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From the Horse’s Mouth: The Trials and Triumphs of IMGs in the U.S.A

Submitted by on April 6, 2016 – 9:35 PM

Doctors“What do you think are the barriers for an international medical graduate coming into your program?”

On my recent trip to the United States, I was fortunate enough to put this question to twenty physicians across the U.S, who were involved in the recruitment process for trainees in their respective programs. They kindly obliged, and I decided to consolidate their replies , and add a few of my own thoughts on the reservations recruiters possess when hiring someone from an international background. By international, I mean anyone who has not been educated in the U.S system. Pakistani IMGs naturally fall into the same international web. Here are some of the interesting responses I received and my own short critical analysis of them.


  • The language barrier

More than 50% of the people I talked to gave me the exact same answer: We are concerned whether they can speak proper English and communicate effectively with patients. One of the directors even expressed profound surprise at my own good communication skills and wanted to know how I could possibly have learnt it in my country. This brings to light the fact that some people in the world still think Pakistan does not have English-medium education. This barrier for me was merely a gap in perception, and I believe we have already overcome it to a marked extent.


  • A hierarchy system

One of the recruiters honestly said to me, “You know I have heard there is a lot of hierarchy system in your part of the world and when international graduates come here, they find some difficulty adjusting to teamwork but they eventually settle so it’s not that big a deal.”


This point, I have to agree with. Pakistan has a hierarchy mentality invested deep into its roots and somehow we still haven’t been able to get rid of it. Every person has a position in the system but it is interlinked in the form of an ascending or descending ladder; not in the form of a wide cast web for maximal benefit.


Being a part of the ladder is sometimes associated with respect, but a lot of times it is associated with derogation and fear. As we evolve into a developing nation at par with the rest of the world, this is one thing we must get rid of. That said, I have no doubts that when one of us goes abroad, we leave our hierarchy far behind and we have no difficulties adjusting to that system.


  • ‘They will not hit the ground running!’

A few recruiters were concerned that someone coming from a foreign background may not be able to cope with the fast paced lifestyle intense work load the life abroad presents.


This statement for me holds true and untrue at the same time. True, because I agree the lifestyle there is much faster paced than what we experience in our home countries. But untrue also, because the number one reason people want to hire trainees from international countries is because of their willingness to work hard.


Coming from Pakistan, we as a nation and as doctors do not fear hard work. We are used to working in mentally and physically exhausting conditions due to lack of ancillary staff and resources. But we put in our utmost efforts to save precious lives. And this I say from personal experience.


  • Curriculum vitae

One of the recruiters’ objective explanation for why more American graduates are hired than international applicants was the following: “You don’t know the junk they fill up their CVS with”.


His point was that when American graduates and international graduates are ranked on the same scale, the former have much more volunteer work, research and achievements to their credit than the latter. This may partly be true because a few of our schools still do not formally incorporate the many facets of a good student and personality into their training. Unfortunately, due to too much emphasis on grades and standing first in class, sometimes we lag behind in building up our CV’s in the broad ranging way that we should. On the contrary, I do believe we bring with us some magnificent and diverse experience that could be an asset to any recruiter who objectively thinks of hiring us. Quality wise, the CV of most international graduates can easily be termed hefty.


  • Brilliant on paper, not in person

Ouch, that one really hurt!


A few recruiters were of the opinion that international graduates are brilliant only on paper: they have amazing scores, they top their class, but when it comes to the practical aspect of things, some of them lag markedly behind and have a tough time keeping up.


Though I give them the benefit of the doubt because their judgement must be based on solid experience, I honestly beg to differ. It is indeed true that we face difficulties when adjusting to a new system, but I firmly believe that we are quick learners and have been taught well at our medical schools how to apply our knowledge to real life situations. So we are not ‘just good on paper’, we simply need to be tested more. And this conclusion is not just a figment of my imagination, it is based on the great number of flourishing physicians in the US from international backgrounds.


  • They are gold!

Most recruiters frankly said they had no reservations. People from international schools were brilliant, diverse and had a lot to offer. And that they would love to hire them: They thought they were gold! An encouraging conclusion for anyone who is looking to practise abroad, this one brought a smile to my face and makes a befitting end to my humble analysis.



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