As a physician in Peru, Luis Garcia amassed nine years of medical education and five years of practice, including successful appendectomies, Cesarean deliveries and other surgeries. Since he immigrated to Southern California four years ago, he has earned a community college degree specializing in geriatrics.
The only work he's been able to find, however, has been cat-sitting, dog-walking and elder care.
That's because Garcia hasn't yet been able to pass the battery of requirements for a U.S. medical license, including several exams and a residency. He represents what a recent report calls a massive "brain waste" of highly educated and skilled immigrant professionals who potentially could, with a little aid, help ease looming labor shortages in California and nationwide in healthcare, computer sciences and other skilled jobs.
"I feel lost," Garcia said. "Sometimes I'm embarrassed to talk to my family back home and tell them I'm taking care of dogs. But I know someday I will be able to do my geriatrics practice, and I know there are people here who need my help."
Nationwide, more than 1.3 million college-educated legal immigrants are unemployed or working in unskilled jobs such as dishwashers or taxi drivers, according to the report by the Washington-based Migration Policy Institute. Nearly one-fourth of them, or 317,000, live in California.
Professionals from Latin America and Africa fare worse than those from Asia and Europe, the study found. Two of the biggest barriers are lack of English fluency and non-recognition of foreign academic and professional criteria.
In some cases, for instance, U.S. medical systems require course work typically not required abroad, such as maternity and psychiatric nursing, according to Julie Hughes-Lederer, interim director of the Los Angeles County Regional Health Occupations Resource Center.
Medical licensing exams are also different, such as the use of multiple-choice exams in the United States -- a format regarded as more difficult than the essay exams used in other countries.
"A lot of this is just technical obstacles they have to get through," Hughes-Lederer said. "We don't have to question their capability to learn and progress. You know they have the gray matter."
Immigrants say shortages of time and money prevent them from pursuing the needed U.S. credentials. Arsal Awan, 50, immigrated to the United States in 1985 shortly after earning his law degree in Pakistan. But he was forced to abandon his professional career ambitions when his father suddenly died and he needed to begin sending money to his family back home. He worked in a duty-free shop, started a radio show and 15 years ago began driving taxis in L.A. -- a job he still does 12 hours a day despite the back, knee and stomach problems he says it causes him.
"I always wanted to be in the legal field, but you really have to study a lot, and I never had a chance to go to school" here, Awan said.
Michael Fix, senior vice president of the Migration Policy Institute, said the need to help immigrant professionals gain the requisite credentials and experience is particularly acute now that the nation faces the impending retirement of 77 million baby boomers, considered the most skilled workforce in history. In California, for instance, the fastest growing occupations are computer software engineer and registered nurse.
California also faces shortages of health professionals who can speak the language and understand the cultures of the state's increasingly diverse population. Latinos, for instance, make up 35.5% of California's population but only 5.2% of its physicians and 5.7% of its registered nurses, according to data compiled by the Welcome Back Initiative, a program primarily funded by the California Endowment and the California Wellness Foundation to help immigrant health professionals overcome barriers to practicing in the state.
Since its inception in 2001, the program has helped nearly 8,000 foreign healthcare professionals from more than 160 countries by offering courses, training, counseling and other services. The endowment's funding, however, is set to expire this year.
The migration institute report noted that competition for such professionals is heating up, with other countries such as Canada and Australia moving aggressively to attract them with better transition programs.
"The U.S. historically enjoyed the advantage in picking the best immigrants in the world," said Jeanne Batalova, a policy analyst with the institute. "But with other countries entering the race for global talent, the U.S. is losing its competitive advantage."
The report urged several new measures to help ease the way for immigrant professionals, including more language and workforce training, national coordination of credentialing criteria and three-year transitional visas to allow employers to "test the waters" with foreign workers.
The report also suggested an expansion of successful programs such as Welcome Back.
At Welcome Back's Southern California center at Mt. San Antonio College in Walnut, several immigrants huddled over a plastic arm sheathed in a tattooed covering to learn how to draw blood. Although all of them had drawn blood countless times in their careers, instructor Xochitl Manriquez was teaching them how to use the latest U.S. technologies. The class was part of their training to become medical assistants -- work far below their qualifications that would nonetheless get them back into the healthcare field.
The group included physicians from Peru, Mexico and Iran, radiologists from Honduras and nurses from El Salvador. They related, sometimes tearfully, their experiences of leaving their homes to come here and the difficult times they've had trying to reclaim their professional careers and identities. Some were pushed out by violence and poverty, others were pulled by the chance to learn advanced U.S. medical techniques.
Marta Martinez, a nurse from Mexico, said she had to lay carpet and sell flowers on the street when she first came to California more than a decade ago. She said she shelled out $850 to a private firm that guaranteed it could help her pass her U.S. licensing exam for nurses, but she failed. Like several of the professionals, Martinez said her big mistake was taking the exams before she had mastered sufficient English.
Manriquez, licensed as a physician in Mexico, assembled lamps in her uncle's factory in her first job in the United States. She passed the first exams required for a U.S. medical license but abandoned the process after being diagnosed with cancer. She now teaches in the Welcome Back program and does volunteer surgeries and other medical work in Mexico with two international medical organizations to "shake my frustration" of not being able to work as a doctor here.
"Human beings in the whole world are the same," said Fariba Fadaee, an Iranian doctor who passed all of her U.S. medical exams and is now applying for a residency. "If we can manage patients in our own country, we can do it here too."