Miami Herald - April 18, 2006
James H. Burnett III, jburnett@MiamiHerald.com

But almost immediately, both hit a wall that some foreign-trained doctors -- mostly from the Caribbean and South America -- have been running into for decades: daunting exams required by the Educational Commission for Foreign Medical Graduates, followed by mandatory training under U.S. standards, followed by a final three-part licensing exam.

Noya and deCardenas familiarized themselves with the exams and knew they would be deficient in some areas, including math and their English language skills. But they couldn't afford to pay for remedial classes, so their medical careers languished.

They worked in retail stores and as medical records clerks. The closest deCardenas came to medical work was drawing blood at a small clinic.

That might have been as far as Noya and deCardenas could take their careers had they not found the Foreign Physician-to-Nursing Program, a charter program at Florida International University that transitions foreign-educated doctors to registered nurses.

"I've heard so many stories like theirs, having to work as cab drivers and grocery store baggers and whatever they can find," said Divina Grossman, dean of the Florida International University's School of Nursing, which has operated Physician-to-Nursing for four years.

"There's nothing wrong with those jobs. But when you've worked so hard to build a career that many feel is a calling as much as an occupation, you can understand how disheartening it could be."

NURSING SHORTAGE

The program is fueled by the growing shortage of registered nurses in the United States -- currently more than 100,000 such jobs are vacant, according to the U.S. Department of Labor. That dovetailed with Grossman's desire to help foreign-trained physicians who couldn't pass the licensing exams. But even Grossman was at first unaware of how many people would respond to the program.

"Honestly, I was aware of this problem, the plight of these people, but not the extent of it," she said. "So I called two Cuban doctors in Miami, who I knew very well. I left them a message asking if they knew of anyone like this, and then I went on vacation."

When she returned a week later, Grossman's secretary presented her with about 350 telephone messages from people interested in the program.

TOUGH SCREENING

Since it began in May 2002, nearly 1,000 foreign-trained doctors applied to the program, Grossman said. Fewer than half made it through the screening process, which requires a level of English language proficiency, as well as basic reading and math skills.

So tough is the screening that the first class had only 40 people. By the third class, that number had risen to just 100.

JoAnne Plumlee, interim chief nursing officer for Kendall Regional Medical Center, said the graduates her facility has hired have largely been successful. "The great thing is, because of their histories as doctors, most bring a knowledge base to nursing that is far more extensive than a traditional nursing graduate," Plumlee said.

But there's been no friction with traditionally trained nurses. "You wouldn't know that they were physicians before," Plumlee said, explaining that is a compliment because it means they have adapted to their new roles without ego issues.

And Silvia Stradi, a nursing supervisor for Cedars Medical Center, which has offered jobs to Noya and deCardenas, said Physician-to-Nursing has allowed her hospital to diversify staff. "We see this as a program that will enhance our patient care and improve our communication with our growing Hispanic population," Stradi added.

For Noya, 35, and deCardenas, 29, FIU's program revived hopes for a medical career.

PARALLEL LIVES

Long before they met and married in Miami, they were on parallel paths.

They grew up in the same town, Santiago de Cuba, and attended the same high school, although in different years. After deciding as teenagers that they wanted to be doctors, they both were accepted into the same medical school, Universidad de Medicina de Santiago de Cuba.

All the while, neither knew the other existed.

Noya spent six years at the Cuban medical school, before leaving in 1994, to finish his studies at the Universidad de Eduardo Mondlane in Maputo, Mozambique, where his epidemiologist father had spent 20 years working with HIV/AIDS patients.

As deCardenas was just settling into med school in Santiago de Cuba, Noya was just wrapping up a yearlong stint as a public health officer in Mozambique for Doctors Without Borders, and in 1997 was moving to Miami with a plan to practice medicine.

"Almost right away I became saddened because I found it was an impossible task to meet all the requirements to be a doctor here," Noya said. Aside from meeting more stringent U.S. medical requirements, Noya's English was, back then, barely conversational and his math skills were deficient.

While Noya was struggling with the realities of the U.S. medical system, deCardenas was still in medical school, but was convinced Cuba was not where she wanted to practice.

"This is not a career about money," she said. "but you expect doctors to receive very good compensation, no? Well, in Cuba a very good physician, with experience -- years of experience -- might be lucky to earn $30 per month."

MOVE TO MIAMI

When she found she wouldn't be allowed to choose her own specialty and would be told where she would practice, deCardenas flew to Miami in 2000, a year after she graduated, and never left.

Unable to get licensed, DeCardenas found work as a medical recorder and drawing patients' blood at an AIDS clinic near her home in Kendall.

"I never got extremely discouraged," she said. "I believe strongly in my situation here, regardless of my job, is better than the life I would have had in Cuba."

In 2002, deCardenas asked a friend how she might get her career back. That was when she was introduced to Noya, who was in the same predicament. If the next 10 months were a movie, the title would've been When Peggy met Tony.By November of 2002 they were married.

Nonetheless, their hopes of becoming doctors again were dimming.

Then they discovered the Physician-to-Nursing program, where they enrolled in May 2004 and graduated last December with a bachelor's degree.

DeCardenas passed the state nurse licensing exam last month and Noya is awaiting his results. With that hurdle cleared, they can choose from more than a dozen nursing jobs already offered to them.

"We're not sure yet which we'll take," deCardenas said.

FUTURE UNCLEAR

Grossman said that although the program has been successful, its future is somewhat murky. Classes so far have been funded by the Hospital Corporation of America, supplemented in recent years by U.S. Department of Labor grants, and so far no new classes are scheduled.

"It is a little frustrating, because we don't have permanent funding for this program yet," Grossman said. "So it's hard to tell people when the next class will get underway. There are nearly 200 people on our waiting list now."

Grossman and her staff encourage those on the waiting list to hang in there.

Said Noya: "It is not easy, but I would tell them it is worth the wait. We will not be physicians again, but still we are recognizing our dream: to once again work with people, with patients."

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