Medhane Mesgena Highlights How Hospitals Can Better Integrate Competency-Based Assessment for Foreign-Trained Providers

Across the United States, health systems face a paradox: while physician shortages are projected to exceed 100,000 in the coming decade, thousands of highly trained international medical graduates (IMGs) remain sidelined. The problem is rarely a lack of skill. Instead, the credentialing process is lengthy, duplicative, and often more focused on bureaucracy than competence.

As Dr. Medhane Mesgena emphasizes, the solution lies in rethinking how hospitals evaluate readiness to practice. A competency-based assessment framework, already tested in countries like Canada and the UK, offers a fairer, faster, and safer way to integrate foreign-trained physicians into the U.S. workforce.

Why Traditional Credentialing Falls Short

Over the past decades, the U.S. has used standardized tests, duplicate residencies, and long licensing timelines to sort through international medical graduates (IMGs). Although these protections ensure patient security, they also impose system-wide delays, frequently benching doctors already in charge of thousands of challenging cases elsewhere.

Dr. Medhane Hagos Mesgena, MD, notes that this system also too frequently tests perseverance rather than ability. A 15-year-old cardiologist with practical experience in Ethiopia, for instance, will also take three to five years to be entitled to practice on her own in the U.S., a schedule that is ever more unrealistic in the face of growing physician shortages.

The problem is structural. Current models emphasize:

• Redundancy over relevance: Requiring IMGs to repeat entire residencies, regardless of proven clinical track records.
  
• Exams over experience: prioritizing test performance rather than bedside judgment and procedural expertise.
  
• Time over talent: Equating years spent in U.S. training pipelines with competence, instead of measuring skills directly.
  
• Uniformity over flexibility: Applying one-size-fits-all requirements without considering diverse practice backgrounds.
  

As Dr. Mesgena argues, the issue is not that the U.S. lacks safeguards, but that those safeguards are misaligned with today’s urgent workforce realities. The outdated evaluation frameworks cannot afford to filter out talent in the healthcare system.

What Competency-Based Assessment Really Means

Competency-based assessment shifts the focus from credentials on paper to skills in practice. Instead of requiring blanket retraining, hospitals evaluate IMGs on their actual clinical performance through:

• Simulation-based testing: IMGs demonstrate decision-making in emergency scenarios such as cardiac arrest, sepsis protocols, or obstetric hemorrhage.
  
• Supervised patient care: Structured rotations where experienced attendings evaluate bedside manner, diagnostic accuracy, and procedural skill.
  
• Objective Structured Clinical Examinations (OSCEs): A gold standard in medical education worldwide, OSCEs allow candidates to demonstrate proficiency across specialties in standardized, measurable ways.
  

As Dr. Medhane Mesgena explains, these methods are not shortcuts, they are direct measures of patient safety and clinical judgment.

Global Lessons Worth Considering

Several countries have already implemented competency-based frameworks with measurable success:

• Canada’s Practice-Ready Assessment (PRA) programs allow qualified IMGs to demonstrate clinical competency through supervised practice before entering independent work, particularly in underserved rural areas.
  
• The UK’s GMC (General Medical Council) requires IMGs to pass the PLAB (Professional and Linguistic Assessments Board) exam, which includes OSCE-style stations that test applied medical knowledge.
  
• Australia’s Competent Authority Pathway enables physicians from select training backgrounds to demonstrate readiness through targeted competency assessments, avoiding unnecessary redundancy.
  

Dr. Mesgena emphasizes that the U.S. can adapt these lessons while preserving its high standards. The goal is not to lower the bar but to measure readiness in ways that are relevant, fair, and efficient.

How Hospitals Can Lead the Shift

Hospitals are uniquely positioned to pilot competency-based pathways, especially teaching hospitals and large health systems. Practical steps include:

1. Hosting assessment centers: Partner with credentialing boards to run simulation labs and OSCEs onsite.
   
2. Structured IMG rotations: Short-term, competency-focused rotations that test skill directly rather than repeating entire residencies.
   
3. Mentorship and cultural orientation: Assigning physician mentors who guide IMGs through both clinical expectations and U.S.-specific medical culture.
   
4. Telemedicine-based assessments: Leveraging technology to evaluate decision-making in real-time patient encounters, a model especially relevant after the COVID-19 pandemic.
   

By spearheading these initiatives, hospitals can demonstrate leadership in both workforce innovation and equity. As Dr. Medhane Mesgena emphasizes, true innovation lies not just in filling workforce gaps but in building equitable systems that value international physicians as trusted partners in patient care.

The Equity Argument

At its essence, competency-based assessment is not simply a hiring solution; it is an equity imperative. In healthcare, an equity imperative structures systems that not only hire but also actively diminish disparities and increase access for the most vulnerable.

Traditional routes of licensure ignore the on-the-ground experiences of physicians as well as the populations they might serve. Numerous international medical graduates (IMGs) are from nations in which health inequalities are not theoretical but a lived reality. They are trained to practice in setting-limited environments, high-volume patient treatment, and within cultural and linguistic diversity, all of which are directly applicable in the U.S. environment.

Dr. Medhane Mesgena emphasizes that ignoring their readiness creates a dual loss:

• For communities: Patients in rural towns, inner cities, and marginalized neighborhoods remain underserved. These areas often have the most severe physician shortages, yet they are the least prioritized under the current system. Competency-based pathways could immediately channel skilled doctors into these regions.
  
• For physicians: Talented doctors endure years of underemployment, often working in positions far below their training while waiting for licensure. This not only wastes expertise but can also erode morale and financial stability.
  

The equity lens is critical. Competency-based models ensure that healthcare access is not reserved only for populations in affluent regions but extended to those most in need. At the same time, hospitals gain from a more diverse workforce—one enriched by global experience and cultural fluency. These attributes matter in a country where patient populations are increasingly multilingual, multicultural, and varied in health literacy.

Ultimately, competency-based assessment reframes the conversation from one of gatekeeping to one of responsible inclusion. It is not about lowering standards; it is about aligning evaluation with the realities of patient care and the urgent need for equity in health access.

Conclusion

Competency-based assessment offers a balanced path forward, preserving patient safety while unlocking the talents of thousands of international doctors. Hospitals that adopt these frameworks will address critical workforce shortages and set a standard of fairness in an era of widening healthcare inequality.

As Dr. Medhane Mesgena emphasizes, progress will depend on shifting perspectives: foreign-trained providers must be seen not as outsiders to be retrained endlessly, but as colleagues ready to be tested, trusted, and integrated.

Key outcomes of this shift include

• Stronger Workforce Capacity – Hospitals expand their pool of qualified physicians without compromising care standards.
  
• Equity in Access—Underserved communities gain timely access to doctors who are both skilled and motivated to serve.
  
• Fairness in Practice—Systems evaluate doctors on what truly matters: the ability to heal patients safely, effectively, and compassionately.
  
• Global Expertise at the Bedside—Patients benefit from providers who bring diverse clinical experiences and cultural fluency into care delivery.
  

The future of healthcare, as Medhane Mesgena frames it, will be defined not by how long doctors wait to practice, but by how quickly systems recognize and responsibly integrate their proven ability to deliver care.