Rodolfo A. Armas-Merino, MD, MACP
Department of Medicine
Hospital San Juan de Dios
Former ACP Governor
If you are a Spanish-speaking international graduate applying for a residency in the USA, may I tell you that you are in one of the most important moments of your life.
You are facing a moment of great perspective. The most important incentives that we physicians may have are good conditions of life and professional work at a reasonable level. Good conditions of life means to live in a place and community where we would like to raise a family and reach an economical status that allows us to live without financial preoccupations. For our work, we want to be members of a friendly and efficient team that works at the best technical level.
It is not easy to have all these conditions in our Spanish speaking countries, due mainly to their economical limitations and, in particular, to the chronic and almost extreme poverty of our medicine. On the other hand, all these conditions are possible in the USA.
It is a fact that we belong to poor, underdeveloped or developing countries and that the USA has the highest living standard of the world. Even more, it is also a fact that the USA invests in medicine more money than any other country in the world. This makes our medicine so different from the North American one. So, I think that you are right in preparing to do your residency in the USA, learning their today's medicine that for us is tomorrow's.
But the great perspectives of this moment are not only related to medicine. If you are married, at this time of your life it will be an extremely important experience to live with your spouse away from pressures and mainly dedicated to your growing family.
You will be facing difficult days. Starting your life in a North American neighborhood and your work in a North American hospital, you will face differences from which you are accustomed. Habits and culture, language, religion, styles of life, food, timing of the day's activities, scale of values, etc. will all be different. Worse than that, sometimes, maybe someone will be prejudiced against you. You will be forced to gain your own space. Progress in communications has been fantastic, but we are still different. I like differences. This world and our lives would be terribly boring if the differences between groups disappear. Difference means diversity, and diversity is strength.
But, in spite of all, you will be a weak minority and you will face difficult days.
Feel confident. Many physicians coming from our countries have been very successful in the USA. Why not you? If you have been successful in your country, why will you not be so in the USA? The USA is accustomed to incorporating foreigners coming from the most distant and different parts of the world, and the condition of being a foreigner seems to disappear after a few years.
You will adapt yourself to the differences and you will adopt and enjoy many of them. If you ever go back to your country, you will miss many of the "difficulties" you had when arriving in the USA. It is a common experience that the shock of returning is harder than the one you have at the moment of emigrating.
Remember that medicine is very important but not everything. We cannot renounce to our condition of human beings, with vocations and cultural interests. It is easy to understand that your residency will be very important and a great preoccupation, but do not forget that it is also the time to go on with your personal development. You will need to learn a tremendous amount of medical knowledge, but it is also true that you will be a better physician if you are also cultivated in humanities and arts. In the city where you will be doing your residency, I am sure you will find cultural activities, arts and opportunities for entertainment most probably better than in the country of your origin. Take advantage and enjoy them. Do not let them go by.
You will face decisions that will change your life and perhaps the life of other members of your family. Time runs fast and at the end of your residency, what? It will be time to return back home? Would it be better to go on with a residency in cardiology or nephrology or any other subspecialty? Remember that you must look for the best for you and for the rest of your family. Remember also that medicine is very important but not all in our life. The longer you stay, the stronger are the links to the USA and weaker the links to your country of origin. You may be sure that once you have finished your residency you will be more useful working in your country than staying in the USA.
It is worthwhile to remind you that there exists some moral compromise with your country of origin. In Spanish speaking countries, usually education and mainly university education is strongly supported by the State. That means that we have obtained important levels of education thanks to the rest of our people. This does not mean that you are not free to do what you think is the right thing to do. It is your life and your life is only yours. But do not forget that you are in debt to other people. If you decide to stay in the USA, try to give back to your country and your people as much as possible. There are many ways you can do that: Helping patients, helping and receiving young physicians, lecturing back at home, etc. Certainly, if you want to, you will find how to do it.
You are in a unique moment of your life and in a unique moment of your career. This is a time of new experiences and for making great decisions. Be sure, this residency will be an agent of great changes in you. Certainly, changes for the better. Don't lose this opportunity and be prepared to enjoy it.
Dr. Rodolfo A. Armas-Merino was ACP Governor for Chile from 1996-2000. He was awarded Mastership in the ACP in 2001 in recognition of his outstanding contributions in the field of human rights, medicine and ACP activities.
This article was prepared for the ACP IMG Web site in 2000.