Security-related delays, worries continue to plague IMGs

Since Sept. 11, 2001, foreign-born international medical graduates, particularly male Muslim physicians, have found themselves among those under increased scrutiny, as the United States seeks to keep terrorists at bay.

The July bombings in London emphasized the importance of heightened security measures, but many IMGs and U.S.-trained physicians are concerned that sluggish security checks are continuing to hinder residents' training and hobble resident programs.

Abdul Rashid Piracha, MD, president of the Assn. of Physicians of Pakistani Descent of North America, said despite slight improvements, delays remain significant.

"For some reason, physicians coming from Pakistan are having the most difficulties," even when compared with physicians entering the United States from other Muslim nations, Dr. Piracha said.

"They're not getting visas at the embassy level in Pakistan. When they do, they then have trouble with security clearance," he said.

The result for many IMGs is that they are missing deadlines to take the U.S. clinical skills test, interview for residencies and arrive for residencies. Even those who have lived in the United States for years could find their practices put in jeopardy if they travel outside the country.

Statistics from the Educational Commission for Foreign Medical Graduates show some improvements. In 2004-05, 288 of the 1,309 IMGs coming for their first year of residency on a J-1 visa were late. In 2003-04, 404 of the 1,133 IMGs sponsored by the ECFMG had missed their start dates.

Those from Pakistan, one of the top three sources of IMGs, experienced the most delays. Of the 157 first-year residents from Pakistan sponsored by the ECFMG in 2004-05, 41 never arrived and 59 were late; 35 of them were more than 31 days late. Of the 154 first-year residents from Pakistan sponsored by the ECFMG in 2003-04, 33 never arrived and 81 were late; 45 of them were more than 31 days late.

First-year residents aren't the only IMGS to get held up at the border. Roughly a quarter of all residents are IMGs, and even after they've passed through security once and have a valid visa, leaving and re-entering the country is no longer routine.

This is exactly what Rizwan Khalid, MD, a cardiology fellow at New York Presbyterian Hospital in Queens, discovered when he visited Pakistan while an internal medicine chief resident at the University of Connecticut.

He arrived in April 2004 and immediately applied for his return visa and security clearance as required. He didn't get his passport back until Dec. 8. Dr. Khalid's program director held his position for him, and his brother, who was also a chief resident at the same program, kept up his rent and car payments.

Meanwhile Dr. Khalid missed his board exams and wondered if he'd lose his career.

"The uncertainty was the worst. I felt helpless," he said.

As a result, he won't be leaving the United States again.

"God forbid if anything happens to my family," Dr. Khalid said. "In cardiology, there are very few fellows. I'd lose my job this time if I were held up in Pakistan."

Dr. Khalid said he knows of several medical residents from Muslim countries who are afraid to risk a trip home now and as a result will be separated from their families for an extended time. Also, he said, word of these barriers is out among medical students in other countries, and some are deciding not to attempt to seek training in the United States.

The delays also have U.S. program directors thinking twice about hiring IMGs. Kiki Nissen, MD, assistant professor at the University of Connecticut in Farmington, was Dr. Khalid's program director.

"We've talked about not even recruiting from countries labeled for harboring terrorists, but we're looking for the best residents possible," Dr. Nissen said, and the graduates they are often impressed by are from Pakistan.

In response to these persistent issues, the AMA decided at its Annual Meeting in June to urge the Dept. of Homeland Security and other relevant federal agencies not to discriminate against Pakistani physicians and to separate IMGs' visa applications from the general pool in order to process them more quickly.

Jailed without charges

While IMGs endure long waits at U.S. borders, some of them have also faced challenges here in the United States. Two foreign-born physicians were among at least 70 people detained by the U.S. Justice Dept. as material witnesses, according to a report from the American Civil Liberties Union. As material witnesses, the detainees were held without charges, not allowed immediate access to attorneys or access to the evidence being used against them.

One of these physicians was a naturalized U.S. citizen originally from Pakistan, who had spent four years as a volunteer in the U.S. Air Force National Guard, according to the ACLU report. In his 60s and retired from his 30-year career as a psychiatrist, the doctor was held without charges for six days in June 2002.

The other was a radiology resident from Saudi Arabia. He was held in a maximum security prison before ultimately being released, also with no charges.