Since she was 2 years old, Elisa Tristan-Cheever dreamed of being a doctor. And by the time she was 30, she had a busy practice as a pediatric surgeon in Brazil.

But in the early 2000s, a financial crisis in Brazil prompted her to migrate to the United States with hopes of resuming her practice here. Instead, she found herself scrubbing toilets.

"Dunkin' Donuts, I worked in a laundry ... I worked as a host at Bertucci's ... delivering pizzas," she said. "And every night I was trying to study and applying."

Tristan-Cheever was applying for better jobs, and she was studying for the United States Medical Licensing Exam, which all doctors must pass before getting a residency. It's a crucible even for someone who hadn’t studied medicine in different country, which in Tristan-Cheever's case took more than 10 years.

She is one of roughly 3,000 foreign-trained doctors in Massachusetts not licensed to practice in the U.S., according to a 2014 report by former Gov. Deval Patrick's Advisory Council for Refugees and Immigrants. Jeffrey Gross of the Massachusetts Immigrants and Refugee Advocacy Coalition, one of the authors of the report, says that across the country there could be more than 60,000 foreign-trained doctors who are not licensed.

Pointing to a drought of doctors on the horizon, some are now calling for measures to assist foreign-trained doctors in meeting the stringent requirements needed to practice medicine in the U.S.

But others question whether there’s a looming physician shortage, and criticize American dependence on foreign doctors.

Dr. Fitzhugh Mullan, at the George Washington University Health Workforce Institute, says foreign-trained doctors are indispensable to the American health care system — about one in four doctors practicing in the United States were trained abroad. But there's no crisis in the fact that thousands of foreign doctors are unable to get licensed in the U.S.

Mullan says the real problem is the "brain drain" of doctors from poor countries to wealthy ones. He says the U.S. absorbs some 6,000 doctors from the rest of the world each year — India and Pakistan send the greatest number of doctors to the U.S. — the majority from countries that need their services.

Insurmountable Barriers

Whatever the reasons for coming, the barriers to getting licensed in the U.S. can be insurmountable.

Tristan-Cheever, 49, says she learned what many foreign medical grads learn during the process: On paper it's relatively straightforward, but only if you have enough money and time can you properly dedicate yourself to preparing for the so-called "STEP" exams and other requirements that must be met.

She realized she had higher priorities — to bring her children and her parents from Brazil — and that required earning money immediately. Tristan-Cheever gave up trying to practice medicine, but she still feels a sense of injustice.

"Why [can we not] help in rural areas, helping people who need, who don't have insurance?" she said. "If we have so many doctors, nurses, physical therapists [who are] delivering pizza, cleaning houses?"

While some foreign-trained doctors are struggling to get licensed, others have resigned themselves to working in different fields. Tristan-Cheever is an administrator at Cambridge Health Alliance, and she’s working on a master’s in public health at Northeastern University. She says she could make another hundred thousand dollars as a doctor, but she's come to terms with that.

Foreign-trained doctors are common in Massachusetts. According to the state task force report authored by the MIRA Coalition, more than a quarter of the 33,000 doctors in the state are foreign born. And two-thirds of them were educated overseas.

“Nationally there's a projected shortage of physicians of more than 130,000 over the next decade," said state Sen. Jason Lewis, a Democrat from Winchester, chairman of the Joint Committee on Public Health, one of the advocates who say allowing more foreign-trained doctors to practice could satisfy future demand.

Lewis says Massachusetts is not immune from that shortage, particularly in rural areas.

"It's absolutely a critical need that we do have more physicians, and particularly being able to tap immigrant professionals is a great way to meet that need,” he said.

Lewis filed an amendment in the last budget proposal to examine the state of foreign-trained doctors in Massachusetts. The proposal was shot down, but Lewis says he plans to bring it up again in the current session. He says it's not about lowering the bar for foreign-trained doctors, but helping them get the opportunity to meet the standards in place.

The Last Obstacle: A Residency Match

Lewis learned of the challenges that immigrant doctors face from a constituent who did her training in Iran, 41-year-old Afsaneh Moradi.