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The Plight of an International Medical Graduate Physician Who Is an American Citizen

Here is a compelling story of a Bulgarian trained physician who has done everything to please the US residency training programs yet she has not been offered any residency position to continue with her American dream - practicing medicine in her new home country.


At the same time thousands of visiting physicians on J1 and H1B visas are enrolled into residency training across America every year.

A story of Neviana Dimova, M.D., M.S.

I am a Bulgarian trained neurologist, and I represent a group of 485 foreign trained doctors, who have passed their licensing exams and certified their education through the appropriate channels, but are unable to practice because we cannot get into a U.S. residency program. We call ourselves "Residency Ready Physicians" (you can find us on Facebook). Many of our members have compelling personal stories of the struggle to enter the U.S. medical system.

According to the latest statistics, there may be as many as 6,000 U.S. citizens and permanent resident IMGs (International Medical Graduates) who have not been able to enter the required residency training. We want to work and are ready to serve where needed. We would consider it a privilege to work in a rural or inner-city area, just knowing that we have the opportunity to use our skills to help people.

Some of our members have been trying for many years to work in their specialties. Instead they are wasting their training and talents working as lab technicians, or even pizza delivery boys, cab drivers, and Wal-Mart cashiers, just to make a living for themselves and their families, instead of helping to alleviate the growing physician shortage.

I would like to tell of my experience as an immigrant, not for my benefit, but as a common example of the problems facing medical professionals who immigrate to the U.S.

Since my citizenship interview and test, I have been reading the Declaration of Independence which identifies our inalienable rights as life, liberty, and the pursuit of happiness. For the majority of physicians, pursuing happiness means practicing the profession they sacrificed so much to train for.

I left my advanced neurology residency in Sofia, Bulgaria to pursue a master’s degree in Neuroscience at the University of Alberta, Canada. As soon as I arrived, I jumped into Step 1 of the licensing exams. I passed with a low score. In retrospect, it is amazing that I passed at all. I have no doubts about my professional knowledge, but attempting a multiple choice test in English (my third language) was a challenge.

A challenge that became even more evident with Step 2. This test, along with Step 3, is very difficult for IMGs. While it tests your professional knowledge, it also emphasizes the American standard of care and tests your ability to understand and conform to standard practices. Unfortunately, to really understand what the test is about, you have to understand the whole system of standardized testing.

I never saw a standardized test until the USMLE [United States Medical Licensing Examination]. As is common for Eastern European physicians, all my exams were in the form of essays, or oral exams with a committee. That testing system stressed full understanding of all concepts, requiring great detail and repeated defense of answers, not just the most likely answer. I failed Step 2, and later Step 3, multiple times before I understood why.

I did not get a position. Everyone one I talked to told me that my immigration status was a huge problem, that transferring my visa from a research position to a clinical position was more than residency programs would want to deal with, especially with prior failures. I was advised to work to get my green card before continuing.

I finally got my green card and applied to the match, and got no interviews. I was advised that my graduation date was old, and my test scores were both old and low.

I could do nothing about my graduation date, but the USMLE people said that since I had not passed Step 3, I could retake all three steps (normally a four to six year process). The first thing I did was enroll in classes to refresh my studies, but instead discovered the information I needed on testing theory. Armed with this knowledge I sat for all three steps in one calendar year, and passed with good scores.

But it is not good enough. My graduation date gets older, and my prior failures work against me. I thought of applying to medical school all over again, but I need an MCAT (entrance exam) and the application process could take years, and I have been told that since I have passed the USMLEs, schools were reluctant to "waste" the spot.

I want to work with patients and make a difference. I applied to several Physicians Assistant Programs, but they will not even interview me. I talked to one admissions counselor who told me that the available slots would go to students dedicated to the idea of being a PA, and that as an MD they suspected I was just trying to get around the residency system.

What is so sad is that my story is not unique, it is almost a cliché. I have spent countless hours seeking interviews with program directors, residents, attendings, and faculty. I barely have to tell my story, they can tick it off on their fingers they hear the same so often from people like me, more than one has listened to the first part of my story and been able to finish.

Everyone I talk to knows someone else, just like me.

Dr Dali Edwards

Founder and CEO of Women In Medicine Magazine

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