When Sarah Abdullah left Iraq as a refugee, there was no going back.
A practicing pharmacist, she left the country after her hospital in Tikrit — a city about 90 miles northwest of Baghdad — was struck by a suicide bomber. She and her husband made their way to the U.S. in 2013, after the International Organization for Migration accepted their application. A year later, the city fell to Islamic State forces.
Abdullah, now 33, expected to start practicing quickly when she got to the U.S. But she soon found that Washington state, with its welcoming posture toward immigrants and refugees, is a difficult place for many foreign-educated professionals.
“It’s not easy at all,” Abdullah said of her attempts to practice in the U.S.
She started applying everywhere, but no one hired her. Employers require licenses to practice in Washington state.
“People were asking me ‘Do you have a license?’” Abdullah said. “OK, how do I get a license? I don’t know.”
She was told that despite being a trained pharmacist, she would have to work as a cashier, get retrained as a pharmacy tech and maybe one day become a pharmacist again.
That was until her refugee resettlement agency pointed her toward Highline College’s Welcome Back Center, where she now works as the program coordinator as she works toward getting Washington credentials.
The Welcome Back Center provides resources and guidance for immigrants and refugees with professional certification as they navigate the complicated bureaucracy and red tape that typifies the experience. Located in Des Moines, the center is one of two in Washington. There are only nine such centers across the country.
The centers were started as part of the federal Welcome Back Initiative in 2001. Since Highline College’s program opened 13 years ago, it has served about 2,000 people, center director Linda Faaren said.
Faaren said many people who walk through the doors think that their degrees are now worthless. But that’s not the case.
“It will be a process to get back into your field, but your degree, your bachelor’s, your master’s or your doctor’s are in fact worth something here,” Faaren said.
However, there are many barriers in the state, especially for health care workers.
A report from OneAmerica found that a lack of information and guidance, inadequate English courses, certification challenges, cost issues, gaps in education, lack of professional networks and employer bias all factor against foreign-trained health care workers and others.
Some 18 percent of foreign-born residents with degrees from outside the U.S. were working in low-skill jobs, compared to 13 percent of U.S.-born citizens and 12 percent of U.S.-educated immigrants. Twenty-three percent of Washington’s foreign-educated immigrants are unemployed or underemployed at low-wage jobs, according to the report.
A 2017 report by the city of Seattle found that more than 20 percent of King County residents were immigrants. It noted similar levels of underemployment, and non-citizen immigrants were more likely to be working in low-paying jobs.
Immigrant and refugee workers are also caught in a larger cycle. Middle-income jobs disappeared during the Great Recession. They have also taken longer to rebound afterward. Workers are moving horizontally to jobs in different fields instead of moving up in their jobs, according to the Seattle report.
“It’s a tough issue because we live in a time where… there’s winners and losers in this labor market and economy,” said Glenn Davis, a workforce specialist for Seattle.
And the state could soon need those underemployed workers. Washington state is facing worker shortages in several professions, including nurses, teachers and doctors. By 2025, Washington is expected to have a dearth of 7,000 nurses, placing it 45th in the nation. Certificates to allow partially-trained teachers to work is multiplying and Washington needs tens of thousands more doctors to keep up with the health needs of an aging population.
Cheryl Cariño-Burr, the health care lead at the Welcome Back Center, said it costs about $1,000 for nurses to get licensed if they pass every test on the first try. Even health care professionals coming from many countries where English is a primary language still have to complete the language test. The OneAmerica report states the Test of English as a Foreign Language exams don’t necessarily reflect the level of language actually needed to perform the job.
The Welcome Back Center lobbied the state to allow a different exam to be used — the International English Language Testing System, which has led to more foreign-educated nurses passing the test while still keeping standards high. It has been described as being more oriented to real-world uses, as opposed to academic. Washington state nursing and health care certifications are approved by the state Department of Health.
Cariño-Burr said other states such as California and Idaho don’t require an English proficiency test if the classes that health care providers initially took were in English. Consequently, many immigrants and refugees will leave Washington state to get licensed, and many never return, she said.
For those with fewer English skills, the report said many English as a second language courses at colleges lack the capacity, knowledge and support to adequately teach professionals. Portland Community College began addressing this recently, for example, and created a career pathway English course for foreign-trained accountants.
Nurses are the single largest category of professionals who access the Welcome Back Center, accounting for 798 people. It also serves nearly 300 doctors, more than 80 dental health professionals and nearly 800 other professionals ranging from accountants to architects.
In Washington, nurses need to complete an evaluation of foreign credentials, pass a rigorous English exam, submit an application to the state, and pass the National Council of Licensure Examination.
The OneAmerica report states that in practice, the process of credential evaluation — the first step — is often an insurmountable hurdle.
“In a lot of ways, we’re missing out,” Cariño-Burr said. “Our communities are missing out linguistically and culturally.”
For example, to get licensed, professionals usually need sealed copies of their transcripts or credentials.
For Abdullah, that’s not possible. The National Assocation of Boards of Pharmacy wanted proof of registration from Iraq to be sent to them directly in a sealed envelope. But to get that sent, she would have had to return to Iraq. Her pharmacist registration lapsed in 2013, and the Syndicate of Iraqi Pharmacists required her to renew it in person.
“I like burned the bridges, I have nothing there,” Abdullah said. “Iraq is not a country that you can apply for that approval online or ask them to send it to the Department of Health in the mail. There is no such thing.”
Returning to Iraq was out of the question. Cariño-Burr helped her write a letter to the board explaining her situation, after which the board accepted her credentials and issued her a foreign pharmacist certification. This was then sent to the Washington state Department of Health to get her pharmacy intern license.
But the Department of Health still said they wanted a letter of good standing for her Iraq pharmacist license. She had to again explain that she couldn’t get that without returning to Iraq in person. So the Welcome Back Center sent a separate letter to the department explaining her situation. Abdullah said the state accepted the letter and granted her an intern license.
“I feel that every step I have accomplished here is because of the help and support from the Welcome Back Center,” Abdullah said.
When additional education is needed, Cariño-Burr said allowing foreign-educated professionals to take specific courses from programs to fill education gaps could help. They were meeting with Bellevue College in the coming days to try and develop an “a la carte” course offerings. For other programs, like engineering, the center is petitioning the state to develop their own re-certification standards, instead of using national ones, to create a more tailored approach.
Rhetoric vs. Action
Still, the report prepared by OneAmerica found some disparities. It cited a study by IMPRINT, which looked at six U.S. cities, including Seattle. It found that Seattle’s immigrants had the lowest rates of “professional success” as defined by their ability to earn at least $50,000 and use at least some of the skills from their degrees.
Professional immigrants in Seattle also applied to have their credentials evaluated less often. This could point toward more complications and barriers for those navigating the system, according to the report.
Employer bias is another potential problem. The report states that employers may dismiss or undervalue foreign work experience. Fernando Ramirez, the STEM and business lead for the Welcome Back Center, said immigrants often arrive with a “mode of survival,” making them solid bets for employers.
“We tell employers that if you give them a chance, they will be surprised by the level of skill, focus and family background,” Ramirez said.
Abdullah experienced this in her own search for an internship. After getting her intern license in late 2017, she applied to more than 50 places for a pharmacist internship. She found one in July 2018.
After years of navigating the system, Abdullah is getting close to the finish line. She passed her Foreign Pharmacy Graduate Equivalency Exam, passed the English test and completed 1,500 hours of training. She’s preparing to take the North American Pharmacist Licensure Examination as well as the Multistate Pharmacy Jurisprudence Examination this year.
After five years of working to become certified, she hopes to soon be fully licensed to practice in Washington state.