HL20: José Ramón Fernández-Peña, MD, MPA—A Welcoming Approach

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. They are making a difference in healthcare. This is the story of José Ramón Fernández-Peña, MD, MPA.

This profile was published in the December, 2014 issue of HealthLeaders magazine.

"Think of individuals who may have been making $10 an hour when they first came to the United States and are now making $75,000 per year as healthcare professionals."

José Ramón Fernández-Peña, MD, MPA, director of the Welcome Back Initiative and associate professor of health education at San Francisco State University, remembers the frustration he encountered when he began working in the United States after earning his master's degree in public administration from New York University.

"What I began to find was that I had a set of skills and knowledge I could put to work, and those were undervalued. I was surrounded by a group of people who had similar skills to mine, who also had jobs that were also relatively low to our level of training," he remembers. "It seemed a waste of resources, quite frankly. We could have been doing higher-level jobs, but we were not even considered for those jobs."

He also learned that the labyrinthine process of medical relicensure for foreign-trained physicians in the United States was bewildering at best. "You asked one person and got one answer, asked someone else and got another," Fernández-Peña says. At the time, there was no easy reference for how to become relicensed as a physician, nurse, or other medical professional if one's initial training had taken place outside the U.S. He remembers thinking to himself, "Wouldn't it be nice to have a 'one-stop shop' where all the information would be available in one place?"

Fernández-Peña eventually moved to California, where he began working at a community-based clinic as its director of health education. Because his clinic primarily served a Spanish-speaking population, employees needed to be fluent in Spanish and have a good understanding of Latin culture.

Finding suitable candidates was always a struggle, he says. "Whenever people left the organization, we struggled to fill the vacant positions. We had people come in who were a perfect fit, but didn't have the U.S. credentials for that job. As a result, there was a population needing these services who were not getting them due to this gap," Fernández-Peña says. Once again, he witnessed the waste that occurs when foreign-trained professionals are denied jobs due to lack of U.S. certification.

By 2001, Fernández-Peña held a job where his primary responsibility was assessing the training needs of the San Francisco Bay Area health sector. In that process, he found there was a very large demand for a multilingual and multicultural workforce to meet the needs of an ever-growing multicultural population. Fernández-Peña recognized a need for a specialized guidance and support program for foreign-trained healthcare professionals, and he was invited by the California Endowment to submit a proposal to start such an organization. He received his first grant from the Endowment hat year.

Initially, some people were skeptical of the effort, which was dubbed the Welcome Back Initiative. "We had to explain we weren't trying to lower standards or find shortcuts for foreigners," says Fernández-Peña, who notes public opinion improved once the organization demonstrated to licensing boards, potential employers, and schools that it was just trying to help its participants meet the established standards.

Since 2001, the Welcome Back Initiative has grown from a single location in San Francisco to 10 offices across the country, in eight states. More than 14,000 people from 167 countries have gone through the program.

The initiative offers individualized guidance and support to anyone who earned a degree in a health profession in another country and is currently residing in the United States. Among its offerings are a homegrown accelerated ESL course that emphasizes terms frequently used in healthcare, an introduction to the U.S. healthcare system, and nurse refresher courses. Also, Welcome Back centers offer step-by-step instructions in relicensure and requirements in each state.

According to Fernández-Peña, it's easy to underestimate the impact that foreign-trained healthcare professionals have on the United States. "Think of individuals who may have been making $10 an hour when they first came to the United States and are now making $75,000 per year as healthcare professionals. They have access to better housing, their children are attending better schools, they are paying higher taxes, and have more incentives to become more engaged in civic activities. The return on investment is not only having a doctor who speaks Spanish—the benefits extend outside the clinic setting."