ILLUMINATION
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ILLUMINATION

The AMA Was Against Foreign Doctors Practicing Medicine in the US During WWll

How did they succeed despite the AMA’s tactics?

By Elizabeth Kaldeck Smith

My parents at a train station in West Virginia in 1941. Photo provided by E. K.Smith, ©2022

As medical doctors fled Nazi Europe for the US before and during WWll, the AMA (American Medical Association) launched an aggressive campaign to prevent them from practicing medicine in the United States. The hostility directed toward foreign doctors was intense.

Writer and researcher Carol G. Vogel reported that in 1938, the AMA lobbied legislatures in every state to pass laws that made full citizenship a requirement for licensing. Achieving citizenship involved living in the US for five years — a requirement impossible for new refugees to meet. By Mid 1939, 44 out of 48 state medical boards made US citizenship a requirement for applying for a medical license. (C. Vogel. Case files From National Committee for Resettlement of Foreign Physicians. Avotaynu, fall 2015).

Before WWll, the reputation of many of the European medical schools was stellar. They were considered to be among the best in the world. Such was the case of the University of Vienna Medical School, my dad’s alma mater. It had seven Nobel Prize Laureates prior to WWll.

The AMA was fearful of competition from foreign doctors. With the increasing number of physician refugees coming into to the country, the AMA changed its previous stance from revering the European medical degree to claiming it was “second-rate”. In fact, the training in German and Austrian medical schools was used to reform American medical education between 1906 and 1920. (Eric D. Kohler, Relicensing European Physicians in the US, 1933–1945, Museum of Tolerance).

“Refugee doctors” and me

I remember hearing about “refugee doctors” when I was a small child. My older brother told us that some of the kids at school were saying that our dad was a refugee doctor. Kids were repeating what they heard at home and it sounded like it was meant to be an insult. Fortunately, the taunting didn’t last long. Now, many years later, I’m surprised at my vivid memories of this time period in my childhood.

American doctors vs. American doctors

While the AMA as an organization opposed foreign doctors, other American doctors within the group viewed things differently and went to great lengths to help the foreign doctors. Dr. David Edsall, former dean of Harvard Medical School, created The National Committee for the Resettlement of Foreign Physicians in February 1939, as part of the National Refugee Service. It was chaired by Dr. Edsall and included many other American doctors who were also interested in serving the needs of the country while helping the foreign doctors who they considered to be a valuable asset.

Difficult challenges

Edsall wrote in his JAMA (Journal of the American Medical Association) article, “The Émigré Physician in America, 1941”, that there was a “human problem that cannot be overlooked by members of a calling dedicated to the alleviation of mental as well as physical suffering.” He also addressed the need to protect American doctors from “the possibility of unfair competition from the émigrés.”

Most of the émigrés were Jewish refugees, but not all. It is interesting to note that Edsall was not Jewish. He stated that the discrimination toward these legally admitted émigrés led to them congregating in New York, Boston, and, to a lesser extent, Chicago, San Francisco and Los Angeles.

More requirements impossible to meet

In addition to the citizenship requirement, other laws were passed with impossible requirements. Dr. Edsall reported that a law in California denied licensure to all foreign doctors unless the country where their school was located was involved in international agreements with American licensing groups. That was not possible with Nazi controlled territories during WWll.

Another requirement was to be the graduate of an American medical school. This also kept out Americans who graduated from foreign universities. There were thousands in that group.

These emigrant doctors arrived with very little money, after their property was stolen and their medical licenses revoked in greater Germany as of September, 1938. My dad, who arrived in September, 1939, was one of those doctors. There was a real need for physicians in the United States at that time, especially in rural areas. That need increased after the start of WWll, when so many American doctors were called to serve overseas.

Work of the National Committee for the Resettlement of Foreign Physicians

Dr. Edsall, in his 1941 JAMA article, wrote that groups were set up in fifteen states to advise the émigrés and work with state licensing boards and local medical societies. While this was going on, more groups were in the process of being formed. What did they do?

The Committee:

· evaluated foreign doctors’ eligibility

· searched out internships

· found rural opportunities where their services were most needed

· gave advice on how to study for the English language competency test

· offered help on how to study for the licensing exams, both state and the National Board of Medical examiners

· required at least one year of internship in the US

· encouraged some émigrés to give up their specialties and become general practitioners to placate American doctors who feared competition

· worked with local medical boards to get approvals and waivers if needed

· gave loans to doctors to help them start their practices

In addition, the National Refugee Service and the American Friends Service Committee provided language and cultural training. It was essential for these doctors to adjust to life in the US. Many of them already had good English skills due to their rigorous schooling.

National Resettlement Committee and my dad

I first learned about the Committee from one of the documents I found among my dad’s papers. I donated his documents, the Robert Kaldeck papers, to the US Holocaust Memorial Museum in 2018. In one letter, dated Oct. 13, 1939, a Mary Miron wrote that “New York permitted foreigners to practice while four other states allowed it “nominally”- Ohio, Maryland, Massachusetts and Connecticut. Those four states would allow doctors to take the exam, but then decided on a case by case basis whether or not to allow them to practice.” By 1943, it was just New York and Massachusetts that allowed foreigners to take the exam.

Mary also mentioned that if one took and passed the New York exam, there would be no reciprocity with any other state. New York at that time had plenty of doctors. They had to pass an oral and written English exam and a four day written medical exam in English.

Documents about my dad at the Immigration Research and History Center, U. of Minnesota

While reading Sarah Wildman’s book,“ Paper Love, Searching for the Girl My Grandfather Left Behind,” I learned that her grandfather, another graduate of the University of Vienna Medical School, had been helped by the National Committee for the Resettlement of Foreign Physicians and that their files are housed at the Immigration History Research Center and Archives at the University of Minnesota.

I was excited to find this out. I contacted the same archivist she mentioned in the book, and lo and behold, there was a file on my dad at the Minnesota center. Within a week, that file was in my hands. I wanted to discover what help, if any, my dad had received from the Committee.

First American internship in Lynn, Massachusetts

The first letter to my dad from the National Committee for the Resettlement of Foreign Physicians came in November, 1939, a month after he asked for information about taking the medical exam for licensure. By that time he had obtained a seven month internship at Lynn Hospital along with refusal letters from other hospitals. There was no other correspondence with the Committee until 1944 when he needed financial help setting up his practice.

Next: internship in Clarksburg, West Virginia

My parents married in June. 1941, after my dad obtained his medical license in Massachusetts. I remember my mom talking about the Clarksburg, West Virginia internship at St. Mary’s Hospital, where part of the assignment was to work in a nearby correctional facility. I am guessing that this was unappealing to many American doctors, and could be one of the reasons this internship was given to my dad. By that time, he already had passed both the Massachusetts and National medical exams.

During that time, my mom had a job playing classical music on the piano for a local radio station. On the evening of December 7, 1941, after Pearl Harbor had been bombed that afternoon, she was called by the station to play her scheduled program. She said it was difficult to play the piano under those circumstances. Everyone was so scared and sad. The next day, the US entered WWll.

My dad applied to serve in the Army Medical Corps but was “physically disqualified by reason of a duodenal ulcer {x-ray }” War Dept., Feb. 12, 1944.

Residency at Boston City Hospital (Boston Medical Center)

After the Clarksburg internship, my parents went back to Boston, my mom’s home town. Here, my dad began his residency in dermatology at Boston City Hospital (Boston Medical Center) where he was paid $1200 a year.

Among the documents from the Immigration History Research Center, I found letters pertaining to where he should settle to practice medicine. He received help from groups in Boston as well as the National Resettlement Committee.

The Boston Resettlement Committee for Medical Emigres

In May, 1944, The Jewish Family Welfare Association of Boston wrote to the National Resettlement Committee that “Dr. Kaldeck’s qualifications in dermatology have been favorably evaluated by Dr. Jacob Fine of the Boston Committee for Medical Emigres and by several leading dermatologists in Boston. They agree that Dr. K was well-trained in Austria and his hospital experience here has equipped him excellently for specialization in the field of dermatology.”

The letter went on to describe the plan for him to settle in Lowell, MA where there was no dermatologist and therefore less fear of competition and resentment from the local doctors. The Boston doctors making this recommendation “assured him of their cooperation in getting his practice underway”. This letter was sent in with a request for a loan of $350. The loan was approved and was paid back in twenty installments of $17.50. This is equal to $5,658 in today’s dollars.

Dr. R. Kaldeck, circa 1950. Photo provided by author, E.K. Smith ©2022

Conclusion

In spite of many major obstacles, Dr. David Edsall, and the individuals of the National Committee for the Resettlement of Foreign Physicians did what they thought was right. Their outstanding work benefitted the émigrés, the medical profession, and the country. With their research, skillful negotiations, and determination, they helped more than 3000 doctors get started in a new country.

Post script

The United States is now facing an alarming shortage of doctors and nurses. The AMA and individual states are taking positive steps to address it. The AMA states on their website, “Foreign-trained doctors are critical to addressing these shortages..”

© 2022. All Rights Reserved. Elizabeth Kaldeck Smith

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Elizabeth Kaldeck Smith

Elizabeth Kaldeck Smith

Elizabeth Kaldeck Smith is a writer, retired educator, family historian, and a singer.