Resident struggles: How hierarchical health care systems impact IMGs

Residents, particularly international medical graduates (IMGs), often navigate a challenging position within health care institutions, where hierarchical structures overshadow their authority and autonomy. This dynamic can leave residents feeling disempowered and vulnerable, underscoring the importance of understanding their rights and protections within their programs. For IMGs, cultural and systemic differences may further amplify these challenges, making knowledge of their rights especially crucial as they enter residency programs.

As a final-year resident, my journey has become an ordeal, derailing my career and taking a significant emotional toll. It began in late 2022 when an anonymous social media account linked to my co-resident started posting personal information about our residency program, institution, and attending physicians. Voicing my concerns to leadership in December 2023 set off a chain of events, exposing the lack of whistleblower protection in residency and leaving me vulnerable to reprisal for raising concerns about patient safety and workplace harassment.

When the account belonging to my resident was confirmed, a flood of retaliatory complaints ensued aimed at sabotaging my career. I was promptly investigated, placed on administrative leave due to a potential HIPAA violation from three years prior, and ultimately terminated from my job, despite inconclusive findings. Throughout this ordeal, my department provided minimal support.

Later, serious but ultimately dismissed allegations of racial and sexual harassment were leveled against me, aiming to tarnish my professional reputation with false and defamatory statements. Despite my efforts to clear my name through official channels like the Title IX office, the repercussions have been devastating. I have experienced significant physical and mental health decline, including weight loss, insomnia, and even suicidal thoughts. The termination has jeopardized my residency completion, threatening years of hard work and sacrifice. The university, hospital, and program also operated disjointedly, leading to confusion about responsibilities and payment structures. Losing my job resulted in the loss of health insurance, access to treatment, and financial instability. Despite remaining in the ACGME-accredited program, I received no pay or benefits.

Two-thirds of the program had signed a hospital contract not approved by the university. According to the agreement, the hospital could take immediate corrective measures, including denying clinical facility access to a resident if it posed risks. However, disciplinary actions were under the university’s authority. Surprisingly, my program officials were unaware of these fundamental aspects of the affiliation.

Violations of my due process rights occurred at every turn, with the hospital and university stripping me of my job, pay, and resident status without following fair legal procedures. I was thrown into a confusing legal process without proper notice or disclosure of charges and evidence against me. Despite being essentially convicted based on undisclosed evidence, I was denied the chance to challenge it, severely hindering my ability to defend myself. The program’s failure to reveal potentially exonerating evidence further undermined fairness, leaving me without legal representation during crucial stages. Additionally, I was deprived of the right to confront and cross-examine witnesses, crucial aspects of a fair hearing.

As a public employee, I expected my due process rights to be respected, yet I was terminated without a proper hearing at the hospital. Punitive damages were imposed without giving me a fair opportunity to present my case. Furthermore, decision-makers with personal interests failed to recuse themselves, raising doubts about the integrity of the proceedings. I faced disproportionate targeting and punishment compared to American colleagues, with legal proceedings unreasonably delayed, denying me timely access to justice.

It’s evident that IMGs face added challenges and potential discrimination regarding due process compared to their American counterparts. Disturbingly, local graduates or doctors within the state, even when accused of different misconduct, received markedly different treatment, with the institution prioritizing their protection while disregarding my concerns.

For instance, as an IMG, I lacked familiarity with the American legal system’s intricacies, placing me at a disadvantage when navigating due process procedures. Additionally, language barriers hindered my understanding of charges, compromising my right to fair due process. Cultural differences led to misunderstandings during proceedings, unfairly interpreted against me. Implicit biases among hospital administrators resulted in unconscious discrimination, influencing evidence interpretation. Moreover, limited financial resources and support networks left me disadvantaged compared to American peers.

Despite my attempts to resolve issues internally, my concerns were dismissed, and I was urged to remain silent, perpetuating discrimination and suppression. Numerous violations of ACGME policies were observed but disregarded by the hospital and institution. Shockingly, despite being at a University, mental health support and clear communication were absent until “the process is completed.” Attempts to contact my program director were ignored, leaving me isolated in this fight for my rights.

Navigating the intricacies of residency programs as an IMG presented unique challenges. To ensure fair treatment and protect my rights, I took proactive steps to educate myself on the specific regulations and protections provided by governing bodies such as the ACGME and the Equal Employment Opportunity Commission (EEOC). I also filed complaints with several state and federal agencies. Although the process was arduous, at least I felt heard, and it reinforced my commitment to advocating for fairness and accountability in residency programs.

In addition to education, I meticulously documented work hours, mistreatment, and communications with program leadership. Seeking external support from professional organizations, mentors, and legal resources provided valuable assistance and advocacy in navigating challenges during my residency.

Reflecting on the experience, I came to understand that my approach to my residency program, treating it almost like family, was misguided. Unfortunately, I was mistaken. For example, confiding in a PD about workplace concerns and expecting support, only to face dismissal or retaliation, felt like a betrayal of the trust placed in that individual. Similarly, when organizational policies were not upheld, despite assurances of fairness and equity, it left me feeling betrayed by the institution I relied on for protection and support. This realization prompted a profound shift in my perspective on workplace dynamics. I began to recognize the importance of maintaining a professional boundary, understanding that while camaraderie and mutual trust are valuable, they must not blur the lines of accountability and authority. I learned that seeking support and guidance within the workplace requires careful consideration.

Val Bellman is an accomplished physician with specialized training in psychiatry, psychotherapy, and public health. Dr. Bellman has a keen interest in pediatric psycho-oncology, immigrant health, interventional psychiatry, and digital therapeutics. With over 50 publications and presentations, he has made significant contributions to the field. Dr. Bellman is currently exploring non-clinical roles to broaden his understanding of health care beyond direct patient care and gain valuable experience in health care administration and industry. His diverse background and expertise make him a versatile and highly sought-after professional in behavioral health.


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