For physicians who decide to migrate to the United States to continue their training, the transition is fraught with challenges, lessons and sacrifice. International Medical Graduates comprise approximately 25 percent of the U.S. physician population and the highest concentration of IMGs are in states where CIR members train: New York at 42 percent, California at 23 percent, Florida at 36 percent and New Jersey at 45 percent.
A number of scholars and journalists from JAMA to the New York Times have attempted to analyze the effects of physician migration on the U.S. and the countries of emigration, yet rarely do readers get insight into the journeys of the nearly 230,000 individuals and their families who’ve migrated in pursuit of personal and professional fulfillment in medicine.
CIR Vitals sat down with three members who began their training outside of the U.S. to learn about their paths to pursuing residency in the United States: Dr. Valdes-Crespo, Dr. Nouraddin N. Nouraddin, (Iraq), Dr. Olukola Adeleke, (Nigeria)
Cuba, Angola, Venezuela, the United States…Dr. Raidel Valdes-Crespo’s resume contains as many countries as your average Amazing Race contestant. This year, the internal medicine resident at Wycoff Heights Medical Center in Brooklyn, began practicing medicine full-time after a five-year hiatus.
“I finished medical school in 2000,” recalled Dr. Valdes-Crespo. “In Cuba, it’s mandatory to do a residency in family medicine. So I finished four years of family medicine in Cuba and afterwards I was sent to Venezuela to work as a community doctor.”
Dr. Valdez-Crespo hails from a family of physicians, and after his year on a medical mission in Venezuela, he decided to join his mother who had already been practicing in Angola for four years.
“I stayed in Angola for two and a half years as a general physician in different hospitals. I enjoyed it and acquired a good sense of the clinical part of medicine.”
He then hit a crossroads. Under a 1995 U.S. Policy, Cuban citizens are eligible for permanent residency in the United States. “I also had the option to go to Spain where they speak my language, but I decided that the U.S. presented a good opportunity for me. I knew that America has its arms open to Cubans.”
But the decision to move to the U.S. wasn’t without sacrifice.
“There are five residents from my country in my hospital and we all have a similar story. Cuban citizens aren’t allowed to travel. If you want to leave the country or experience what life is like outside of Cuba, you can hopefully join some medical mission and then you decide whether you want to go back or not. But that decision to leave altogether comes with some risks. For example, we cannot go back to Cuba now. It’s not written down or anything, you just can’t go back. You are separated from your family and childhood friends so it’s pretty tough. That’s one thing that’s different for Cubans than for other immigrants.”
He moved to Kentucky in 2007 where he found work as a medical assistant and began studying for the boards. Now, five years later, he begins his journey through residency anew at Wyckoff Heights Medical Center.
“I knew I was going to study hard and do everything to become a physician because it’s my life. I don’t think I can do anything other than this.”
Dr. Adeleke knows a thing or two about organizing. During his tenure at St. Barnabas Hospital he helped form a CIR chapter and bargain the first housestaff contract. But his political work began long before in his home country of Nigeria.
From 1982 to 1996 he was involved as an undergraduate in the National Association of Nigerian Students, serving in 1986 as the National President.
“I knew from a young age I wanted to be a doctor. When I was growing up in my country there were only two noble professions that people wanted to be, a doctor or a lawyer. And with the compassion I had for people, seeing a lot of suffering, especially infectious diseases, tuberculosis and diabetes, I knew I wanted to practice medicine.”
“I lost my father when I was 3-years-old, so I was raised by my mother with six other children. It was tough, because she was uneducated. She was doing many jobs here and there to support our family, to feed us and to put clothes on our backs. In fact, my older brother stopped going to high school so that I could go because my mother could not pay for the two of us at the same time. I observed all of this, and it shaped me and prepared me to be more active in university.”
“When I got to university, I found that they already had a well-run student union. The Nigerian students’ mission was to bring social justice and equity into Nigerian politics and represent a silent majority because at that time most of the Nigerian population lacked education, and there was broad inequality between the haves and the have-nots. If you find your way to the institution of higher learning like that, you have no choice but to be involved.”
When Dr. Adeleke began residency at St. Barnabas, the housestaff were in the thick of an organizing campaign to establish a union in the hospital. “My colleagues in CIR brought memories back. I saw that there were people who were dedicated to fighting for changes and providing representation to residents and interns. And not only in terms of our work but also for patients and hospitals around the country in general.”
Of commonalities between his work in Nigeria and his experiences working to establish CIR at St. Barnabas he says, “In both efforts we wanted to make sure that the people are well taken care of, whether they are patients or workers. You have to ask in any situation you find yourself, ‘what did I do when I was there to contribute to society?’”
Dr. Nouraddin N. Nouraddin, Iraq
Dr. Nouraddin Nouraddin, who is finishing his last year in internal medicine at Lincoln Hospital, is surprised to have found himself becoming a strong union advocate during residency.
“I never wanted to get involved in unions in Iraq because I felt they were politically motivated. When I was in 8th grade, a local official came to my school after I was elected as a class representative. He told us in a firm tone ‘you, as representatives of your class, should get involved with the Baath party.’ I really was dismayed by what he said and procrastinated in signing up with the Baath party, and I am grateful I never did.”
“I lived in the north of the country, the Kurdistan region, which had separated from the central government in 1992. From my previous experiences with student unions, I was turned off by politics.”
Throughout medical school, the student unions he encountered continued to have strong political affiliations.
“Kurdish government back then had a number of conflicts. The two main student unions were related to the two main Kurdish parties. Were you to join one, you would have the stigma of that party.”
Upon finishing medical school, he intended to begin residency in the United States but encountered difficulty. “I graduated from medical school in 2000, but it was around the time of 9/11 when I first started to search for residency programs in the US. It was difficult to get visas at that time,” Dr. Nouraddin said. He used the time to provide medical support to underserved communities. “In medical school in Iraq, we follow the British system: study for 6 years, 2 year of internship, then a year in an underserved area.”
In 2003, Dr. Nouraddin began to study in Turkey under Dr. Ihsan Dogramaci, a world-renowned pediatrician, diplomat and philanthropist. He went on to work with the Ihsan Dogramaci Arbil Foundation to help establish a clinic to provide free healthcare to local children in his home region of Iraq.
“Our greatest challenge was figuring out how to get schools actively involved who were skeptical of the idea of a private clinic providing health care free of charge, so we sent buses to the school and a couple of nurses to provide education about coming to clinic. Ultimately, we had 20 or 25 schools that were getting care from our clinic.”
During this period he never gave up on his goal of training in the United States, he took the USMLE in 2006 and in 2009 was accepted to Lincoln Hospital’s Internal Medicine program.
“I chose to get involved in CIR, because the main focus is resident life—fighting for residents, not hidden agendas.” He also saw CIR tackling similar issues to those he faced in Iraq.
“As a delegate, I explained the Healthy Bronx Initiative to other residents. In Arbil I worked in an underserved area and I work in one now in the Bronx. Both are economically disadvantaged and in both I saw similar issues—like medication safety, preventative care, and getting care before diseases progress to a more critical stage. Healthy Bronx efforts are mainly preventative and educational and our work at the Arbil clinic was similar.”
As he finishes his final year of residency, he looks back on the experience with gratitude.
“I’m thankful to my colleagues that gave me the opportunity to serve as a delegate for two years. I was able to be an advocate for my residents and the community.”