International Medical Graduates
By Alex Strauss
Imagine that you are a physician or medical student facing the prospect of caring for patients without access to the most advanced technology, the full range of medications, or ancillary services to support your patients’ recovery. In the US, even isolated rural doctors can typically access specialists electronically or, in the worst cases, refer their patient to a larger medical center.
But for a quarter of doctors practicing in America - and about the same number in our area - the limitations described above are often all too familiar. These are foreign born physicians and surgeons who, for a wide range of personal and professional reasons, have chosen to leave their homes, extended families, and familiar worlds behind to establish new lives and practices in the US.
With the supply of US-born primary care providers and generalists dwindling and the healthcare needs of baby boomers on the rise, the contributions of these international medical graduates are more vital than ever, especially in underserved and rural areas like ours. Despite the limitations of the federal immigration system and complex state-level credentialing requirements (not to mention the lack of foreign restaurants), the six foreign-born doctors we spoke to say they are happy with their decisions to resettle in the South Dakota region.
But what does it really take to make such a move? Here are some insights from our conversations.
You have to have high standards.
Sanford Cardiologist Marian Petrasko, MD, PhD, a native of Czechoslovakia (from the part of the country that is now Slovakia) applied to a US residency program shortly after the fall of the Berlin Wall. Petrasko had begun his medical career in the large and historic city of Prague, where he had attended Charles University School of Medicine. But, despite the city’s size (more than 1.26 million) and status, Dr. Petrasko was acutely aware that his cardiology practice was destined to be limited.
“Certain things were not available there,” he recalls. “There was just one beta blocker available, for instance. People would take a long time for testing. So I didn’t like it too much.”
Petrasko moved to the US with his wife and one-year-old daughter for an internal medical residency at the State University of New York followed by a cardiology fellowship at Brown University and was impressed by the technology available in the US. Like many foreign-born physicians we spoke with, he took advantage of the opportunity to gain US residency by agreeing to practice for a time in an underserved area which, in his case, was rural Oklahoma. In 2004, his search for a permanent position led him to Sioux Falls where he now works at Sanford Heart Hospital.
“We liked the Midwest and Sioux Falls was close to the size of the town where I grew up,” says Petrasko, who, had five children by the time he moved to Sioux Falls. After 12 years here, he retains his rich Slovak accent but says it has rarely been a problem. “For most of the time, nobody minds it. It’s more like curiosity. People always ask you where you are from. But it is good the way everybody melds together here and works together.”
You have to be forward-thinking (and so does your partner)
Pulmonologist Olufemi (Femi) Lawal, MD, MBA, and his wife, internal medicine physician Olawunmi (Ola) Lawal, MD, were both raised in medical families in southern Nigeria.
Femi earned his medical degree from Olabisi Onabanjo University and Ola from the University of Lagos.They both did residencies at Harlem Hospital in New York and Femi went on to fellowships there and at Memorial Sloan Kettering. Ola has been with Avera in Aberdeen for two-and-a-half years with the couple’s two boys. Femi joined her after a year and they welcomed their third child this summer.
“We have a friend here who told us a lot about Aberdeen. They told us it was a small, family-oriented place and a good place to raise kids,” says Dr. Ola Lawal. “It was a difficult decision to leave Nigeria but we projected forward and thought about what kind of lives we wanted to have. Being together gave us strength. I would not have done it alone!”
Although Aberdeen is far less diverse than New York was, and getting authentic African food requires a trip to Fargo or Sioux Falls, the Lawals say the trade-off has been worth it for the friendlier, more relaxed atmosphere. Both talk of the warmth and acceptance of the community and the high quality of medical care in Aberdeen.
“In Nigeria, we follow the same medical standards but the difference is that the resources are much more limited,” says Dr. Femi Lawal. “Physicians are more limited so practice is more intense because one doctor is going to care for so many people. In the US, we have an abundance of everything, including the ancillary services and resources that make it easier to take care of the patient.”
You have to be a good communicator
Like many middle class Pakistanis, Infectious Disease specialist Jawad Nazir, MD, already had good English when he started his residency at the University of Pittsburgh in 1998. It was even better by the time he finished his fellowship at Cornell and moved to Sioux Falls in 2003. Which is why he was puzzled by the reaction of one of his earliest South Dakota patients, a farmer from a small town.
“I was explaining things to him and he just kept staring at me silently. Finally, I said, ‘Sir, why do you keep staring at my face?’ and he said ‘I just can’t understand how you can speak English so well!’,” recounts Dr. Nazir.
A graduate of King Edward Medical University in Pakistan, Dr. Nazir practiced for several years at an 1800-bed hospital in Lahore before deciding to make the move to the US.
“To be honest, my reasons for coming here were pretty much the same as the founding fathers...A better future, a better economy, job opportunities,” says Dr. Nazir. Nazir took advantage of the opportunity to earn citizenship by going where the need was greatest and joined Infectious Disease Specialists, PC, in 2003. “Sioux Falls was my best path to citizenship. We had no idea what it would be like here, but now it is our home,” he says. He became a citizen three years ago.
“When you come as a foreign medical graduate, there are challenges,” says Dr. Nazir. “It is always an adjustment to get used to a new culture and to become familiar with that community’s medical needs. This is the case even if you move from Alabama to Sioux Falls. So there is a feeling that you have to always be proving yourself equal to or better than those around you.”
Although Nazir has not been immune to anti-Muslim sentiment in South Dakota, he has been encouraged by the support of the local health systems and says the key to acceptance is for everyone to remember that international medical graduates like him are filling a need.
“The basic thing to understand is that there is a need,” says Dr. Nazir. “Patients need to look at their physician as a person, someone who has left his country and come to another place. And we, as physicians, need to show them that we are here to care for them.”
As cities like SIoux Falls become more diverse, International medical graduates are also helping to make them more welcoming for other immigrants, including new doctors. A case in point is the Muslim Community Center in Sioux Falls, which Dr. Nazir and some colleagues established with support from Avera.
You have to be easygoing and adaptable
Like the Lawals, Habiba Ikoghode, MD, grew up in Nigeria. A family medicine physician with Sanford in Jackson, Minnesota, Ikoghode says (in her near-perfect English) that she, too, has sometimes felt the need to “prove” herself in her new home.
“When I first started here, I had to wear my badge all the time,” says Ikoghode. “When I walked in, people would be like ‘Where’s the real doctor?’. But that didn’t last long. For the most part, my colleagues just want to know about my culture. Sometimes I get teased about the way I pronounce things, but I feel like I have had their respect from the beginning. After all, not everybody wants to come to Jackson!”
Dr. Ikoghode herself did not imagine that she would want to come to a place like Jackson until she happened to pass by Creighton University Medical Center in Omaha on a visit to the States while she was in medical school. “That was around the time that I lost my grandfather who was hit by a car while crossing a road. The nearest medical center was hours away and he died before he could get there. Seeing Creighton, I thought that there were probably a lot of things going on in medicine here that we didn’t have back home.”
Ikoghode left Nigeria for Windsor University School of Medicine in St. Kitts, and went on to complete her residency and fellowship at Southern Illinois University School of Medicine. After clinical rotations in Atlanta, Ikoghode relocated to Jackson with her husband three years ago and now has two small children, ages 2 and 4, and a third due next year.
“I am from a very family-oriented culture so I feel comfortable In a small community where I know my children’s teachers,” says Dr. Ikoghode. “You have patients who come and give you oranges to say thank-you.The hardest thing I’ve had to learn in this small community is don’t go to Walmart without makeup!”
Minnesota’s cold winters also took some getting used to, as did the fact that Minnesotans don’t show up at each other’s houses without calling first. Overall, though, Ikoghode says she has come to feel at home in Jackson and even her parents enjoy the community when they visit.
“It has been a great time with these people,” she says. “When they get to know you, you become part of their family, as well.”