IMG FOCUS GROUP

October 4, 2009

3-5:15 PM

Participants:

• Yanelquis Acosta (Cuban doctor, refugee, 1.5 years in US, now studying English and studying for USMLEs, passed Step 1)
• Adelberto Torres (Cuban doctor, refugee, 1.5 years in US, now studying English and studying for USMLEs, passed Step 1)
• Gerard Idrissa (Congo doctor, refugee, seven months in US)
• Dayen Raad (Iraqi professor of dentistry, refugee, passed Step 1, studying for Step 2 exams)
• Jameelah Hassoon, (Iraqi anestheseologist, refugee, 25 years experience, eight months in US, studying at Kaplan for USMLEs)
• Natalia Dorland, (Russian neurologist, in US for five years, US-native husband, passed Step 1, Step 2, CK, CS, failed to find internship match last year, completed two observerships, has six interviews arranged for upcoming match.

Plus:

• Stephen Nguyagwa, Program Coordinator, African and American Friendship Association for Cooperation and Development
• Wilhelmina Holder, Director, Women’s Initiative for Self Empowerment
• Tony Schmitz, Health Advocates

Discussion:

Difficulties with testing process

• Dayen observed that, despite his masters and Ph.D degrees, he found that returning to the study of basic science required for the Step 1 exam was “most difficult. It was shocking.”
• Adelberto said, “It’s difficult to live only studying.” He and his wife, Yanelquis, both said they were grateful for help they got from AAFACD and the Guadalupe Program on St. Paul’s West Side. “We study 10 hours a day, and of course it is hard to read and study only in English. But we have a better opportunity than many of our friends because we don’t have somebody to support other than ourselves.”

Adjustment to a new reality:

• Adelberto said that in his previous position, he was the number two doctor in a 600-bed hospital. He considers himself lucky to have landed a volunteer position in the University of Minnesota ER. “Now I am wiping down beds in the ER. I need to think, to remind myself, ‘I am serving the people I am serving.’”
• Similarly, Jameelah recalled her 25 years of experience in anesthesiology, treating thousands of patients. “Now at my age I am reading day and night, studying for m exams.” While she might be able to hope to qualify as a family practice physician, she doubts she will be allowed to find placement in an anesthesiology residency program.
• Cultural aspects of US medicine can be confounding. “In Russia I am supposed to be modest about myself,” Natalia explained. “Here in interviews I must talk about myself and say I did this and I did that. I have to sell myself. Modesty? Forget about it.” The language barrier can make IMGs appear stupid or hesitant, the group agreed. “People appear shy but they might be very clever,” said Jameelah. “There are famous doctors who are shy but very clever. They can seem stupid but they may be brilliant.”

What is helpful:

• Natalia said that she perceived a pattern of depression among IMGs hoping to pass their exams and find a residency placement. “I got depressed, then I realized that everyone got depressed at some point. It’s a time consuming, long and difficult process. You have to stay positive, but it’s a huge disappointment when you get to the point of trying to find a residency and you see that no one wants you.” She said it would be helpful for IMGs to have more places to share their stories — in online forums, in physical places where IMGs could meet and talk, or both. Further, she thought that meeting with friends and other IMGs to role-play scenarios similar to those in the CS exams would be helpful.

Perception of discrimination against IMGs:

• Natalia said that in some instances this is very open. When she called a Duluth program, she was told that it accepts only US or Canadian graduates. But she regarded this as preferable to programs that claim to accept foreign-trained doctors but actually don’t. “You have to fight for a position here,” said Yanelquis, “even if you had a very good position in your own country.” Specialties, many in the group agreed, were reserved for Americans. “For a foreign doctor, it’s a waste of time trying to compete.”

Trade a residency slot for practicing in an underserved area?

• With the exception of Jameelah, who said, “I will have to think about that,” the prospect of this sort of trade was a no-brainer.
• “I don’t need to think about that — I’d just say yes!” — Adelberto
• “I would be happy with that. I love the rural areas. It is the same in my country. I first worked out of a tent for six months. I can do it again.” — Yanelquis
• “This is a good idea. In my country they send you to a rural area to practice at first.” — Gerard

Retraining instead of pursuing MD licensure?

• Yanelquis noted that many of her Florida friends are pursuing a nurse practitioner degree, because there is a program that allows them to finish the course work in a year.
• Dayen observed that it might be easier for him to become a dental hygienist, and said that the pay for that position was really quite good. “But if I were a hygienist, I would still be looking to become a dentist,” he concluded.
• “Everything depends on your situation,” said Adelberto. “You need to be clear; it’s very hard to become a doctor here. Nurse practitioners make a lot of money here. But I have never worked only for money in my life. Naturally it’s different if you have a family.”