Rabbia Irfan, MD; Shamayel Safdar, MD
WMJ. 2024;123(4):249.
Who leaves behind all they have ever known and ever had for the love of a profession and for the love of a land that promises the freedom to be their best self? An International Medical Graduate or “IMG.”
Being new to the US health care system, it is almost mandatory for IMGs to have some sort of US clinical experience before applying for what is euphemistically termed the “Match,” a residency affiliation with a hospital/school institution.
Applying for a match in the United States is a stressful process. Visas, financial burdens, and incompatibility with the home institution’s curriculum all present impediments that must be confronted and overcome. Adding to these is the limited number of schools offering international students visiting electives. Indeed, just before the COVID-19 pandemic, only 21 medical schools offered spots for IMGs from institutions without affiliation agreements.
In a good year, the match rate is unlikely to exceed 70%, although the pandemic saw a significant reduction to little more than 57% – probably due to the difficulty of obtaining US clinical experience, the economic impact of the pandemic, and the increased competition for residency spots.
As mentioned already, US clinical experience is a crucial component of the matching process. Being a requirement for many residency programs, it allows IMGs to gain exposure to the US health care system and to network with potential mentors. However, with travel restrictions and other pandemic-related challenges, it has been challenging for IMGs to obtain US clinical experience in recent times. For example, the economic upset, lack of visa appointments, and hospitals and clinics being overwhelmed by dealing with the pandemic were among the many hurdles to overcome. Meanwhile, even as IMGs have had to pay for their own US clinical experience, the pandemic made it more difficult to find the required funding and get an appointment for a visa interview. Even when visa offices opened up, the wait times remained hopelessly long.
As IMGs, we continued searching online to find any opportunity, but none was in sight for a long time. For those of us in our final years of medical school during the first 2 years of the pandemic, we lost our chances of getting an elective – considered the best form of US clinical experience. Many hospitals and clinics closed their doors to visitors, and those that were open were operating at reduced capacity. As a result, we could not find any observerships for several months. We finally applied to a few places when the world started opening up. At first, mostly clinics were available, not hospitals, and those accepting applications for observerships had a long wait time.
We want to share our story to help other IMGs who are struggling to find US clinical experience during these difficult times. We emailed many doctors as well as hospital and university administrators. The response was overwhelmingly negative, and as days passed, while searching web pages and social media groups for opportunities without any promising response, a cloud of hopelessness began to overshadow our dreams. However, our passion for this noble profession was fierce enough to illuminate those dark days and help us through this challenging time, aided in part by a focus on other meaningful activities like telerotation and research projects to continue moving toward of our shared dream.