Navigating the Obstacles: Challenges Faced by Foreign Medical Students as Immigrants, Refugees, and Asylum Seekers in a Foreign Country

This article was exclusively written for The European Sting by Ms. Sadia Khalid, early-stage researcher (ESRs), medical writer and research engineer at Tallinn University of Technology (TalTech), Estonia. She is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

Throughout history, humans have embarked on journeys in search of better lives, work opportunities, education, safety, and refuge from various hardships. This article focuses on the challenges faced by foreign medical students who are immigrants, refugees, or asylum seekers in a foreign country, shedding light on their struggles and potential solutions.

International medical graduates (IMGs) constitute a significant portion of the medical workforce in countries such as Canada, Australia, the UK, and the USA, surpassing the number of domestically trained doctors. However, the dynamics may change due to evolving policies, such as those influenced by Brexit. Meanwhile, the demand for healthcare professionals is rapidly increasing, with projected shortages of healthcare workers in the United States and Europe.

The process of overcoming these challenges is complex, as there is no one-size-fits-all solution. Inconsistent immigration policies and licensing requirements set by medical councils often hinder the migration of IMGs to the European Union (EU). Strict language proficiency criteria, including fluency in multiple local languages, in addition to licensing exams conducted in a third language, not only create stress during the migration or settling process in a foreign country but also discourage highly qualified and professionally ambitious international medical graduates and physicians from attempting to enter countries desperately in need of their services. These countries could benefit from their expertise, training, and professional development. Furthermore, financial burdens associated with medical licensing and exam fees, as well as the costs of materials, travel, and visa applications, pose significant barriers for fresh medical graduates and medical students wanting to continue their medical education, especially those from low- and middle-income countries seeking opportunities in high-income countries with expensive medical education.

The political environment and ever-changing immigration policies in countries like the UK and the USA further complicate matters, adding another layer of complexity and difficulty for IMGs and their families. And this process is even harder for refugees and asylum seekers. The bureaucracy surrounding work permits, and family sponsorship processes in foreign countries can be exhausting and costly. Yes, exceptions are made for asylum seekers and refugees for the visa process but visa renewal policies to extend the stay after 6 months or a year can be strict in terms of eligibility criteria that can include B1 language proficiency, permanent job contract, current income and other requirements which may vary from case to case.

Countries that require employers to apply for residency before allowing trainees to appear for licensing exams, or those that demand work permits instead of visit visas, may be less attractive to IMGs. In some cases, training schemes exhibit a bias against IMGs, as evidenced in the USA and the EU. The fear of language barriers is often cited as a primary reason for rejecting IMGs in the EU. The length of time it takes to obtain an EU or US visa for residency training also influences IMGs’ decisions regarding their careers and whether they will stay after completing their training or return to their countries of origin. Successfully obtaining a license in any of these countries requires a foundation built on motivation and patience.

To address these challenges, a guided program provided by the licensing government body that assists IMGs in navigating the migration process and requirements, along with relaxed visa requirements and reduced fees, would encourage IMGs to consider countries they previously deemed inaccessible for work, despite being attracted to their healthcare systems and potential for professional growth.

Each country has a unique culture and offers different opportunities for residents and physicians, and it is up to medical students seeking opportunities in these countries to determine what works best for them and initiate the licensing process with careful planning, including financial considerations. The medical practice encompasses crucial elements such as patient care, research, teaching, hospital management, policy advice, and service design and development. Medical graduates from different countries and medical schools possess varying skills, experiences, and expectations, influenced by personal factors and the emphasis placed on these components by their respective medical schools. This further compound the challenges faced by IMGs during their adjustment and acculturation phases after migration. They are likely to encounter both subtle and overt discrimination at various levels.

Regardless of the cultural background, each individual brings a distinct cultural capital, which refers to their diverse educational models, understandings, language preferences, and levels of training when approaching patient care. This cultural capital can either ease or complicate the process of adapting to new settings. Assimilation, biculturalism, and deculturation are observed among IMGs, making them susceptible to bullying. Ensuring their emotional safety in the workplace becomes crucial, even more so than for native medical graduates.

Cultural capital is closely tied to the institution where doctors received their training. Although it is distinct from economic, social, educational, and political capital, cultural capital can be influenced by these factors. Even with familiar cultural capital, doctors often face various forms of discrimination in the workplace, which is not surprising given the current global climate of nationalism.

IMGs are valuable assets to the healthcare system. And refugees and asylum seekers with disrupted medical education and practice can contribute a lot more to our healthcare system on the brink of collapsing after COVID-19, given we provide them favourable conditions to settle in the medical system in their country of stay. In countries like the USA, UK, Canada, and Australia, IMGs serve the most vulnerable sections of the population, often in underserved specialties and locations that local graduates may overlook. It is essential to recognize refugees and asylum seekers are not individuals who will steal jobs from locals but equal contributors who should be embraced as an integral part of the country, rather than treated as outsiders seeking personal gain.

About the author

Sadia Khalid, early-stage researcher (ESRs), medical writer and research engineer at Tallinn University of Technology (TalTech), Estonia. She has been working on her PhD research project  “The role of Helicobacter pylori intestinal microbiota in the development of liver diseases. under supervision of Dr. Pirjo Spuul at Faculty of Science, Institute of Chemistry and Biotechnology.,TalTech. Her current research interests include Molecular Medicine, cell biology, infectious diseases, bacteriology, hepatology, and gastroenterology. I believe in the mission of public health, safety, and awareness.