REFUGEE DOCTORS: PTSD AND DISCRIMINATION WITH US RESIDENCY REQUIREMENTS
Sumeyra Baskoy, M.D., Volunteer Physician, VCare Family Practice, Vernon, CT
Steven Lippmann, M.D., Emeritus Professor, University of Louisville School of Medicine, Louisville, KY
Refugee physicians are an asset to the healthcare system in the U.S.A. They often bring medical skills, knowledge, and experience; they also could thus contribute to healthcare for underserved communities. To obtain a medical license in this country, refugee doctors must complete at least two years of post-graduate residency training in this country.
Residency programs, however, usually favor applicants who graduated from medical school within the last 3–5 years. This timing is a barrier for refugee physicians who completed medical education in their home country years ago. The recent medical school graduation stipulation makes it difficult for many of them to gain admission to residency. And without that, becoming medically licensed is not possible.1 Unlicensed doctors are not able to practice clinical medicine; that results in frustration and disappointment for many trained and qualified practitioners. It also deprives our population of an opportunity to fill physician-storages.
Additionally, the stressful uncertainty associated with the residency application process can exacerbate the posttraumatic stress disorder (PTSD) symptoms that many refugee doctors already experience due to the past trauma that made them become refugees.2,3 Indeed, some programs discriminate against these doctors based on the age of their medical degree instead of individually evaluating qualifications and experiences.4 Such discrimination has mental health consequences, especially for individuals with already established trauma. That can worsen isolation, anxiety, and depression, aggravating PTSD issues, and compromise their ability to qualify at the competitive process of applying for residency.
The medical community, policymakers, and our citizens ought to recognize these challenges. Hopefully, they could create an inclusive, alternative pathway that is supportive for refugee doctors to qualify for restarting their medical careers in the U.S.A. Training programs could begin by offering new educational options for refugee doctors. For example, they might allow extended timelines following medical school graduation. Training also could focus on an encouraging understanding of our medical system and language, with less emphasis on basic medical education. These doctors often also nicely bring experiential knowledge from their past to our trainees and patients. Besides that, they require less supervision than needed by new, inexperienced physicians.
Subsequently, lots of international graduates who became US-licensed physicians seek citizenship by performing clinical services at medically under-served areas. Such doctors move to and work in parts of our country with a dearth of healthcare options; they help us provide attention to our people and that aids those doctors at gaining citizenship. That is a means of obtaining permanent resident status with insurance of a so-called Green Card that authorizes someone to stay, live, and work in the U.S.A. Secondarily, it might mitigate some of our society’s various prejudices against individuals perceived as “different” or “other”.
By providing refugee physicians with the what they need, we can help overcome official challenges, mitigate their PTSD aspects, and though that facilitate better healthcare to our population and communities.5,6 Once political and medical education decision-makers recognize the potential contributions of these doctors it can improve our healthcare system. By providing more opportunities and adding a measure of respect, we all can harness their skills and experiences into our healthcare system. Yes, everyone could benefit.
1-Bell SB, Walkover L. The case for refugee physicians: Forced migration of International Medical Graduates in the 21st century. Social Science & Medicine. 2021;277:113903. Date accessed April 29, 2021.
2-Nickerson A, Hoffman J, Keegan D, et al. Intolerance of uncertainty, posttraumatic stress, depression, and fears for the future among displaced refugees. Journal of Anxiety Disorders. 2023;94:102672. Date accessed March 30, 2023.
3-Jou YC, Pace-Schott EF. Call to action: Addressing sleep disturbances, a hallmark symptom of PTSD, for refugees, asylum seekers, and internally displaced persons. Sleep Health. 2022;8(6):593-600. Date accessed March 30, 2023.
4-Franklyn G. “We’re IMGs, and we’re often seen as human garbage outside of primary care”: A qualitative investigation of dynamic status hierarchy construction online by medical trainees. Social Science & Medicine. 2023;317:115611. Date accessed March 30, 2023.
5-Burgess AM. Resettlement of refugee physicians in the United States. The New England Journal of Medicine. 1952;247(12):419-423. Date accessed March 30, 2023.
6-Kureshi S, Namak SY, Sahhar F, Mishori R. Supporting the Integration of Refugee and Asylum Seeking Physicians Into the US Health Care System. Journal of Graduate Medical Education. 2019;11(4):22-29. Date accessed March 17, 2023.