Dr. Onunkwo has been aware of misperceptions about his professional competency. “Depending on what part of the country you find yourself in, you need to continually prove yourself,” he says. “There is this perception, maybe due to the accent or the way you express yourself. It’s unspoken, but it’s there and you don’t need to be a rocket scientist to observe that. You need to prove that you’re good to be able to survive.”
This is easier for some than others.
“I cannot say I have experienced any barriers in that respect,” reports Gunter Kurrle, MD, lead physician with the WellStar Kennestone Hospitalist Group in Atlanta. “I’m European, like most Americans with European background, so it has not been my personal experience to encounter prejudice.” Dr. Kurrle’s journey to his present post as lead hospitalist is also atypical compared with most IMGs who come to the U.S. He initially took his foreign medical graduate examination in the late 1980s, just before the United States Medical Licensing Examination was initiated. He then returned to Germany for five years of additional training after his residency in this country. He came back to the U.S. for personal reasons (his wife is a U.S. citizen and was starting her residency training here) and found that entering hospital medicine was “a better fit than trying to start a practice on my own.”
Hemant Patel, MD, president of the American Association of Physicians of Indian Origin (AAIP), based in Oak Brook, Ill., believes discrimination toward foreign-born physicians has been greatly reduced since the early 1980s, when he entered the country. AAPI, with membership of 45,000, was founded in 1982 to offer support to IMGs from India. Physicians of Indian origin constitute the largest group of IMGs.2
“At that time, it was very difficult to obtain residency slots due to competition, and we had a lot more physicians to occupy those slots,” says Dr. Patel.
Dr. Fajardo believes the inclination to discriminate is inherent in everyone: “It’s latent, but if you give them the reason to discriminate against you, then it will manifest.” With regards to the physician-patient relationship, Dr. Fajardo reports that initially, on rare occasions, he encountered resistance from patients who were reluctant to trust their care to him because of his name (“I can’t pronounce it—are you a terrorist?”) or his looks (“You look too young to be a doctor—are you sure you can take care of me?”).
“At the end of the day, it’s very fulfilling when you hear them say, ‘Thanks a lot, doc, for getting me better,’’ says Dr. Fajardo. “I believe that it isn’t where you come from that matters; it’s what you can do.” Overall, he says, the realities of the medical profession are that “the outcome of what we do speaks for itself, and that’s what matters most.”
Dr. Onunkwo is philosophical about the initial skepticism he sometimes senses from patients and other colleagues. “I understand that people are wary of the unknown, and I think it’s just natural,” he says. “Usually, what happens in my situation is that I feel the skepticism, but I don’t do anything about it. I still treat the person with the respect that they deserve and ultimately, I just let my work do the talking. Everybody gets the same level of respect and attention that they need and nine times out of 10, before patients are done with their hospital stay, their attitudes toward me have changed.” TH
Gretchen Henkel is a frequent contributor to The Hospitalist.