Twelve years ago, Kamalika Roy, MD, made the journey from India to continue her medical training in the U.S. as an international medical graduate (IMG). She has since completed residency and fellowship training, her master’s in clinical research, and continued as a faculty member. She is an associate professor of psychiatry at Oregon Health & Science University (OHSU) in Portland, Oregon.
Dr. Roy is a former chair of the AMA International Medical Graduate Section, which has produced the AMA IMG Physician Toolkit. She is now an alternate delegate for the Academic Physicians Section Governing Council. She also serves as the minority and underrepresented Trustee at the Board of the American Psychiatric Association.
During IMG Physicians Recognition Week, Oct. 21–25, the AMA will honor and celebrate the IMG physicians who are a vital component of the physician workforce and the AMA. An Oct. 21 webinar, “Physician Journeys and Contributions in the U. S. Health Care System,” will delve into the unique experiences that shape the careers of this diverse set of physicians, from medical school to clinical practice, highlighting the challenges and triumphs along the way. AMA members can register now.
As part of IMG Physicians Recognition Week, Dr. Roy offered insights on some of the challenges faced by the IMGs who train and practice in the U.S.
AMA: What was your journey as an IMG like?
Dr. Roy: Coming here to this country, I was supported by a lot of people. A lot of my teachers and mentors helped me to get into residency, and later at every step of my career. Overall, my journey was exciting, fulfilling, and intriguing in many ways.
Initially, when I first came, I was a research assistant at New York University Langone Medical Center. I worked at a cognitive impairment lab in Alzheimer's Disease Center. And then I did my psychiatric residency in Wayne State University—Detroit, Michigan. After that, a consultation liaison psychiatry fellowship at the University of Michigan, Ann Arbor.
AMA: What are some of the major challenges of being an IMG?
Dr. Roy: I would say there are quite a few limitations of being an IMG here in this country. The major limitation is about the immigration status. From a country like India, IMGs face a different kind of challenge because of the unending backlog to get permanent residency for decades specific for Indian citizens.
It’s challenging to maintain a temporary visa on an ongoing basis for decades, being in the backlog. It needs to be renewed every year, or every few years, as needed by the U.S. Citizenship and Immigration Services. I faced with some challenges with renewing my visa in 2020, amidst the pandemic, which exponentially worsened the renewal process and essentially took away the option of visa processing at the embassies. Many IMGs could not visit their family even if there was dire medical need during the pandemic, only due to visa processing issues.
Dive deeper:
- How IMGs can navigate challenges to thrive in U.S. residency training
- Key advice for IMGs to succeed in U.S. medicine
- Meet Your Match: An IMG's guide to residency selection
AMA: What are the barriers IMGs face to success in the clinical realm?
Dr. Roy: One of the barriers they face is implicit bias, which sometimes restricts their options for professional and personal growth.
There's not much objective data about the impact of this bias, or official recognition of this biases against IMGs, despite the widespread experience of biases by IMGs. IMGs usually work uphill against these biases throughout their career.
When it comes to international medical graduates, the experience was a good experience for me and that's why I'm here. That's why I decided to join the American Medical Association—to help others in their efforts of career advancement.
Subscribe and thrive in residency
Get tips and insider advice from the AMA on navigating and making the most of medical residency—delivered to your inbox.
AMA: Why is it beneficial for IMGs to be involved in organized medicine?
Dr. Roy: When I reach out to IMGs, I try to encourage them to be part of societies, specialty societies, state societies, and national societies such as the AMA, state and specialty medical associations. Getting involved in organized medicine and being part of a professional society not only helps develop identity and the sense of belonging, but also actually opens a lot of doors of networking and opportunities, direct and indirect.
Dive deeper:
- Why IMG physicians are vital to U.S. health security
- Easing IMGs’ path to practice: What Congress should do
- IMGs overcome barriers to offer critically needed care
AMA: What is a misconception physicians and the public at large may have about IMGs?
Dr. Roy: When IMGs come to this country, they are basically at the mercy of the immigration system. For example, if an IMG is diagnosed with a chronic disorder, which needs an extended or indefinite time off from work, being on a work visa can be a barrier to that possibility.
Our physical existence in this country is tied with our employment. And most physicians and the public might not know the implications of it. If we cannot not be employed for some reason, we cannot stay in this country. So that's one thing which makes it an existential struggle for international medical graduates and their families.
One other thing is many believe that IMGs don't have a good understanding of American health care system, employment contracts, legal system or American society. Many might have the bias against the accent and medical education outside of the US and their comparability with the US standard.
AMA: What advice would you offer for IMGs looking to practice in the U.S.?
Dr. Roy: First and foremost, IMGs thrive when they are focused, perseverant and open to possibilities.
And they should not lose patience in the process of getting into residency. Sometimes international medical graduates may not match for the first time into a residency position, but they should not give up on the hope of matching. They should continue to improve their profile by volunteering with other academic physicians, identifying and analyzing the areas of improvement and working with one or more mentors.
International medical graduates must remember that they have been an integral part of the U.S. work force. Many physicians and people would help, support, mentor and nurture them despite implicit biases and all other challenges would come their way.
