Tales of an Immigrant Doctor

Written by Julio Cesar Nunes, MD

First and foremost, this piece was written in a café across the street from Yale University’s Museum of British Art. I arrived at New Haven, CT at 3pm on a Tuesday and was merely days away from starting my residency in Psychiatry at that same institution (not the museum, of course!). Amidst moving, new intern responsibilities, and adapting myself to a new city, I found comfort in knowing two things: (1) other people are going through the same challenges right now, and (2) OH MY GOD I GOT ACCEPTED TO YALE!!! (Internal voice says: “remember to breathe, Julio”).

Moving to New Haven represents both a new beginning and the closure of a long, exhaustive cycle. Yes, I am talking about years of preparation for USMLE steps, audition rotations, endless bureaucracy, applications, interviews, and all the other well-known challenges of getting accepted to a medical residency. There is a catch, however: I am a non-US citizen International Medical Graduate (non-US IMG for shorts). In this piece, I would like to exemplify some of the unique and additional obstacles faced by IMGs in the hope that, when you cross paths with us, you can better understand what it means to be in our skins.

I will start from the beginning. In March 2020 I was given a rare, and extremely important, opportunity as I was invited to be a postdoctoral research fellow at Stanford University. At the time, I was still a medical student at the Federal University of the State of Rio in Brazil. I was supposed to graduate in December 2020 and smoothly transition to this new position in January 2021. However, as life tends to test us, the pandemic hit hard and my plans had to be adapted. I managed to convince my university and 100 professors in the academic council to allow for earlier graduation to facilitate visa matters. As any person with experience with the public sector will know this was not an easy achievement, but somehow it happened.

Happiness was only transitory as I got drafted for mandatory military work as a physician. The opportunity of working as a fellow (a much-needed bridge to the dream I am living today) was at risk, as I would have to serve for at least another year. As I told the story of my acceptance to Stanford, word of mouth from lieutenant to lieutenant and from colonel to colonel got me a chance to speak with the general himself. With a pat on the back and words of advice, that impressive wise man released me from my duties in the interest of representing Brazil as a scientist abroad. Easy, right?

Another curve ball would be thrown in my direction. Because of the increasing rates of COVID transmission, all the US embassies in Brazil were closed and for a very long time, there were barely any exceptions that would grant you an appointment. A fellowship at Stanford was not a good enough reason. After my original appointment was canceled, I started to lose hope. Thankfully, an unlikely idea hit me, and I decided to go for the hail-Mary. As someone with double citizenship, I asked the Mexican government for a passport to be able to attend a US embassy appointment in Mexico (special regulations still allowed them to work). Mexico unfortunately would only provide me with a provisional 1-year passport, which I used to travel. Back in my birth country, I tried once again to get my fellowship visa and failed, as a permanent 10-year passport was required.

Don’t ask me how I got the necessary document, I honestly don’t know the answer to that question. Basically, my Mexican uncle, knew someone, who knew someone, who knew someone, who knew someone. You can choose whether it was sheer luck or destiny (as it was when I met the General!). I finally got my passport and visa, gathered all my belongings in two suitcases, and flew from Mexico City. I still remember crying as I saw the sign saying, “Welcome to San Francisco”.

My next year at Stanford would be filled with additional challenges, some of which I am sure you have lived yourselves. To name a few, adapting to a new culture, to new work environments, meeting new people and co-workers, gaining confidence in a new language, and of course, visiting the DMV 4 or 5 times before they would finally decide to give me a driver’s license. Since I got to the United States, I also experienced prejudice against my Latino origins and my accent; but received praise and support from even more people. I helped people and asked for help. I fell in love. I moved across the country again (this time with more than just 2 suitcases) to pursue the residency I always wanted.

I hope you can realize from my story that IMGs are just like everybody else, we also dislike the DMV, work hard for what we want, and find it is very hard to organize stuff inside of a UHaul container. However, extra layers of challenges may be imposed upon us: military service obligations, international documentation differences, getting visas, renewing visas, staying on top of the immigration paperwork, airfare chaos, and distance from family and friends, among others. As I walk the halls of Yale-New Haven Hospital, I will be sure to ask you, my fellow residents and friends, “how are you doing?” hoping you will feel comfortable sharing the truth. We are here to support each other, IMGs, AMGs, it doesn’t matter. And now, as you better understand our struggles, I am sure you will do the same.