Saturday, 4 February 2012

Cost of getting into a residency for an International Medical Graduate

Today while surfing NEJM for editorial pieces, I came across a very poignant article written by Dr. Srivastava called “A Bridge to Nowhere — The Troubled Trek of Foreign Medical Graduates”.  In this, he discusses the hardships faced by established physicians who come to US seeking residency or training. His story of the Russian orthopedic surgeon or the story of the Iraqi thoracic surgeon working as a PA was very moving. I have also come across folks who have left everything including their busy practices behind to pursue their dream of practicing medicine in the USA.

The lure of the field is strong enough that we spend countless hours and immense amount of struggle to get into medical schools. At times our effort seems thwarted by the brick wall of fate, circumstances in our countries back home are difficult and yet we persevere to join the elite few who take the Hippocratic oath. Some stay on while others move on to start careers elsewhere. Still stronger than the desire being a physician, for some is the desire to be a physician in the USA. One particular person in my experience was an elderly Chinese woman who worked as a lab assistant. Quiet, reserved and meticulous she would not seem to be who she was at first glance. After I was acquainted with her and few months of general talk, she divulged that she was a pediatric oncologist back in her country and had a good practice. I was studying for USMLE at the time and she was curious and interested as to the path for an IMG to get into residency. There was eagerness in her eyes and I could see that she missed being a physician but the reality of the situation immediately covered up the traces of longing for being a doctor again. New country, new language, new people and new situations are all very distressing but not distressing enough to leave things behind and start anew. In my naïve optimism, I tried to encourage her to consider studying for medical exams, but she said that she had tried when she moved here many years ago but did not do well because language was a big impediment. “Its too late”, she sighed and turned her head down to clean some lab ware.

As rightly pointed out by Dr. Srivastava, 

the professional lives of foreign doctors exist mainly in their imagination, as they face an unpredictable future. Even if they manage to secure steady mentoring and jump the hurdle of costly and competitive exams, many must move to rural areas to nurture a career. 

For some it is not only a step down professionally but personally. Many surgeons who have tried the system for years, end up with a compromise. Happiness is ultimately a congruence of  perception of your situation and your innate concept mold for your life. When both of them fit, you are satisfied. Until then we as physicians will keep trying.
Reference
A bridge to nowhere--the troubled trek of foreign medical graduates. Srivastava R. N Engl J Med. 2008 Jan 17;358(3):216-9. 
http://www.nejm.org/doi/full/10.1056/NEJMp0708599

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