To Serve in America

In the first part of this two-part series, we examined the implications of international medical graduates (IMGs) in hospital medicine groups (November 2007, p. 1). Part 2 features stories from hospitalist IMGs as they establish themselves as professionals in their communities.

December 2005 was a tough time for Charles Onunkwo, MD, and his wife. He had been working since July 1 as a hospitalist with St. Clare’s Hospital in Wausau, a small town in central Wisconsin, and had just received alarming news. His H1-B visa transfer, filed by his immigration attorney, had been denied.

His wife’s application to change from a visitor visa to an H-4 (dependent of an H1-B visa holder) was also denied. As a result, his wife was considered “unlawfully present” in the country. Dr. Onunkwo was now “out of status,” because the Naturalization and Immigration Service (INS) did not recognize St. Clare’s as exempt from caps on the annual number of H1-B visas granted. The couple was faced with a mandatory return trip to their native Nigeria, and no guarantee that the U.S. Consulate in Lagos would grant them permission to return to the United States to work as physicians.

“It was a bad time for us,” he recalls.

^{Charles Onunkwo, MD, hospitalist, St. Clare’s Hospital, Wausau, Wis.}

I feel the skepticism, but I still treat the [patient or colleague] with the respect that they deserve. Ultimately, I just let my work do the talking.

Barriers and Adjustments

The obstacles faced by IMGs in obtaining visas and eventual permanent employment status have been well documented.1 For the Onunkwos, the story had a good outcome: a new immigration attorney hired by St. Clare’s was able to establish the hospital as a “cap-exempt” organization. Intervention by the staff of Rep. David R. Obey, D-Wis., allowed them to secure new H-1B visas and a return to this country.

Dr. Onunkwo and the other hospitalist IMGs attest that immigration hurdles constitute their biggest challenges.

There can be other barriers as well. Mark Dotson, senior recruiter for Cogent Healthcare in Nashville, Tenn., has encountered resistance toward IMG candidates from hospital administrators in some communities. Concerns usually relate to candidates’ ability to communicate effectively and demonstrate appropriate bedside manner. “There are also some misperceptions about some residency programs that can hinder an international medical graduate,” he says. In addition, some communities “want the doctors to reflect the makeup of the local community.” That means in a community that is 95% Caucasian, hospital administrators may be reluctant to hire a physician of color.

Dotson says attention to communication skills should be the primary goal of IMGs, and that buy-in from hospital administrators or leaders of hospital medicine groups is critical for smooth transitions. “I think some of the best physicians we have out there are doctors who are international medical graduates who see this as their life calling,” he says. “And, I think that even people in the general population understand that IMGs are extremely intelligent, and that they work extremely hard.”

As the following stories affirm, communities in remote or medically underserved areas are often welcoming of physicians who offer much-needed primary care.

Dr. Fajardo and his wife, Beverly

A Long Journey

In 1997, Emmanuel Fajardo, MD, medical director of the hospitalist program at St. Dominic-Jackson Memorial Hospital in Jackson, Miss., found himself “between the devil and the deep blue sea.” He had just been offered a chief residency position at the Meharry Medical College Affiliated Hospitals Internal Medicine residency program and was torn between accepting that job and a J-1 waiver offer in Shubuta, Miss., a federally designated Medically Underserved Area (MUSA).