As I sit here contemplating the beginning of this unsent letter, I find myself questioning its intended recipient and purpose. The truth is, I don’t have the answers just yet. Perhaps, by the end of these few paragraphs, some clarity will emerge.
When I left my home country to come to the United States, I envisioned hospitals here as being on par with what we would consider “first-world country” institutions. I expected to find top-notch education and advancements in medicine, reflective of an advanced society. After all, it is from here that we often hear about the importance of self-care and controlling working hours for residents, not only for the residents’ well-being but also for the safety of patients. Let us not forget the case of Libby Zion, who tragically passed away in 1984 under the care of residents in training, doctors who routinely worked 36-hour shifts with little or no sleep. This unfortunate event sparked important discussions and prompted reforms within the residency structures. As for whether these reforms have been effective, that discussion will be reserved for another letter.
To my surprise, however, I discovered myself in a hospital with infrastructure resembling those I had worked back home, facing similar disparities and deficiencies that plague “third-world countries.” It is in this hospital that a significant number of international medical graduates (IMGs) come seeking opportunities in the developed world, providing care to communities in need, particularly among immigrant populations.
I take great pride in being able to communicate with my patients in Spanish, providing them with a feeling of familiarity and comfort in a place where translation systems are insufficient and waiting for an interpreter on the phone is often not an option due to the overwhelming workload. Unfortunately, it’s not just the patients who experience disparities based on their immigration status; discrimination permeates the very system itself. This discrimination can even extend to something as trivial as the choice of phone brand, pressuring individuals to buy specific products for communication purposes.
Text messages are exchanged with a lack of remorse, carrying insinuations like “only Americans should be hired.” Insensitive comments such as “this is too American for you, right?” or “what can we expect from the standards of other countries?” are made openly. Shockingly, none of these actions seem to face any consequences or even draw attention.
To my astonishment, my disappointment extended beyond physical and infrastructural aspects. I discovered that those in power still hold the belief that residents must sacrifice their lives for the sake of medicine. Having a life outside of work is deemed incorrect and frowned upon. Concerns about education and work-life balance are brushed off with statements like, “When I was a resident, we used to work over 100 hours a week.” It is a system where complaints and concerns are dismissed, and if you desire to go home to your family after a 12-hour shift, you are criticized for not being passionate enough. Retaliation looms, which is precisely why this letter remains anonymous.
Furthermore, as a consequence of this broken system, my program has fallen under ACGME probation, the governing body responsible for accrediting all graduate medical training programs, and now must “comply” with the rules, compelling us to adhere to a set of rules that are imposed upon us. Our concerns and opinions are dismissed as the administration makes decisions without hearing our input. Leadership finds it easier to blame us, claiming that we lack resilience, rather than addressing the flaws in the system. Consequently, residents abandon their dreams because they cannot endure the broken system any longer. And yet, those in positions of power fail to question themselves, neglecting to ask, “What am I doing wrong?”
One might think that this is a clear case of residents versus a broken, outdated program. Regrettably, that is not the whole story. Cracks exist within the residency itself, leading to a lack of unity and camaraderie among all levels of PGY. I have encountered a system that is broken at every turn, where senior residents judge and dismiss their junior counterparts. They perceive their own mistreatment and lack of respect as normal and acceptable, deeming anyone who raises their voice as an outlier.
This system not only requires enduring an 80-hour workweek, twice the length of a regular working population, but as a foreign medical graduate, one must also withstand racism, classism, and discrimination. The realization that I am now encountering a similar broken system, albeit far away from home, is disheartening and unexpected. My love for medicine drives my desire to enhance medical practices, not only in my home country but also in other locations. That is why I’m writing this letter. I still don’t know who the recipients of this letter will be, but I hope they will be many. I hope these paragraphs will provide strength and reassurance to those who find themselves navigating this broken system, assuring them that they are not alone. Remember that there are others who share similar experiences and frustrations. Together, we possess the power to shape a system that supports and uplifts health care professionals and patients alike.
The author is an anonymous physician.