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CHICAGO — The first time he applied for a medical residency in the U.S., Rafel AlHiali felt buoyant.

With nine years of experience as a physician, the Iraq native and recent immigrant to Chicago felt confident he’d be treating patients again soon.

He sent off the applications and waited. And waited. “First week, first month, second month. There was nothing,” AlHiali said. “I was really shocked.”

Five years later, after several failed attempts to land a residency, AlHiali, 40, works part-time as a medical interpreter while he tries to reclaim his derailed career.

Obstacles: Highly skilled immigrants like AlHiali often encounter a labyrinth of obstacles when they try to find jobs in the U.S., frustrating not only their ambitions but also their earning potential as they settle for lower-skill positions.

President Donald Trump’s support for merit-based immigration systems, like those used in Canada and Australia, could make it easier for immigrants with advanced educations and skill sets to enter the U.S. Trump praised those systems for adhering to “a basic principle that those seeking to enter a country ought to be able to support themselves financially.”

But those already here say the expertise they brought with them to the U.S. often goes to waste. Lengthy recertification processes, language barriers and employers’ unfamiliarity with foreign credentials hobble immigrants’ efforts to find work in their fields. They take jobs as janitors, babysitters and valets to get by.

The Migration Policy Institute, a nonpartisan research organization, calls it brain waste. Nearly 2 million college-educated immigrants and refugees in the U.S. are unemployed or working in low-skill jobs despite years of education and work experience.

Meanwhile, a growing share of immigrants are highly educated. Almost half of adults who entered the U.S. between 2011 and 2015 were college graduates, up from a third who came from 2007 to 2009, according to the institute.

The Trump administration has not made any policy announcements about what a merit-based immigration system might entail. A White House spokesman said only that the president has tweeted about the concept generally. Trump sent a tweet March 3 that said: “The merit-based system is the way to go.”

Priorities: The current U.S. immigration system prioritizes family unification.

Nearly two-thirds of the 1 million legal permanent residents accepted into the country in 2015 were either immediate relatives of American citizens or sponsored by family, while 14 percent were employment-based admissions, according to the Department of Homeland Security. Fifteen percent were refugees or asylum seekers, and 5 percent came through a diversity lottery for people from countries with low immigration rates to the U.S.

Some experts have reservations about a merit-based system.

One concern is that focusing on highly skilled immigrants ignores the demand for lower-skilled labor, such as in agriculture, where employers say they struggle to draw a workforce.

Yet even for highly skilled immigrants, the system might not be as promising as it sounds.

Canada: Canada pioneered the merit-based concept in the 1960s, but even there, more than 40 percent of highly educated immigrants are overqualified for the jobs in which they work, said Jeanne Batalova, a senior policy analyst at Migration Policy Institute.

In Canada, applicants receive points for education, occupation, the ability to speak one or both of the country’s official languages, an existing job offer and graduation from a Canadian university.

Part of the mismatch — in Canada as well as in the U.S. — has to do with the strength of the local labor market, but it also reflects a need for community organizations to help both immigrants and employers navigate unfamiliar territory, Batalova said.

“Employers are frankly lost in terms of how to evaluate credentials, legal status, languages,” she said.

Some advocates for stricter immigration applaud Trump’s support of a merit-based system. Highly skilled immigrants wouldn’t compete with U.S. workers for low-skill jobs, and they could have a positive impact if they pay more taxes and use fewer services, said Steven Camarota, research director at the Center for Immigration Studies, a nonprofit group that favors reducing immigration.

Still, Camarota is skeptical that the U.S. needs such immigrants to plug talent shortages.

Wages haven’t increased for many jobs employers say they have trouble filling, and many educated Americans have trouble finding work in their fields, he said.

Even if Trump emphasizes an immigration system based on skills and education, officials will need to address how easily that experience can be put to use.

Facing licensing tests that require hundreds of dollars, or having to repeat an entire course of study, many immigrants with advanced skills take lower-paying “survival jobs” to pay rent and buy groceries.

The situation is not only demoralizing for immigrants but robs communities of scarce skills, Batalova said. Ethnic communities are in particular need of professionals who can speak the language and understand cultural nuances in key fields like health care.

Julio Godoy, 54, earns minimum wage cleaning the inside of airplanes at O’Hare International Airport. The job is a stark departure from his life before he immigrated from his native Guatemala, where for 25 years he held managerial positions in banking institutions, earning about $3,200 a month.

Godoy, who has his green card, left Guatemala City with his son in 2013. His priority was to learn English so he could land a good job, but when his savings ran out he took the airplane cleaning job and now works 60-hour weeks at O’Hare. That leaves little time for him to improve his English, which is barely better now than when he arrived.

“It’s a vicious cycle that I’m stuck in,” Godoy said in Spanish through a translator.

The brain waste is costly. Nationally, those working in low-skill jobs missed out on $39.4 billion in earnings they might have seen had they worked in middle- or high-skill jobs, according to a Migration Policy Institute analysis. That’s about $10.2 billion in lost tax revenue.

Most college-educated immigrants are legal permanent residents or refugees, but those who don’t have legal status face additional hurdles, with 40 percent working low-skill jobs.

At Upwardly Global, a group that helps find job placements for immigrants here legally with at least a bachelor’s degree, clients include engineers, doctors and nurses who work as babysitters, cabdrivers and in factories.

“These are people who the United States has welcomed into our country,” said Tamar Frolichstein-Appel, a career counselor at Upwardly Global. “The people we work with are not in any way looking for handouts. But they have these skills, and they’re in areas where our country needs these skills.”

The group helps with job application basics that change from culture to culture. Refugees arrive with pages-long resumes that need slimming. Selling yourself, rude in other cultures, is vital here. Corporate volunteers help immigrants practice eye contact or tout their skills, which also builds their professional networks.

In an immigration system based on merit, even those who arrive with skills might find they can’t easily use them. Many who want to be self-sufficient find that reaching their earning potential is a slow process.

Overqualified: Aleksandra Dimo, 28, was a psychologist in Albania. She came to the U.S. in 2015.

Here, she slices meat in a deli and her husband, a trained engineer, works as a valet. Upwardly Global helped connect her with English classes.

Someday, she hopes to work in something closer to her field. In the meantime, she volunteers every day at a community center, where her therapeutic skills are used to comfort homeless people and pregnant women.

“That makes my day,” she said. “Working three hours there, then I don’t care if I work at a deli.”

She is grateful that the deli provides a place to practice English — despite speaking Albanian, Spanish and Italian, she arrived knowing no English — and a paycheck. Still, she said, her friends ask, “You have a master’s degree and you’re working at a deli?”

Doctors face particular challenges.

Health care is an industry heavily affected by immigration legislation. In the Midwest, 25 percent of physicians and surgeons were born outside the U.S., according to a 2016 report from the Chicago Council on Global Affairs.

Residency is often the roadblock. Many programs prefer U.S. clinical experience and applicants who have graduated within five years. So despite years of experience, a foreign-born doctor like AlHiali might be quickly disqualified.

Even in nursing, where certification is more straightforward, challenges exist.

The Chicago Bilingual Nurse Consortium started in 2002 to help nurses pass the National Council Licensure Examination. Some didn’t speak English or had difficulty getting school transcripts.

The consortium’s test prep has helped 725 internationally educated nurses from 60 countries. Still, the process usually takes 12 to 46 months.

Several states have formed task forces to knock down the barriers. Minnesota’s Department of Health released a report in February suggesting relaxed requirements for doctors, and a new program allows some foreign-born physicians to be eligible for state-funded residencies in rural or underserved areas.

At the federal level, the White House Task Force on New Americans under President Barack Obama explored a system to streamline professional certification and licensure.

AlHiali, the Iraqi physician, has spent years applying for medical residency and waiting to treat patients instead of translate for them.

He hoped his time with Upwardly Global, which helped him revise his resume and practice interviews, would help him.

“I applied even to Alaska,” said AlHiali, who said he came on a K-1 visa, or a visa for fiances traveling to marry a U.S. citizen, and is now a citizen. “I’m ready to take anything.”

Two weeks ago, for the fifth year in a row, he braced himself for the email that would reveal if he was accepted into a medical residency program.

This time, it read, “Congratulations.”

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