The path to becoming a medical resident and adjusting to the U.S. healthcare system for Medical School grads is difficult, arduous, and laced with uncertainty. Navigating this process is even more difficult for those who are not born and raised here. International Medical Graduates (IMG’s) and Foreign Medical Graduates (FMG’s) make up 25% of the physician workforce in the United States and often serve the most vulnerable populations within the nation. IMG’s and FMG’s play a vital role in primary care and in health professional shortage areas. These physicians enter the U.S. workforce through Graduate Medical Education, and nearly 80% of them are not U.S. citizens when they begin their medical residency training.  

While all residents face the stressors of long work hours, financial strain, and the pressure of absorbing large amounts of medical information, FMG’s experience unique challenges in addition to these while adjusting to U.S. healthcare system. FMG residency training is at the intersection of immigration, acculturation, and the beginning of training within the U.S healthcare system. These challenges can be divided into four themes, as described by:  

  1. Navigating both learning curves as immigrants in a new country and as residents in U.S. healthcare systems 
  2. Facing insensitivity and isolation in the workplace 
  3. Experiencing personal and global costs as a consequence of leaving their homeland  
  4. Facing specific needs as they prepare to complete residency training 

Navigating dual learning curves as immigrants and as residents  

While all residents are expected to master the clinical practice of medicine, FMG’s must do this while learning to live in a whole new country. FMG’s come with the knowledge of medicine and practice from their home country and then are tasked with learning a new culture of medicine.

Despite the shared global knowledge base in terms of physiology and disease processes, clinical practice often differs from practices in FMG’s home countries because of differences in resources, technology, and epidemiology. Compounding this, FMG’s must adapt to the expectations of patients, colleagues, and supervisors, and learn appropriate behavior and practices in the workplace.  

Facing insensitivity and isolation in the workplace  

FMG’s report feeling marginalized in the workplace, from subtle to overt ways. These instances range from minor cultural misunderstandings and microaggressions to discrimination and racism.  

FMG’s migration has personal and global costs  

The experience of emigration, acculturation, and assimilation comes with internal strife. Residents may feel guilty for leaving their homelands, especially if the medical sector in their country of origin is not doing well. 

FMG’s face specific needs  

FMG residents are often worried about their Green Card/Citizenship status and the restrictions that come with it. Many FMG residents cannot travel, cannot moonlight, and must work in locations where American doctors do not want to.  

Recommendations for supporting FMG’s/IMG’s  

Considering that FMG Residents undergo unique challenges and experiences, residency programs themselves can offer remedies and proactive solutions to help FMG’s navigate entering a U.S. Medical Residency while adjusting to the U.S. healthcare system. At the beginning of the residency, programs should address the culture shock FMG’s may experience. Workshops should be offered that focus on patient-centered care, cultural sensitivity, and patient interviewing. These three areas can drastically differ from what an FMG has been exposed to before entering a U.S. Medical Residency.  

During residency, programs should offer to link FMG’s to peer and mentoring programs. Social support can remedy any feelings of isolation and learning from FMG mentors can provide FMG residents with a safe space to discuss any cultural nuances or instances of insensitivity in the workplace. Additionally, U.S. Medical Residency programs should revisit and revise policies for workplace discrimination to ensure their FMG and IMG residents are working in a culturally humble space.  

When transitioning into post-residency, residency programs should familiarize themselves with visa and immigration issues that FMG’s must deal with. Considering that 80% of FMG’s are not U.S. citizens when they begin their path in a U.S. Medical Residency, it would be helpful for residency programs to offer support through this process. This could include having resources for immigration attorneys and other legal aid.  

How Residents Medical supports FMG’s 

Residency programs can be an excellent space to remedy FMG challenges, but the reality is not very many have this capacity in place as of yet. The team at Resident’s Medical has a time-tested program that specifically supports FMG’s successful adjustment to the U.S. healthcare system. Residents Medical is currently the only organization that offers FMG’s comprehensive packages that address all their concerns. This includes assistance with the visa process, interview preparation, and constant communication and support to FMG candidates.

Our organization has helped transition countless FMG’s into seasoned U.S. medical professionals. We understand the unique difficulties and struggles that FMG’s face, but we firmly believe that FMG’s are an invaluable asset to the medical profession in America. We understand that you have worked hard to fulfill your dream of being a physician in the United States and have comprised a U.S. Medical Residency Pathway to help you reach that goal. Our program addresses all of your concerns, including the interview.  

One of the most intimidating parts of the residency process for FMG’s can be interviewing for different residency programs. This is due to the lapses in culture; everything from vernacular to body language can differ from what an FMG is used to in their home country. Residents Medical has a specialized Residency Dream Team that addresses all of these nuances. Our Interview Preparation will link you to former Program Director, current deans, and other Graduate Medical Education professionals. Interview training will be based on an assessment of your CV, and you will be provided with questions interviews often ask, as well as the responses they are looking for. Following this, you will be given two mock interviews with critiques.  

Currently, Residents Medical is the only organization that can support you through your Visa process. We will link you to the resources needed to streamline this process and connect you with other FMG’s who have been through our program. The road to acclimating to the U.S. Medical system can be difficult, but Residents Medical is with you every step of the way. Please speak to a member of our Residency Dream Team today to learn more.