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Against All the Odds

By Dr. Poorvi Agrawal

Since I was a young child, my father taught me to dream. That is how a young me, with no medical background or exposure to the healthcare profession, dreamed of becoming a provider one day. I graduated from B.J. Medical College, which is affiliated with one of the largest hospitals in Asia, Civil Hospital, Ahmedabad. I was introduced to research and the science behind it during my practice, and it was then that my dream expanded: I dreamed of one day becoming a physician-scientist. The idea of juggling caring for patients, where every patient poses a new question for science, and working in the lab to discover answers to those questions, sent an adrenaline rush to my system. It was then that I decided to pursue the dream of furthering my medical education in the United States, due to its large investment in the research sciences.

Frontline COVID worker

ECFMG was the first point of contact for me in this pursuit. All I knew about it was an email address to contact, which I used frequently to help assuage my many doubts. Over the next two and a half years, I tackled the challenge of taking the USMLE exams. I wouldn’t have believed it then, but now that I look back, the exams were the easiest part of my journey. This is in part because as soon as I began looking for clinical and observership opportunities, the COVID-19 pandemic descended like a dark cloud. It was a period of uncertainty where every sort of travel was closed overnight. Nobody had an answer about the future course for IMGs. Like everybody else, I could not see the end of this uncertain road. I continued to work as a frontline provider for the pandemic in India, take my USMLE step exams, and gathered required paperwork from my medical school.

What was heartwarming during that difficult time was that every acquaintance I had in the United States responded to my queries and offered advice. In fact, even those with whom I had never met before (including physicians, residents in training, and program directors) responded and helped me navigate the unpredictable circumstances of that time. Nevertheless, I experienced a major setback when all my efforts to travel for an observership failed at the embassy gates. I now faced a big dilemma: whether to apply without U.S.-based clinical experience, which could be detrimental for my applications, or to wait another year for travel to hopefully open up in a time when the whole world was fighting for survival amid the pandemic.

I tried my luck, applied, and was fortunate enough to get interviews. The program directors were aware of the potential for travel difficulties and were considerate of it. Though the interview portion is generally rated as the most stressful part of the match process, I somehow enjoyed it the most. I got to meet so many talented human beings—stars in their fields who are reaching new heights every day, all across the seven seas, all through a screen and a click away. Though uncertainty prevailed throughout, I matched! It would not have been possible without those genuine hearts who guided me through the process of matching into a country’s healthcare system which I had only heard and dreamed about.

Every IMG’s journey to U.S. training is different and is challenging and exciting in its own way. There is no single framework for success, no set of rules, no right or wrong way to go about it. In the end, I would say that exams, scores, research, publications, and clinical experience are only half of the requirements necessary to match: the other half is determination. If I could match against all the odds of being an old IMG (more than 10 years post-graduation) and having no U.S. clinical/observership experience during a pandemic, I believe that anyone can match.

It is interesting to note that the word “journey” is from the Old French jornee, which means “day, a day’s travel, a day’s work.” This is a paradoxical way to describe our “journey” in medicine, because—and I think I can speak for all the physicians currently practicing in the United States, and in any other healthcare system around the world for that matter—our journeys are never a day’s work. They result from years of aspirations, hard work, setbacks, and sweat. It will certainly take more than a day to go on such a journey, but if you are determined, you will reach the dream you have envisioned for yourself.

Farewell from my institute TNMC, Mumbai