Spoiler alert: I am biased. I graduated from St. George’s University, a medical school in Grenada that graduates more physicians annually than any other medical school in the world. It is a school comprised of people who are so determined to become doctors that they are willing to move to a different country — some taking their families with them, some leaving everything behind — to study medicine. My peers came from all over the United States and Canada and had prior graduate degrees, prior jobs and life experiences. Eventually, we all came to the same conclusion: No career would make us happier than a career in medicine.
We fought for our medical education. I was lucky to have supportive deans and clinical instructors, but certain things are out of administrative control. Power outages, tropical storms, water shortages. Alumni from earlier classes remember sitting in lecture halls post-hurricane Ivan, with rain falling through gaping holes in the roof onto their notepads. I’ll never forget the time (which turned out to be multiple times) when the local airline workers went on strike, and I slept and studied in the airport in Trinidad for two days. We joked that our school was like Hogwarts from Harry Potter — the elusive school that could only be reached by magic. Most significantly, we were all thousands of miles from friends and family, our support systems, our rocks.
All of this in fear of Match Day. International medical graduates (IMGs) have less success matching to PGY1 residency positions than do U.S. medical graduates. I’ve mentored third- and fourth-year students through the application process. They are so afraid that all the hard work and sacrifice will yield to the demeaning claim of IMGs as inferior medical professionals.
Because of our struggle, there are a number of professional advantages to having been an IMG:
1. We work hard. I remember interviewing with some U.S. grads who barely passed the USMLEs and still didn’t doubt they would match into a residency program. As IMGs, we had to achieve higher grades, higher USMLE scores and publish more research to be considered on the same level as U.S. applicants. We also applied to at least three-times the number of programs, knowing that the odds of an interview invitation were against us. By the time we reach residency, our determination is so well-developed that it is part of our normal work ethic. In the end, I pitied the students who were never asked to prove themselves. Ultimately, our need to be competitive is what made us realize our potential.
2. We never developed a sense of entitlement. Everyone — especially anyone who’s ever been a patient — can agree there’s nothing worse than an arrogant doctor who feels entitled to respect. As IMGs, nothing was ever guaranteed to us except a tough road ahead. We were told from the very beginning that even if we got high grades and scored above the 90th percentile for USMLEs, we still might not match into a residency program. While there are bound to be complainers in any group, I have found my peers (now colleagues) to be grateful for work. Period.
3. It takes a lot for us to complain. Because of the aforementioned wringer we’ve been through, and the gratitude we feel for being granted our dream job, it would take a severely morbid work environment to make us complain. I remember when the electricity ran out in our main library, no one even blinked; we learned to save all our documents off-line, and the light from our laptops collectively allowed us to finish our work. In resource-poor, inner city hospitals, we make do with what we have and move forward. This tends to be a favorable personality in team work. We know there is no point to complaining when there’s work to be done.
4. We are trained to know our patients. From day one, studying in a developing country, we are trained to understand the context in which we practice. We met diabetic amputees who lost their limbs because they could afford either shoes or insulin, but not both. In our third and fourth years of medical school, most of us trained in high-volume, inner city community hospitals. There we saw similar, morbidly advanced stages of disease among the homeless and uninsured. The medicine we know is medicine for people with limited access to care. That skill — the skill of eliciting context and socioeconomic origins of disease — not only make us more thorough, but also more compassionate.
5. We are dreamers. The from the moment we stepped on a plane wondering what the next four, or eight, or 12 years would entail, we began to develop our own version of a dream worth defending for the rest of our careers. It’s not a dream we let go of. Whether it’s owning our own private practice, improving medicine in hospitals or whole health care systems, or improving health care in our home communities, the dream of practicing medicine is something we’ve reinforced throughout our challenges.
In a time of severe physician shortage, growing health care disparities, millions of people without health insurance, and additional millions who may have their health care rights taken away, it is critical now than ever to enlist hard-working, compassionate physicians to the health care workforce. The professional qualities of grace, gratitude, hard work and determination so well-cultivated among IMGs can be encouraged throughout the medical profession as a whole. I am clearly proud and clearly biased. Nonetheless, I stand by my humble, small statement that I’m sure no one will argue with: International medical graduates will save the U.S. health care system.
Jenna T. Nakagawa is a resident physician who blogs at her self-titled site, Jenna T. Nakagawa.
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