Let’s go back to 2007. Very vividly I remember my first ever conversation at a coffee shop in Ahmedabad, India (my medical school town) which had sparked interest in this land of opportunity- The United States of America (USA) -thousands of miles away from home. A few medical students were discussing their experience of clerkship in New York. “The air is so fresh and crisp,” they said. “By the way, if a patient with severe anemia gets admitted, they don’t discharge the patient just after giving blood transfusion- they actually find the etiology”! “Wow,” I said. “That’s how I want to practice. I want to find what’s wrong with my patients”. Having memorized all the possible causes of anemia, while witnessing lots of patients get discharged with outpatient follow up predominantly due to limited resources from the largest hospital in Asia- Civil Hospital, Ahmedabad, I was excited to learn physicians get to solve the jigsaw puzzle of diagnosis and then treat the patient in the USA. After quite a bit of back and forth with my family, I decided to come to the USA. I recall the day I left India. My entire extended family had gathered to say goodbye. After all, I was the first daughter amongst many, to leave the country alone, and pursue higher education in a distant land with no family whatsoever, at the tender age of 23. I remember, seeing tears and sadness amongst my family members but I was determined and happy. “I am going to the USA to be a cardiologist”, I had announced many times as the phone in our household kept ringing to wish me luck on my journey. I literally left on cloud seven, bursting with joy, on a one-way flight to Philadelphia, on February 18th, 2008.
Fast forward April 6th, 2021. India had recorded another surge in COVID numbers that day. Two in the morning, I kept tossing and turning in my bed. Three days later, I was supposed to fly on a bubble flight to India. India had done okay with COVID in early 2021 and my parents were vaccinated. I saw a chance to see them after 1.5 years but now this covid surge out of nowhere!? All these years, I always told my family, “I am only 17 hours away. I can fly if I need to. The world is smaller than ever”. COVID had changed a lot. The entire year I had literally imagined myself hanging over the Atlantic, with the body in the US and mind and heart in India, many times. To complicate the issue, I had to renew my visa to the USA this time, to return back to the USA. “what if India goes in lockdown”, “What if I catch the new highly infectious variant prevalent in India and give it to my mother, who has been diagnosed with pulmonary fibrosis” “What if they decide to quarantine me at the airport”, “what if I don’t get my visa renewed and cannot return to the USA”. 2:30 AM, I got up, canceled my flight tickets, my visa appointment, and other arrangements. Like a giant infant then, I cried for at least half an hour. It was not fair at so many levels. Yeah, I know, that I made that choice for myself. I know I had decided to leave my family and come to the USA. After all, Life is a matter of choices and every choice you make, makes you, as John Maxwell- an American author once said. My stay in the USA had made me what I am today, but also made me feel how I felt during that night. I often think of the contrast in my experience when I came to this country compared to now.
This pandemic has been hard on immigrant physicians. During the early days of covid, I felt like stepping in a warzone as I entered the hospital. I would recite Hanuman Chalisa (Hindu hymn chanted for strength and courage) every single day multiple times as I saw COVID patients. I often discussed with fellow immigrant cardiologists- “we cannot get sick. God forbid if we get sick, who will take care of us? Who will update our families? what if we get so sick, we cannot do our jobs and get kicked out? What if we die? How will our family manage everything while thousands of miles away? For my married friends with children at home, it was challenging. Some were sleeping separately to keep the family safe. One of my friends who is an ICU physician told me he didn’t sleep well for months during the surge. The chances of getting COVID from super sick patients were high. If he became disabled or died, his family would lose their legal status, income and would be forced to leave the country. I have a close friend who lost his mother to COVID and couldn’t see her for the last time or do the death ritual as the eldest son. During hardship, it’s easy to think of extremes. Precovid, we were part of American society, flourishing professionally, doing well. COVID changed us. The sense of security and being home in the USA eluded. Where was home?
1/3 of the physicians in the USA are immigrants1. More than a third of those IMG (International Medical Graduates) have visa restrictions in spite of legally residing in the country and paying taxes as a US citizen. The top three countries that send IMGs to the USA are India, China, and the Philippines2. For those of you who think, immigrant physicians, take up opportunities from physicians that were born in the USA, the Association of American Medical Colleges projects a shortage of up to 139,000 physicians in the US by 20333. The jobs that offer visas often take advantage of the need for visas by foreign physicians by offering little compensation for a lot more work mostly in distant parts of the country. Professional and personal uncertainty posed by the pandemic has changed the future for many immigrants particularly the physicians having witnessed the surges of covid during the peak of the pandemic before vaccination started5.
I really hope in midst of an ongoing pandemic with no sight of the end, the immigration reform gives more flexibility to the physicians to travel to their home countries without the need for visa renewal. I also hope that this land of opportunity accelerates the permanent resident status for highly skilled physicians particularly those who are on the front lines during the pandemic and served their adopted country with vigor and in certain cases with their lives.
I don’t know how the COVID pandemic is going to change immigration patterns across the world. I often think about this, now being away from family for more than a year. This country has made me who I am today, and I am so incredibly grateful for my stay in the USA, for the education, incredible career opportunities, social status, and freedom I have acquired, particularly as a female cardiologist. However, I often wonder, if all the sacrifices that I have made are worth these successes. I guess the grass is always greener on the other side, but this pandemic has definitely made me pause and reflect on my choices and decisions.
2 Harker YS. In rural towns, immigrant doctors fill a critical need. Health Affairs. 2018;37(1):161-164. u
5 Benji K Mathews, MD, SFHM, Manpreet Malik, MD, FHM, Immigrant Physicians Fill a Critical Need in COVID
“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
Dr. Purvi Parwani is an assistant professor of medicine(cardiology) at Loma Linda University. She is a cardiac imager by training. Her clinical focus is multimodality imaging and the use of imaging for diagnosing and treating women’s cardiovascular disease and its prevention. She is the early career chair and board member of the Society for Cardiovascular Magnetic Resonance(SCMR) and social media consultant for the Journal of American College of Cardiology. She has been named cardiovascular physician to follow on Twitter twice since 2017 via different CV web agencies. @purviparwani