I Woke Up One Morning and I'd Lost My Identity as a Doctor

— Foreign-trained physicians like me face immense barriers to practicing in the U.S.

MedicalToday
A Black man sits on the edge of his bed and looks out the window.

My family arrived in the U.S. in 1992, after the Civil War in Somalia. I spent my childhood in Washington state for about a decade until my father's import business expanded internationally. During the course of my life, I've lived in six different countries and learned five different languages. I earned my medical degree in China and worked as a physician for the early part of my career -- but everything changed when I tried to practice in the U.S. as a foreign-trained doctor.

My Early Life As a Doctor

In 2006, a carbon monoxide endemic affected my community in Kent, Washington. Due to a power outage, families had to cook and warm themselves over a charcoal grill brought indoors. But cooking indoors with charcoal caused 34 residents to get carbon monoxide poisoning -- they were all in critical condition and admitted to the hospital that night. This experience motivated me to pursue a career in medicine. I remember telling myself that I wanted to become the first Somali-speaking physician who could advise my community during accidents like this.

When I finished high school, I was living in China and decided to apply to Norman Bethune College of Medicine at Jilin University. I learned about Chinese traditional medicine and various home remedies preferred by my patients. This experience helped me develop a unique perspective on the impact of culture on medical beliefs and practices.

After graduating from medical school in 2014 and earning a Chinese medical degree, I went to a rural town in Somalia to care for patients and learn from physicians who practice medicine with limited resources. Many patients could not afford to pay and often cooked food or brought eggs to show gratitude. I practiced in that rural clinic for a year, but eventually returned to the U.S. to be with my family.

Facing Barriers to Practicing in the U.S.

My return to Seattle, however, did not feel like a homecoming. I could not qualify for a state medical license since I was foreign-trained, and recruiters in other industries told me I was "overqualified" for employment opportunities. I eventually got work as a security guard and picked up shifts at the pie factory to pay my bills. But I remained committed to rebuilding my career and pursuing family medicine training. Between 12-hour work shifts, I volunteered at local clinics to gain U.S. medical experience. I slept only 4 hours a day to prepare for the United States Medical Licensing Examination (USMLE).

In 2017, 2 years after I'd moved back to Washington state, I finished all my exams and got certified by the Educational Commission for Foreign Medical Graduates (ECFMG). This meant that I could finally apply for U.S. residency training that fall. It was the most exciting time of my life. I spoke with mentors at family medicine interest groups and reached out to programs across the country. I saved up every dollar I had and applied to 300 programs.

In November 2017, I received my only interview that season. It was from a program that serves a large Somali community in Seattle. I saw this opportunity as a blessing and prepared to give it my all. I researched the program and arrived at the interview with a big smile on my face.

The interview went great, and after a few days, the program sent me a card. I told myself this could be my chance. I knew my scores were decent and thought my observership (shadowing) experience would be enough to demonstrate my understanding of how the U.S. medical system works.

But in March 2018, I got an email from the National Resident Matching Program (NRMP) saying, "Sorry you did not match." I entered the Supplemental Offer and Acceptance Program (SOAP) and wasn't successful in that either. I will never forget that early morning in March, surrounded by my whole family, when it felt like someone hit my face with a huge rock. It was not easy to get up the next morning, but I fought through the pain.

A few months later, I reached out to the program that interviewed me to understand what went wrong. They told me the painful truth: "We just had too many applicants for a few spots." My response was, "How can I get better and what can I do to improve my chances?" They apologized and wished me good luck. I was baffled and didn't know where to turn. Before I knew it, September had arrived, and I had to apply for the Match again. After a couple of months, I got the same results: "Sorry you didn't match."

I very quickly learned that the journey from medical school to residency training is not a straight path for everyone, especially if you're an international medical graduate (IMG). And the harsh reality is that thousands of doctors, including many who are foreign-trained, never get the opportunity to practice medicine and take care of patients. I will never forget when I spoke with a colleague who described the process as a game of musical chairs where those left standing lose their identity. Imagine waking up one morning and not knowing who you are.

Changing Career Paths

After not matching for a few years, I decided it was time for a change. So, I started a WhatsApp group to see if others in Washington state were facing the same issues. I reached out to nonprofits and posted messages to recruit people on Facebook and Twitter. People joined slowly and we reached 100 members in 3 months. That's when we decided to schedule meetings and incorporate as a nonprofit organization.

We named our organization the (WAIMG). Since then, we've passed several innovative pieces of legislation to help IMGs in our state. These include to discuss strategies to lift barriers for IMGs; that is aimed at funding and implementing an IMG assistance program; and that established the , which allows doctors who passed all steps of the USMLE to practice under the supervision of a physician until they match into residency. In addition to our legislative advocacy, we've helped homeless doctors find jobs and eventually match into residency programs, have guided people during times of depression, and have provided support to individuals facing domestic violence.

While my journey has been long and challenging, I'm proud of the work I do. There is nothing I enjoy more than waking up each day and helping others achieve their dream. At a certain point, I decided not to apply for the Match again. I changed my career path. I didn't reach this conclusion out of a fear of being unsuccessful or a lack of passion for medicine. I just loved the work I was doing and thought leaving would jeopardize the progress my organization had made. Many people ask me if I miss medicine. Of course I do. The feeling of being a doctor is one that only a doctor can understand. But if I can help thousands of physicians by pushing for a few policy changes, that sacrifice is very much worth it.

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