By Dr. Shruthi Mohan
Recipient of the 2023 Grant Opportunity for J-1 Physicians: Well-being Projects Supporting Foreign National Physicians
I am Dr. Shruthi Mohan, a PGY-5 from India specializing in pediatric nephrology at Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio. When I first walked through the doors of Cincinnati Children’s Hospital as a pediatric resident four years ago, the moment was filled with euphoria. Confident in my prior residency training from a prestigious institute in India, I was ready to embrace new training, worlds away from home, with enthusiasm. However, the initial euphoria quickly gave way to the daunting realities of visa processes and adapting to a new culture, lifestyle, and healthcare system in a new city. It was a steep learning curve, navigating a system that was entirely foreign to me, with minimal guidance.
At the beginning of my training, my confidence wavered during those first family-centered rounds. Communicating complex medical terms in a language I seldom used for patient interactions made my voice tremble. I spent long hours on documentation, hampered by my unfamiliarity with electronic medical records and my slow typing speed. The anxiety of relying on unpredictable taxi services before dawn without a driver’s license and finding reliable childcare services were some of the unnoticed battles I silently fought each day. The struggle was real and feedback was daunting. My skillset and the root cause of my struggles went unrecognized. Being the only international medical graduate (IMG) on the team and fearing judgment, I found it hard to share, which heightened my sense of solitude and exacerbated feelings of imposter syndrome.
With time, supportive friendships, and bits of advice from other IMGs, I have weathered my residency, emerging stronger and more resilient, and ultimately thriving in my pediatric nephrology fellowship training. I’ve found solace in the shared experiences of other IMGs through this journey, which reinforced the necessity for a support system tailored to our unique challenges—a system our institution lacked. While individual IMG backgrounds may be different, our struggles are similar. Learning from one another and offering support in our most vulnerable moments ensures that no one has to struggle in silence. This has strengthened my belief in extending proactive support to IMGs, rather than waiting for them to reach out.
Right around the time I was thinking about how to improve IMG experiences at my host institution, I discovered the 2023 Grant Opportunity for J-1 Physicians for well-being projects supporting foreign national physicians offered by Intealth with the U.S. Department of State. Inspired by my personal journey and with encouragement from my mentor Dr. Elif Erkan, a pediatric nephrology program director and a former J-1 physician, I collaborated with like-minded J-1 physicians at our institution to apply for the grant. Our group, which we fondly called the “IMG Powerhouse,” included me, Dr. Jose-Antonia Elizondo-Leal, a PGY-3 specializing in pediatrics from Mexico, Dr. Laura Rangel-Rodriguez, a PGY-3 specializing in pediatrics from Colombia, and Dr. Daniela Bullard-Elias, a PGY-4 specializing in pediatric pulmonology from Peru.
We were thrilled when we received the grant award. It validated our ideas and their potential for positive change. This win further inspired us and fueled our conviction that with this financial support, we could build a community that not only recognizes IMG potential, but also empowers us to thrive and become the physicians we have always aspired to be. Our first step was to collaborate with the Graduate Medical Education (GME) department at our institution. We identified and reached out to IMG trainees (pediatric residents and pediatric subspecialty fellows on a J-1 visa) and introduced them to the grant project’s mission. We established a WhatsApp group for those IMG J-1 physician trainees to foster a sense of community and support. Beyond virtual connections, we organized get-togethers and cultural outings to create a warm, inclusive environment for our “IMG family.”
To establish an effective supportive system for our IMGs, we first needed to understand the specific hurdles they faced. We crafted a questionnaire informed by our own experiences and distributed it to all IMG J-1 physician trainees. The responses from the survey highlighted the critical areas needing attention, which included: travel to the home country to visit family and attend scientific conferences outside the United States; introduction and orientation to the U.S. healthcare system tailored to IMGs; and finding reliable childcare options prior to the start of training. To address these concerns, we first collaborated with our institution’s immigration services department to invite an external attorney to come and discuss the intricacies of J-1 visa paperwork for timely renewal, which would enable smoother travel outside of the United States without interruption of training. We hosted other expert-led sessions covering a range of topics, from culture shock, learning to cope by becoming more resilient, financial wellness, and tax filing for IMGs. These sessions were designed to equip our IMG colleagues with the tools to adapt and thrive in their new environment.
As of the writing of this entry, we are in the process of creating a comprehensive guidebook to assist future IMGs in transitioning to life and work in Cincinnati. This guidebook will contain information on what IMG trainees need to know and do even before they arrive at our institution. This will be complemented by an IMG buddy system, which will pair currently training/working IMGs with newly matched IMGs to help with everything from housing to navigating the healthcare system at our institution. To ensure the longevity of our initiatives, we have secured IMG representation on the GME’s Diversity, Equity, and Inclusion (DEI) committee. This representation will consist of IMGs who will be responsible for maintaining the project’s activities annually and continuing to support future IMGs on any visa. This project is dynamic and will be constantly evolving with fresh ideas and goals to ensure that future IMGs can seamlessly transition to this institution. Together, we will continue to enable IMGs to excel in their roles and provide exceptional patient care, while forming lifelong professional and personal relationships with other IMGs from various parts of the world.
In reflecting on the journey of this project, the formation of a supportive community stands out as the most impactful outcome to me. It has reinforced our team’s initial belief that a sense of belonging can dramatically ease the transition into a new environment. Witnessing our IMG pediatric interns, who began their journey overwhelmed and uncertain (strongly reminding us of our early experiences), start to flourish has been incredibly gratifying. Something that surprised me was the breadth of collaboration this project fostered. It has been amazing to witness the generosity of those who are eager to support IMGs. It turns out that when we reach out for help, there are many hands ready to lift us up.
For all IMGs out there reading this, if you sense a gap in the support system at your institution, I urge you not to view it as a deficit but instead as an opportunity to be the catalyst for change. This will not only enhance your experience but also that of many others. We are happy to share our ideas with anyone who wants to listen and help make a change. Additionally, never underestimate the power of sharing your journey and its challenges: embrace the strength found in the vulnerability of storytelling. Telling your story can cast a light that illuminates a path for others in similar situations, inspiring them to persevere and succeed. Just knowing there are others who share your struggles and who are there to support you can profoundly boost your morale and self-confidence.
For our team, more than anything, this project has proven that a supportive community can significantly elevate well-being. The overwhelming gratitude and positive feedback we’ve received because of this well-being project have further fueled our determination to keep creating and nurturing supportive environments like this, no matter where our careers may take us. We are dedicated to applying these strategies to assist marginalized groups at any institution where we may serve in the future, thereby upholding Cincinnati Children’s mission of “Changing the Outcomes Together.”
In 2023, Intealth launched the inaugural Grant Opportunity for J-1 Physicians: Well-being Projects Supporting Foreign National Physicians. This well-being initiative, led by Intealth and funded in part by the U.S. Department of State, awarded grants of up to $5,000 to three J-1 physician-led projects supporting the well-being of foreign national physicians at their host institutions. This entry is about one of those projects. For more information on this initiative and details about this project, click here.