new_n_lost
Politically InCorrect
Topics: 653
Posts: 6,085
|
Someone finally noticed our plights and confusions and frustrations and the humongous task of getting into the medical fields of the west is finally being acknowledged in one of the most respected Journal of Medicine in the World. I literally came to tears when i read this article and it moved me a lot as i m sure it will move you guys also but what i really hope is that the Physicians who read this get moved and show more compassion towards us and our struggle and realise that many of us dont have it all as easy as they might think we have.
http://content.nejm.org/cgi/content/full/358/3/21...
Just in case if someone cant open the page here is the whole article.
A Bridge to Nowhere — The Troubled Trek of Foreign Medical Graduates
It is a typical day in my Melbourne clinic, with missing files, scans gone astray, and patients overwhelmed by their diagnoses. Though a mountain of dictation remains, the day's end appears promisingly close . . . but for a scheduled tutorial. Biting into lukewarm leftovers, I am sorely tempted to cancel it. After all, I reason, it is volunteer work, squeezed in among other pressing commitments. The students will surely understand and perhaps even be grateful for the reprieve on a balmy summer evening.
Maybe the time has come to give up the tutorials, I muse. I have taught since I was a resident. Now, busy workdays added to new motherhood fill my plate; many days, the planning and patience required for the tutorial seem beyond my reach. Soon my musings turn to resentment, resentment to self-righteous justification. Surely, it is someone else's turn to assume the mantle. The hospital is filled with doctors — someone must have spare time. Seizing on this thought, I reach for the phone. But before I finish dialing, I receive a page: "Doctor, don't worry if you are late. We will wait."
My conscience pricks me. I rush through the dictation and climb the stairs to meet my students, silently rehearsing my farewell speech.
Six expectant, eager faces greet me.
"I'm sorry I'm late."
"That's OK! We thought we would have to miss the tutorial altogether, so we are lucky!" There is a nodding of heads, shuffling of chairs and books as the students get into position.
"What a beautiful day!" I enthuse.
"To us, all the days seem the same," a glum voice says.
"What's new?" I ask.
"No one got a spot for next month's exam."
"Oh, I am sorry to hear that. What happened?" I already know the answer.
"There were too many people and too few spots." Disappointment and resignation hang in the air.
My students are foreign-trained doctors taking a "bridging" course to earn medical credentials in Australia. Their training, in almost all cases completed in a non-Western country, is not recognized here, so they must pass exams and undertake retraining to enter the system. Every year, hundreds of foreign graduates in Australia slog through thousands of practice questions ranging from internal medicine to gynecology. They must not only relearn the theory, which many of them first studied decades ago, but also master the social and behavioral nuances of being a doctor in the West. Some must do so while supporting themselves by driving taxis or picking fruit; others rely on meager personal savings or small government handouts. They are driven by the dream of becoming doctors again, but the reality can be a nightmare.
We begin with Yakov in the doctor's role. Yakov is a 40-year-old orthopedic surgeon from Russia. His wife works as a secretary while looking after their two children. He discovered very early the impossibility of breaking into the tightly controlled orthopedic training program, but it took him a long time to overcome his reservations and fears to enroll in the bridging course with the aim of becoming a family practitioner. Finally, he did it for his children, wishing to set them a good example.
I play the part of a young man with classic coronary risk factors who presents to the ER with myocardial infarction. I make the case as uncomplicated as possible, mindful of Yakov's background in surgery. Unfortunately, he starts poorly and botches the encounter, as his colleagues nervously avert their eyes from his apparent lack of knowledge and seemingly uncaring attitude. Sweat trickles down Yakov's forehead. Even as I strain to find something constructive to say, my confounded words escape: "I don't think you even tried."
Another student shakes his head. "But we just studied it this morning!"
It has taken just 8 minutes for Yakov's shaming to be complete. His eyes flash defiantly, "This is why I am here all day. Because I need to learn!" He buries his head in a well-thumbed Oxford Handbook of Medicine. I walk through the history and management of myocardial infarction, but I know I've lost Yakov. What meaning should such terms as angioplasty, abciximab, and door-to-balloon time have for this surgeon who always summoned a medical consultant at any whiff of chest pain? I kick myself, but it is too late.
Next is Abbas, an Iraqi thoracic physician, who has spent the past 3 years working as a personal care assistant in a nursing home. One day, a nurse caught him reading a patient's chart. He quickly divulged his background but begged her to keep it a secret lest he lose the sole livelihood for his family of five. After months of her encouragement, he came to see me. With deep longing in his eyes, he said, "There is nothing wrong with being a carer, but all I have ever wanted was to be a doctor." He wept when I offered to let him to join my tutorial group. "Just to pretend to be a doctor again will be so nice," he exclaimed.
I ask Abbas to demonstrate a knee joint examination. To my surprise, his years of isolation have not affected his capacity for being thorough and pleasant. I commend him on his performance. The others throw in their appreciation, and his face momentarily lights up. Then his modesty returns. "I have a long way to go. The examiners will not be as kind."
Little do I know that his circumstances will force him to put off his journey. After being absent for weeks, he e-mails me to apologize — he cannot afford to cut back on his 60-hour week to attend tutorials. He tells me that the 2 hours he spent with the other doctors were some of the happiest in his recent life, and he asks me to wish the others luck. Abbas would have been an asset to patients. He has never returned my calls.
We race onward, reviewing various clinical scenarios. I play the emphysematous woman and the drug-seeking adolescent, the dying cancer patient and the school-avoiding teen. I try to praise reasonably and criticize constructively. Between the role-play scenes, there is random conversation. Have I ever met a successful foreign medical graduate who put his life back in order? (In fact I have — for instance, a physician who left 20 years of factory work behind to become a successful family practice doctor.) Which ward is friendliest to foreign doctors? Which branches of medicine are both accessible to foreigners and lucrative? But we rarely follow these probing questions to meaningful conclusions, mindful of the tutorial's precious academic purpose.
I have observed over the years that most foreign doctors receive little encouragement, advice, or collegiality from a medical hierarchy engrossed in its own needs. The professional lives of foreign doctors exist mainly in their imagination, as they face an unpredictable future. Even if they manage to secure steady mentoring and jump the hurdle of costly and competitive exams, many must move to rural areas to nurture a career. This often involves uprooting a family that may just have found its feet in a new country. Those who get jobs in metropolitan centers often find themselves in a silent second tier of staff members, whose needs are different, diverse, and largely unmet. Personal lives suffer, as their families face prolonged periods of financial constraints. Most graduates report having left a comfortable lifestyle in their home countries, despite the social or political upheaval that prompted them to leave. Here, the conditions are reversed, but the resulting reality may be equally unpleasant. Family relationships become testy, fueling doubt about the decision to migrate. The sacrifices sometimes seem too great, the end too murky.
The foreign doctors I teach are uniformly respectful, diligent, interested, and interesting. Armed with uncommon wisdom born of their arduous journeys, they trade me life lessons for my lessons in Western medicine. So why is it that when one group finishes, I'm always hesitant about taking on another?
After many groups, I am beginning to see why: their needs are much larger than I had ever imagined or feel equipped to handle. I can expound on peptic ulcer disease or the staging of breast cancer, but I feel helpless when I stumble onto the legion of unexplored personal issues. When a doctor 20 years my senior is driven to tears of exasperation over the ailments of a mock patient, I feel like crying, too, out of frustration with a system that can barely see to adequate medical retraining, let alone psychological assistance. When the group, hungry for help, protests at a truncated tutorial, I am dismayed, even irritated by the needs I cannot fulfill. And I can never confidently deliver a tutorial, knowing that even a casual comment may uncover a secret that is beyond my capacity to address effectively.
The colleagues of a Muslim doctor indicate that she is being harassed by her husband for wanting to step out into Western society. My circuitous attempts to engage her fail miserably. A Chinese doctor feels discriminated against because of his strong accent and is contemplating returning to the factory where he worked unpaid hours but was left alone. The father of another is dying; she can spend her money either flying overseas to see him or saving up for her exam. Beneath their affable smiles lies a private world of doubt, resignation, and impossible choices. They wear their medical degrees like ill-fitting overcoats — too awkward to parade but too warm to discard. Every week I console myself that perhaps if I just help them get through the exam, the other pieces will gather into place.
The last time I expressed my unease, a colleague retorted that foreign doctors ought to stay in their home countries to serve their own people. Ironically, he and I are both migrants; we were simply fortunate that a previous generation undertook the hard work of assimilating into a new society. Certainly, millions of people lack basic health care and resource allocation is a just concern, but just as our parents ensured our eventual success, these doctors seek opportunity and stability, partly for themselves but largely for their offspring. Who can begrudge them this most fundamental of life's quests?
When foreign graduates ultimately qualify as physicians, they go on to serve ably, often working in areas of great need. Indeed, the medical systems of many Western countries rely on immigrant doctors to function. It is reasonable to expect foreign medical graduates to comply with local practice standards, but it is incumbent on us to deliver the support and infrastructure they require in the process. Governments may espouse principles and pledge funding to facilitate assimilation, but it is ordinary doctors in the course of everyday work who will guarantee the endeavor's success. We pride ourselves on our compassion for patients; it is high time we offered the same to our dislocated colleagues.
Finally, the tutorial is over. I think of my original resolve to call it a day.
"Can we please not do the next one on Monday?" a voice pleads softly. "I really don't like missing these sessions."
"Sure," I reply, about to tell them they can work it out with the next tutor. "Thank you," says the relieved voice.
"She has to go the airport to pick up her baby," someone else feels compelled to add.
It takes me a few seconds to register the comment.
"How long has it been since you saw your baby?"
"Two years. My mother has been caring for her since her birth while I try to get the exam."
I am staggered by her resilience before I realize that everyone else in the group probably has a story to match, if I dared to ask.
I think of my own baby, whom I saw only this morning and feel the urge to return to. I think of my annoyance this afternoon at having to fit in this tutorial. I think of all the doctors I have taught, many of whom still await their chance to be doctors again. I swallow hard, unable to raise my guilty eyes.
"Can you do Friday?"
"Absolutely," they respond eagerly.
"See you then."
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| seem.bh
|
wow!...*tears in my eyes*..for the brilliant article!!..
n to u nnl for findin one
|
| new_n_lost
Politically InCorrect
Topics: 653
Posts: 6,085
|
Forgot to add the name of the author and for people who couldnt get to the correct page here it is again.
Ranjana Srivastava, F.R.A.C.P.
Dr. Srivastava is a medical oncologist and internist in Melbourne, Australia.
http://content.nejm.org/cgi/content/full/358/3/21...
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| acintya
FOCUS on your Goal!
Topics: 7
Posts: 765
|
Couldn't stop my tears from flowing ......
What a find, NNL!
___________________
Life is a Mind Game! Remember, obstacles aren't meant to prevent your success; they only slow you down and show you where you must work harder.
|
| drsmiley
Topics: 7
Posts: 35
|
i wanna read this article but it's sooo long...hmmm shall i read this or shall i go back to conrad fischer's blabbing? im so lazy,...
|
| naki
Forum Newbie
Topics: 3
Posts: 28
|
Dr. Smiley,
I think you should read the article, I cannot stop my tears from flowing also.
Great Article, I think every doctor should read it.....whether they are AMG'S FMG'S or
AFMG'S.
|
| dermdoc57
Forum Junior
Topics: 4
Posts: 78
|
God bless Dr. Ranjana Srivastava.It is extremely rare to find such compassion and concern.These are the kind of people who force you to believe that God does exist and takes the form of people like Dr. Srivastava.Many people go through the same hardships but once they manage to get into residency they forget everything .
As for bringing out the article thanks to Dr.NNL.
Rest assured that no Doctor in the west will ever read it and if anybody ever reads it his/her only remark will be-"Why do they leave their own country ?"There cannot be a bigger insult to injury.
|
| babydoc4usmle
Forum Guru
Topics: 18
Posts: 634
|
thanks, NNL, great article indeed
|
| aimfor2007
Forum Junior
Topics: 10
Posts: 94
|
I hope none of us forget the individual journeys we have all undertaken once we reach our goals...more over have compassion for not only our patients but also our medical students and colleagues.
When I had newly moved to the USA I had to undergo surgery and found the nurse ( from my home country )was actually a doctor back home,I wondered how could she not do the same in the US.After undertaking my exams I realize I am fortunate to have a family which constantly supports me ,spurs me to do well.
I even know an old uncle (did has MBBS ) who recently gave his step 1 with his son,a medical student as his study partner!!!
Keep the faith people!!!
|
| dermdoc57
Forum Junior
Topics: 4
Posts: 78
|
Dear NNL.I am just curious.I know you are from Pakistan from one of your posts but what impresses me most about you is finding articles like this in NEJM.May your tribe grow.What are you doing at this time and what is your location?
|
| new_n_lost
Politically InCorrect
Topics: 653
Posts: 6,085
|
Location = Earth
State = Darkside
Area = Banana Republic, US
Doing = Step 1 (again)
Edited by new_n_lost on 02/04/08 - 09:38 PM
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| nerve09
Forum Junior
Topics: 6
Posts: 128
|
just curious....nnl hey when r u givin it??
|
| milee99
Forum Guru
Topics: 40
Posts: 888
|
great pick,nnl
there isn't an appropriate smilie to put here
i hope my husband didn't notice my tears
  the pangs of migration
But we all have each other to look up to ,don't we??
and ofcourse our family and God
Edited by new_n_lost on 02/05/08 - 02:55 PM. Reason: Auto merged
___________________
Do not pray for easy lives,Pray to be stronger men; Do not pray for tasks equal to your powers, Pray for powers equal to your tasks; Then the doing of your work shall be no miracle, but you shall be the miracle.
|
| dermdoc57
Forum Junior
Topics: 4
Posts: 78
|
One conclusion I drew from my experience migrating.IT IS NOT WORTH IT.Back at home you felt frustrated at the system and here they will create every possible road block to frustrate you.Back there you had at least your degree and you were a doctor.Here you are neither a doctor nor anything else.You are a loser both ways but here you will lose all confidence and self esteem.So is it worth all your efforts and money.NO.
|
| babydoc4usmle
Forum Guru
Topics: 18
Posts: 634
|
dermdoc57 wrote:
One conclusion I drew from my experience migrating.IT IS NOT WORTH IT.Back at home you felt frustrated at the system and here they will create every possible road block to frustrate you.Back there you had at least your degree and you were a doctor.Here you are neither a doctor nor anything else.You are a loser both ways but here you will lose all confidence and self esteem.So is it worth all your efforts and money.NO.
dear dermdoc57, i hope you are not trying to generalize your own experience, though i can conclude that it was not very fortunate.
people make choices and live the consequence...
if you feel that you are not happy with your relocation, you can always go back and be happy there.
there is a saying in my language, and i will try to translate it and preserve it's purpose..."there are people who can act as a lowlife, but they can't make you be a lowlife..." something like that....
my point is, you write "you are a loser both ways but here you lose all confidence and self esteem"... can i ask why is relocation at fault? or country? or anything/anybody else? you are an owner of yourself, you are the one who can do something about your life.... no matter where you live and what you do... no one can make you lose your confidence, your self esteem...
look inside you and try to figure out what is it that you want and what should be done to get there....and no matter what the answer is, always keep your chin up
|
| dermdoc57
Forum Junior
Topics: 4
Posts: 78
|
Dear babydoc4usmle.It is not me alone but hundreds like me who were referred to in the article quoted in NEJM.But as your name suggests babys have long way to understand life which they just started.Do you think Dr Vandana Srivastava wrote the article just out of fun.My intention was to tell people that it is indeed not worth the effort.Going back is personal.
|
| cutekity
Forum Senior
Topics: 6
Posts: 177
|
i agreee with babydoc totally !! i understand that all this exam process and getting into residency is pain in the a** ...but this can not be generalized cuz it depends totally on different individual that what we want in our life and where do we want to see ourselves 10 yrs down the road ......and as far as family and friends are concerned we are prolly going thru all this hassle so that one day our lives and their lives(family) which is related to us in someway can be better !! well thats my point of view , you dont have to agree with this !!
___________________
where there is will, there is always a way !!
|
| babydoc4usmle
Forum Guru
Topics: 18
Posts: 634
|
you still can not say, that if this is what you feel then this is how other people should also.... even if there are hundreds of people who turn around and go back...thousands stay and work/study/fight 10 times harder and find a way to enjoy their lives in case if they were not successful in medical field...
i did read the article, and i do know what people are going through on the way to a medicine in different country (i am one of those, remember?) and if you say that your relocation is not worth it, than you are saying that you made a mistake... it is your mistake... but not mine, and definitely not those who practice medicine these days.... i am happy that i came here (in the US), and i know another couple of dozens how went through the same ordeal (or even worse) and are happy....and it doesn't mean that their lives are walk in the park... exams is the easiest part in the whole process, and there are obstacles ahead of me and others, but there is no regret.... and you know why? because we respect our obstacles, and overcoming them makes us only stronger.... and if you lost your self respect and self esteem along the way, that too bad... and i am very sorry that your goal was wrong for you.
as for babydoc, it does not "suggests babys", it suggest that i am a BABY's doctor, and your remark about me understanding life only tells me that you are very far from maturity yourself....
Edited by babydoc4usmle on 02/12/08 - 08:55 AM
|
| silver
Forum Guru
Topics: 21
Posts: 774
|
this article is a great reminder of when you think that you're having the worst possible time to look around you and realize that there are people in much worse situations but nevertheless are continuing to face their challenges and haven't given up--so neither should you. count your blessings and keep moving ahead.
bottomline is life is about struggle, and the sooner you embrace the idea the better off you are....nothing is smooth sailing, but the waters will only get rough if you let it.
___________________
Every disaster hides an opportunity.
|
| Jackofknives
Ipwnpoker.com
Topics: 91
Posts: 708
|
dermdoc57 wrote:
Dear babydoc4usmle.It is not me alone but hundreds like me who were referred to in the article quoted in NEJM.But as your name suggests babys have long way to understand life which they just started.Do you think Dr Vandana Srivastava wrote the article just out of fun.My intention was to tell people that it is indeed not worth the effort.Going back is personal.
lol are you trying to thin out your competition?
___________________
There are many things in this world that can’t be changed no matter how hard you try. That’s why you must not hesitate when the time comes where you have to give it all you’ve got.
|
| damian33
Forum Junior
Topics: 5
Posts: 91
|
The truth is that it is true. We FMG's whatever we came from need to do robust amounts of sacrifice to make it............But it is possible. Any FMG that wantsthis very bad he/she will achieve it. It would take a year for some people and 10 for anothers. Good Luck to everyone
___________________
Expect the worst and you won't be disappointed
|
| anzar
|
Well really a Wonderful article
|
| mjbapana
Forum Senior
Topics: 27
Posts: 155
|
wow!! It just about sums up what most of in this forum are going through. The place might be different, each ones story and situation may be different but THE BOTTOM LINE FOR ALL OF US IS THE SAME "WE ARE IMG's"!!!!
|
| mytime
Kick my butt!
Topics: 39
Posts: 3,173
|
Thanks NNL, I was being so cranky abt everything today not getting to the issue, reading this just hit the spot!!!!! Don't lose ur focus ppl. soon it'll be worth it! SO WORTH IT!
|
| abusedpostdoc
Forum Junior
Topics: 6
Posts: 47
|
alexaE,
I see your ducky has some white smoke on the right side of its yellow mouth! What exactly are you smoking - must be from the fun stuff!
Who exactly is supporting you during the last year and a half? That is a lot of time to allocate for taking the exams. These article refers to people with families and kids, not everyone is fortunate enough to be young and single when they come to this country or to have relatives living here who can give them financial support and possibly a mentoring advice.
Working summer jobs as a college student (been there, done that) is not the same as trying to establish yourself as a clinician in a competitive academic environment.
If someone's professional goal is to do a residency in Family Medicine (or whatever one can get into) and start making big bucks in some hillbilly small town - than go for it. But if you come to this country because you would like better professional opportunities and want to make something out of your life ( I don't mean the financial reimbursement) - than it is a much more steep and upright path.
___________________
There is no limit to what you can achieve in science as long as you don't care who takes the credit for it.
|
|
| |
| | | | | | | | | | | | | | | | | | | | | | | | | |
