In an inaugural gathering that coincided with the 2023 American Society of Clinical Oncology (ASCO) annual meeting, speakers cast a spotlight on the often-transient journey of international medical graduates (IMGs), who face unique hurdles and challenges while navigating the American medical system.
The International Medical Graduates Community of Practice meeting aimed to shed light on the challenges this community encounters and offered a beacon of encouragement through the personal stories of resilient young oncologists who overcame barriers to eventually thrive in their careers.
“My generation didn’t ask questions. We put our heads down when we worked. We didn’t even think that we could try to change things as they are,” said Gilberto De Lima Lopes, MD, professor of medical oncology at the Miller School of Medicine in Miami, who shared his perspective after moving from his home country of Brazil to the U.S. “That’s what truly brings me hope that we're going to be living in a much better world in the next 10, 20 years because your generation is not afraid of doing that.”
The session began with an acknowledgment of the support that IMGs, who are still navigating their early careers, have received from the established leaders who have pushed for increased diversity, inclusion, innovation, and mentorship. Research presented at the session also highlighted key issues IMGs often face, as well as their large role in American oncology.
Nearly one-quarter of practicing physicians in the U.S. are IMGs; in hematology/oncology, this climbs to about one-third of doctors, according to research presented by Ayesha Butt, MD, postdoctoral associate at Yale School of Medicine in New Haven, Connecticut. Still, many at the session described significant and persistent biases against IMGs, including within residency and fellowship programs and jobs, especially in the selection process.
“We need to recognize the important role of IMGs in providing exemplary patient care, particularly to our most underserved and vulnerable populations,” Dr. Butt said. “America is a nation of immigrants, at the end, and the immigrant positions are a huge part of our workforce. Improving the equity in the process of training them and selecting them for training will only have positive far-reaching consequences.”
During the session, moderators highlighted the results of recent IMG surveys outlining common challenges. These include adapting to a new culture, communication, and language barriers; navigating the American housing, daycare, and medical system; and personal challenges associated with being far from home, among others.
Overall, visa problems are the number one issue respondents report encountering. Speakers touched on various immigration-related challenges, including limited visa availabilities and uncertainty of sponsorship.
This was especially tricky during the COVID-19 pandemic, when U.S. embassies limited visas. During the session, speakers shared stories about how some IMGs were reluctant to leave the country – even forgoing funerals for loved ones – due to worries that they would be unable to reenter the country and return to their educations and careers.
Speakers noted that program directors often do not understand the immigration process. Highlighting the common misconceptions and general lack of awareness about visas and related restrictions, panelists said, could be a potential catalyst for change. This includes raising awareness about visa functions and limits, as well as where potential policy change advocacy could be directed.
“A lot of program directors are not familiar with the different visas and how the pathway works and what the implications are,” said panelist Alfred Lee, MD, PhD, professor of medicine and program director for the hematology/oncology fellowship program at Yale School of Medicine. “There’s a lot of stigmas, unfortunately, that comes with that.”
Speakers emphasized establishing support systems and mentorship programs tailored to the unique needs of IMGs, as well as raising awareness about the barriers they face. Despite these challenges, other speakers provided words of encouragement, highlighting that these barriers can be overcome.
“I want all of you in this room to believe that you can do it,” said Aakash Desai, MD, MPH, assistant professor at the Mayo Clinic in Minnesota. “If I’m here today, you can be here too, and you will be here.”