Alien physician

Khalid Shalaby discusses some of issues facing international medical graduates training in the US.

Many thoughts were racing through my head as I was writhing in bed with a fever in March 2020. Internal medicine residents have been on the frontlines of America’s fight against the pandemic. I was among the afflicted with the deadly virus while caring for COVID-19 patients despite taking precautions and wearing PPE. I was distressed by the possibility of infecting my wife, ending up on a ventilator, or worse. While I thankfully had a full recovery, it was a terrifying experience. Losing as many patients as we did in the past months has taken a toll on our morale. The sight of vaccinations being administered has made it easier to drive to work every morning. However, a few burdens remain heavy on my shoulders and those of many International Medical Graduates (IMG) who chose to train in the U.S.

Three years ago, I was ecstatic when I got an email with the sentence every medical student longs to read: “Congratulations! You have matched!”. I was accepted for graduate medical training in the United States. As the initial excitement settled, I contemplated the final hurdle to overcome, a U.S. visa. In my home country, Egypt, we heard murmurs of the nerve-racking visa process. Experiences of medical students who matched in residency programs only to have their visa status “in process” for months on end spread like wildfire.

Even though these incidents were rare, I could not help but feel a lump in my throat as my wife and I handed our cell phones to the security officers and entered the U.S. embassy for an interview. These feelings were exacerbated by the ban on travel from our neighboring countries Libya and Sudan, among others. Thankfully, our appointment went smoothly. We got our visas quickly and I breathed a sigh of relief as I clutched my passport with a freshly stamped “Alien physician” status. I pushed aside the anxiety-provoking thought of repeating this process every year in Cairo as long as I remain in training.

As the pandemic rattled the globe and disrupted our daily lives, the U.S. embassy in Cairo and other cities around the world remain appropriately closed to the public, only granting emergency appointments, thus inadvertently delaying visa renewals for many foreign physicians. There is no end in sight as to when U.S. embassies will reinitiate routine visa issuance placing those who choose to travel for a variety of reasons in a state of angst.

Foreign physicians in training are valuable irreplaceable members of our society who deserve a more convenient and efficient visa issuance process. This is especially more pressing in light of the Department of Homeland Security’s (DHS) proposal, that has been temporarily on hold, to “amend its regulations by changing the admission period of F, J, and I aliens from duration of status to an admission for a fixed time period”. If instituted, this proposal would disrupt the training of 12,000 J1 physicians and would “have an immediate and devastating impact on U.S. health care”. Many organizations have urged DHS to withdraw its proposal.

The pandemic has shed light on the inadequacies of visa processing for foreign physicians. It is high time we examined it closely and advocated for its reform. So, what can program directors (PD) do in the interim to support IMG residents? I implore PDs to continue advocating for more streamlined visa issuance on every platform they deem appropriate. While all residency programs offer counseling services, I would advise PDs and faculty to check in on the mental health and wellbeing of IMGs in their programs during these stressful times. If your program can afford it, offer as much flexibility in vacation for IMG trainees to sort out their visa issuance. Ensuring that your residency program has a “training program liaison” who is efficient, and a great communicator makes all the difference in the world. Lastly, I would implore program directors not to be dissuaded from recruiting IMGs but rather rekindle their commitment to diversity, inclusion, and equity.

I understand that as a society we have a finite capacity for empathy. I realize that there are more pressing issues that the U.S. administration has placed front and center. It is not lost on me how privileged I am to remain employed at an excellent institution while millions of Americans have lost their jobs in the past months. However, having lived in the U.S. for the past few years, and especially the last year, I have learned that we should not settle for mediocre but strive for excellence, that reform only happens when we speak up till our voices are heard and that tenacity, solidarity, and empathy are core features of the American character, not temporary fads. Physicians who rise to the occasion and continue to serve our communities deserve better.

Khalid Shalaby is the Chief medical resident in the University of Connecticut Health Center, in the department of internal medicine.

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