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Since selling her private practice eight years ago, Dr. Gulshan Harjee has spent most of her professional career invested in the Clarkston Community Health Center, a charity clinic she co-founded that serves a steady flow of immigrant patients.
The internal medicine physician came to the United States after fleeing three different countries in her childhood and adolescent years — experiences that moved her to help others in trying circumstances. As the pro bono medical director of the Clarkston charitable clinic, Harjee sees patients in a town where about half the residents are foreign-born and nearly 1 in 5 are uninsured.
“I left a thriving practice to do this because I was paying it forward,” she said.
Unlike Harjee, who trained at Morehouse and Emory medical schools in Atlanta, many other immigrant doctors struggle to practice medicine in Georgia. Those who received medical degrees outside the United States often face difficulty competing with American-trained doctors for a limited number of residency spots.
It’s not that there’s no demand for more doctors in the state. Georgia’s government has indicated severe physician shortages in many counties, especially rural areas. The Clarkston clinic only has volunteer physicians in large part because of this gap, Harjee said.
To her, part of the solution to both problems is for the state to create a program for qualified internationally taught doctors to train at American health facilities until they are ready to enter the workforce as fully licensed physicians.
That could expand the state’s supply of doctors for little to no cost, and versions of such a program have been implemented in states including Tennessee and Alabama.
“This way, at least they continue to serve in the capacity of a physician,” Harjee said. “They learn our system, they learn our drugs, they know our patient style.”
She also sees particular value that immigrant doctors could add to her clinic, which serves dozens of immigrant communities that have made homes in DeKalb County. That can make it difficult for the clinic to provide care in languages patients can understand, a shortcoming that immigrant doctors could help address.
That’s one of many reasons why she’s advocated for creating this type of pathway since the early 2010s.
“It seems like such a perfect solution for us,” she said.
But unlike some of its neighbors, Georgia has yet to pass a law that helps this reservoir of physicians enter the state workforce.
In the state’s 2024 regular legislative session, lawmakers introduced a bill that would allow foreign-credentialed doctors who have met American medical standards to train at licensed health care centers and eventually apply to work in medically underserved communities. But the proposal died without a vote, and attempts to attach the provisions to other bills had broad support but were also unsuccessful.
As Georgia legislators prepare for the 2025 regular legislative session, Harjee said she wants them to focus on passing a bill that she’s confident would improve the health of people in her community. But after years of unsuccessful pushes to create a pathway, she worries this year may be no different.
“I think there’s going to be a lot of other issues that will take priority over us again,” she said.
Addressing physician shortages and language barriers
While the health of Americans is shaped by a variety of factors inside and outside the hospital, their access to family medicine has major implications for well-being. An additional 10 primary care physicians per community of 100,000 people was associated with people in that area living an additional 51.5 days, according to a 2019 Harvard University study.
In Georgia, the supply of all health care workers is unable to meet demand, and the gap is expected to grow in the coming years. A 2022 commission set up by Gov. Brian Kemp highlighted that the industry loses about 4% of its workforce each year and is expected to need 239,000 new employees by 2032.
Even after accounting for more doctors graduating medical school and moving to the state, the commission expects there to be 1,800 unfilled primary care job openings in 2025.
Many of the Georgia communities with the most urgent doctor shortages are in rural counties, but the Atlanta metro area isn’t immune from the problem. Jeremy Cole, the Clarkston clinic’s executive director, said a study his organization commissioned found that DeKalb County lacked over 100 primary care providers compared to residents’ needs.
Central DeKalb, where the Clarkston clinic lives, had some of the largest gaps in the county. As some of the area’s many resettled refugees have medical training, Cole wishes he could leverage their skills to begin addressing this shortage.
Darlene Lynch, an Atlanta lawyer and longtime advocate for refugees and immigrant communities, has worked to help reform international professionals’ state licensing requirements in a variety of industries. She noted that Georgia’s strong history of refugee resettlement brings many high-skilled residents to the region.
While Kemp’s commission recommended different ways to add and retain frontline health care workers, Lynch said Georgia’s qualified and willing doctors in its international community could also play a vital role in addressing physician gaps.
“We can’t train our way out of this shortage,” she said. “It’s too big.”
Other groups, like the Georgia Latino social services nonprofit Ser Familia, see foreign-credentialed doctors as a way to increase the number of physicians who can provide quality care in patients’ language of origin. Belisa Urbina, the organization’s chief executive officer, said many of the people she serves aren’t native English speakers and are best equipped to speak about their health problems in Spanish.
While the federal government requires many health centers to offer some interpretation arrangements, those services can be insufficient. And Urbina said a doctor appointment that requires a separate interpreter can extend how long a visit takes for people who may not have much discretionary time.
“If you use an interpreter, everything has to be said twice,” she said.
Other states optimistic about licensing programs
When working on a bill to bring more foreign-credentialed doctors into the Tennessee workforce, state Rep. Sabi Kumar, a Republican, reflected on his own experience as a doctor in the Volunteer State.
Kumar, a surgeon born in India but medically trained in the United States, said he knew of many qualified international providers sidelined because there were no residency spots available to them. As Tennessee has experienced health care workforce gaps, he said it was important to bolster his state with as many doctors as possible.
“It’s really opened up an avenue for physicians who are qualified, trained, who have passed the same exam that our graduates in the United States do, to find a pathway that’s much easier,” Kumar said of that bill, which was signed into Tennessee law in April 2023. Its language is similar to the Georgia bill that died earlier this year.
The law and a companion bill passed earlier this year have yet to take full effect, so Kumar said it’s difficult to know how they will impact the health of Tennesseans. He also mentioned there have been some issues making sure foreign-credentialed physicians have facilities to practice at.
But he’s heard the state Board of Medical Examiners has received dozens of emails inquiring about the program. And the law’s effects seem to have rippled beyond state borders.
“We had a bunch of doctors talking to us about ‘well, why don’t we just move to Tennessee? I can become a doctor there much more quickly,’” Lynch said.
Georgia state Sen. Kim Jackson, a Democrat who represents Clarkston, was the lead sponsor of the bill that aimed to create a similar process earlier this year. She said she would propose the bill again at the start of this session.
While lawmakers didn’t enact the bill last session, Jackson said she anticipates that her 2025 proposal will become law.
“I have really great, strong, bipartisan support,” she said. 2024 bill co-sponsor Sen. Kay Kirkpatrick, a Republican, said she would be happy to work with Jackson if the bill is reintroduced.
Although Harjee, the Clarkston clinic medical director, expressed skepticism that a bill would be completed in the next few months, she couldn’t help but imagine the possibilities for immigrant doctors should Georgia pass the law.
She thinks about all the time she’s spent caring for people who’ve struggled to access health care and wants more people in her shoes to have that opportunity as well.
“Think of how much paying forward there would be, think of how much gratitude there would be,” Harjee said. “Giving care and taking care of these patients that can’t get anything anywhere else.”
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