In today's post, one of our first sponsored physicians talks about the challenges of pursuing a career in America, the support she received from Vituity, and her plans for the future.
Perspectives welcomes Gurvinder Kaur, MD, Hospitalist Medical Director at Adventist Medical Center – Hanford (Calif.).
Perspectives: Tell us a little bit about your background. What inspired you to practice in America?
GK: I'm from India and completed medical school there. Pretty quickly, I found myself yearning to learn more and do more. Indian medical education provides a very strong clinical base, but it's not exactly cutting edge in terms of therapies, research, and so forth.
I was also very interested in the business side of medicine. I thought that having some administrative training would really help me bring the latest research and evidence-based practice to patients.
Perspectives: How did you set about pursuing this dream?
GK: I originally came to California in 2004 on a student visa to pursue a master's degree in healthcare administration. I also wanted to complete a residency here, and from a visa standpoint, it made sense to do both at the same time. So I passed the licensing exam, and completed an internal medicine residency at the University of Southern California + Los Angeles County Medical Center. Then I went through the very in-depth certification process to transition to a J-1 (exchange visitor) visa, which is the type offered by most residencies.
Perspectives: How did you choose hospital medicine as a specialty?
GK: During medical school and residency, I always gravitated toward inpatient practice. The hospital is where you see the sickest, most complex patients who need you most. I felt like that's where I could make the biggest difference.
Perspectives: So you graduated. I understand that's where it gets complicated for visa holders.
GK: Right. After residency, the J-1 visa requires you to return to your home country for two years. The only way around that is to work what's called a waiver job for three years. For physicians, that usually means working in a medically underserved area.
The nearest waiver job I could find was with a small hospitalist group practicing at Adventist Medical Center – Hanford in California's Central Valley. It's a rural community hospital with 142 beds and an ICU. A lot of the patients are seasonal agricultural workers or recent immigrants. Historically, it's been difficult to attract physicians to the region, so visa sponsorship makes a lot of sense.
Perspectives: After working in Los Angeles, did you have any reservations about moving to the Central Valley?
GK: Maybe at first, but it turned out to be an excellent move for me. The Hanford administration genuinely cared about their patients and physicians. They valued the input of the medical staff and were very supportive of my career.
And in the Central Valley, the patients really need you. Many of them haven't had much access to healthcare, so they're grateful for the smallest things. Working with this population is very intellectually challenging, and it's very satisfying to me as a physician.
Perspectives: I understand that about a year into your sponsorship, you hit a bump in the road.
GK: One of the things you dread as a visa candidate is something happening to your employer. If they go out of business or lose a contract, that can be the end of the road for you.
In my case, Adventist Health decided to bring in Vituity to manage all of its hospitalist programs in the Central Valley. I was pretty anxious at first, but my administration really came to bat for the physicians. They wanted us to stay and encouraged us to join Vituity. Vituity also agreed to take over my visa sponsorship. It was one of the first times they'd done that for a physician, so I felt really fortunate.
How was the transition?
At first, Vituity and I had to learn everything together. Few people comprehend the massive bureaucracy that goes into maintaining a visa. There are fees that need to be paid, paperwork that needs to be filed. And if you make a mistake or miss a deadline, it can cause big problems.
The good news is that they had a very dedicated, responsive human resources team that was backed up by in-house legal counsel. Whenever I had a question, someone would work with me to get the right answers. So despite a few early hiccups, the process ended up going very smoothly. I felt I had a lot of support.
In mid-2014, you completed your three-year waiver commitment.
That's right. If needed, Vituity would have continued my sponsorship until I obtained my green card. But the employer-sponsored pathway takes a long time — as long as seven years for an Indian citizen — because the United States sets quotas for each country. So to speed things up, I chose to apply through my husband (who's a U.S. citizen) and received my green card about a year later.
That being said, Vituity just finished sponsoring one of my Hanford colleagues all the way through the green card process. He's a hospitalist from Colombia who has been a wonderful asset with our Spanish-speaking patients.
Any advice for international medical graduates who are choosing a sponsor?
Waiver jobs are becoming more common as the physician shortage deepens. However, it's really important to choose an employer with longevity and contract stability who will be around six to ten years from now.
Vituity was founded in 1975. They have a very stable and successful model that has allowed them to thrive in a challenging healthcare climate. I always felt very secure with them as my visa sponsor. I'm confident they can take international physicians the distance and offer them amazing careers in the United States.
Now that you're free to practice hospital medicine anywhere, what's next?
To be honest, Hanford and Vituity have served me very well. I feel very loyal and motivated to give back. So I have no plans to leave.
I also love practicing in the Central Valley. In Los Angeles, if I went out sick or took a vacation, I always knew there were plenty of hospitalists around to take my place. Here, patients need me. The hospital needs me. And that makes me feel good about my job at the end of the day.