Authors: Arnav Mahajan1, Prerna Ladha1
1 MetroHealth Medical Center
As an international medical graduate (IMG) arriving in the United States, I find myself at the intersection of immense opportunity and profound responsibility. My journey to the United States isn’t just a personal milestone – it is a plunge into a crucible where the practice of medicine meets deeply rooted disparities that permeate the essence of American healthcare. My position as an ‘outsider’, often a barrier in many other contexts, allows me to bring a unique perspective to navigating this multifaceted relationship. However, it raises important questions about my role in addressing these disparities that shape patient outcomes. At the root of solving this complex equation is allyship.
In the realm of academic trauma surgery, the role of the surgeon transcends the operating room. It’s often about grappling with the social drivers of health that lurk behind patients’ charts: racism, gun violence, and social, cultural and economic disparities. Each patient’s chart whispering stories of these silent epidemics. Trauma surgeons are often the first responders to society’s failures. Academic surgery to me, at it’s core, has not only been about advancing surgical excellence but also about the ongoing quest to address these complex issues that lead to health challenges for many of our patients.
Is it presumptuous for someone who has not lived through the nuances of American societal issues to engage with these sensitive topics? Perhaps. Without a deep reconciliation of these issues, how does one balance the eagerness to contribute with the humility to respect and understand these entrenched issues? Allyship is not only important in this context, but is necessary to temper the delicate dance between contributing positively and overstepping cultural and experiential boundaries.
What role do IMGs play
IMGs frequently serve in communities with lower socio-economic status, where the most glaring deficiencies in healthcare are immediately apparent. These areas, often marked by high poverty rates and limited access to services, present unique challenges for all physicians. Frequently witnessing these challenges from the frontline, IMGs have a critical vantage point from which they can observe and respond to the myriad issues affecting our patients. This exposure not only deepens the understanding of specific healthcare needs but also primes us to lead efforts in research and advocacy, targeting the systemic failings we encounter daily. In this sense, the responsibility of an IMG is not merely a matter of filling gaps in the workforce; we represent a vital contribution to the care of communities often overlooked by the American healthcare system.
However, it is important to acknowledge that the majority of this experience and engagement happens in a clinical setting. While this reality frames understanding and approaches to these issues, it is not one that must only remain as a clinical observation. The practice of evidence-based medicine necessitates a deep understanding of the underlying causes behind these social issues such as institutionalized racism. It demands that we not only observe but also actively engage in learning about the intricate factors that contribute to health disparities.
In academia, where challenging the status quo is the norm, it is arguably the IMG who stands as the epitome of this transformative spirit. However, we may often be unaware of the totality of the issues that they have to face, such as the intricate dynamics of healthcare politics, the nuanced challenges of patient advocacy in a system vastly different from their home countries, and the subtle biases that can permeate even the most progressive institutions. Navigating this complex landscape requires not only clinical acumen but also cultural agility and the ability to forge strong alliances within the surgical community. Recognizing the role of IMGs is thus deeply rooted in the very ethos of academic surgery.
Allyship
The responsibility of an IMG in academic surgery is multifaceted. First, there is a need for a deep and empathetic understanding of the local context and social drivers of health. We must invest time in learning about the historical environment that shapes the healthcare landscape. Contextual allyship from mentors who are well-versed in understanding racial and ethnic disparities, socio-economic factors and historic injustices is essential and invaluable. These mentors, who may come from various personal and professional backgrounds, offer insights that are crucial for understanding the complex nature of issues and their impact on marginalized communities. They serve as bridges, connecting us with the nuanced realities of the communities we are researching.
Second, we carry the responsibility of bringing a unique, often global perspective to the table. Our experiences and insights from different healthcare systems and cultural backgrounds can shed new light on entrenched problems. By integrating these perspectives with local knowledge, we can contribute to a more holistic understanding of care disparities and propose innovative solutions. Allyship in this context goes beyond traditional academic guidance. It encompasses cultural allyship, where we are sensitized to the local socio-political dynamics that shape healthcare disparities. This form of allyship is crucial for ensuring that research is not only technically sound but also culturally relevant and respectful.
IMG surgeons must navigate the ethical implications of their research with care. This involves ensuring that our work does not inadvertently perpetuate stereotypes or biases, and that it contributes positively to the communities it studies. This role demands a high level of humility and awareness of one’s position as a community ally rather than a savior. It’s vital for us to collaborate closely with local researchers, healthcare professionals, and community leaders. Such collaborations can foster mutual learning and ensure that research initiatives are grounded in the realities and needs of the communities we aim to serve.
Finally, the role of the IMG surgeon as a researcher in trauma care and disparities is an ongoing journey of learning and adaptation. It requires a commitment to continuous engagement with local communities, staying informed about emerging issues, and being responsive to feedback. Allyship within the surgeon’s own department plays an invaluable role, and success would not be possible without supportive colleagues. They provide a sounding board for ideas, offer constructive feedback, and help navigate the often complex dynamics of academic institutions. Allies within the department can also assist in building connections with other experts and community leaders, facilitating broader collaboration and engagement.
Conclusion
As I reflect on the journey of IMGs in the field of academic surgery, it becomes evident that the path is one of paradox. We stand at the intersection of distinct worlds, blending our diverse experiences with the intricacies of American healthcare. Yet from this fusion of uncertainty and perseverance, we do not merely emerge as surgeons—we rise as pivotal agents of change. Our unrelenting hard work and adaptability mold us into integral members of the United States workforce, where we stand as staunch advocates for healthcare equity.
The paradoxical role of being both an insider and an outsider in American healthcare is not simply a transient phase, but a continual state of being for IMGs that we are privileged to own. We are insiders through our medical expertise and commitment to patient care, yet outsiders in terms of our cultural and professional backgrounds. This unique position allows us to view the healthcare system through a lens of global perspective and local engagement, offering insights that might be overlooked by those deeply ingrained in the system. We do not merely traverse these intersections; we reside in them, making it a space of rich exchange, learning, and growth. By embracing this space, we add value to our departments and communities, not despite our differences, but because of them.
The path of IMGs in the field of academic surgery is not a solitary one-it is deeply intertwined with the concept of allyship. These allies provide invaluable guidance, helping the IMG academic surgeon to thrive in their new professional environment. We are partners in the evolving narrative of academic surgery, writing a story of progress, innovation, and empathy. Our shared journey, marked by mutual support, is not just about enhancing individual careers but about advancing the entire field of surgery to new heights of excellence and inclusivity.
As I embark upon my own journey to become a trauma surgeon in the United States, I see many unfamiliar aspects that remind me of being an ‘outsider’, and simultaneously see the similarities in the responsibility that doctors have all over the world – to provide and advocate for equitable healthcare, and I cannot be more excited to make my contribution.
Arnav Mahajan
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Prerna Ladha