bill] can fill the void to a point, but what we all learned over the past few years with health care worker shortages is that it’s not going to be a one-size-fits-all.”
While both Dora and Jules Semikenke expressed hope that Kaine’s proposed legislation will have some positive impact on their continued attempts to carry out their vocations in the U.S., Dora said she and her husband are thinking about returning to Uzbekistan once their children have graduated college and are settled on their own.
One of their daughters recently graduated from UVa, and another is currently a graduate student at the school. Their two younger sons are at Albemarle High School.
“We are here for our children,” said Dora, who added they specifically moved to Charlottesville so their children could attend UVa. “Nobody from our friends and relatives didn’t understand us because we had respect in Uzbekistan, a good job, our own house and a lot of material things. But, for us, education is very important, and so we moved here.”
However, if the couple is “unsuccessful in their efforts” to find meaningful work, then, Dora said with resignation in her voice, “maybe, after five or six years, we will go back to Uzbekistan.”
