When I was younger, I observed a neighbor facing challenges after experiencing a stroke. He made it through, but without rehabilitation, he found himself ensnared in his disability, relying on others for all activities. That experience formed my perspective on medicine: Simply surviving is insufficient. Patients deserve the opportunity to regain their independence and dignity.

Years later, following my medical training abroad, I arrived in the United States as an international medical graduate (IMG), resolute in my goal to attain residency in physical medicine and rehabilitation (PM&R). Like many IMGs, I was driven by the conviction that my insights and experiences in underprivileged communities could benefit the U.S. healthcare system. I recognized the challenges ahead, but I did not foresee facing blatant exclusion.

In April 2025, I commenced an observership in a university medical center’s department of physical medicine and rehabilitation. My supervising physicians offered encouraging feedback and even agreed to write recommendation letters, which were vital for my residency application. For weeks, I diligently shadowed, studied cases, and aimed to absorb every lesson imparted.

However, one afternoon, a senior physician took me aside. His message was direct: “You have no chance here. We do not accept IMGs. We already have sufficient American graduates, and this program has not taken an IMG in over twenty years.”

I was taken aback. This wasn’t a critique of my work, but an absolute dismissal of my identity and where I had trained. Despite his warning, I persisted in my observership, confident that my dedication and the support of other mentors would propel me forward.

What ensued was a series of retaliatory measures that left me unsettled. I was suddenly barred from clinics without any explanation. Staff members who had previously engaged warmly with me now deliberately avoided eye contact. I received threats of police involvement and even immigration enforcement if I continued seeking access to my mentors. Most disheartening of all was the withholding of the recommendation letters I had been promised, which severed my opportunity to apply for residency this year.

In that moment, it became evident: my identity as an IMG, rather than my qualifications as a physician, dictated my fate.

The ramifications are severe. Without those letters, my residency application remains incomplete. I am now required to wait an additional year, sacrificing time, income, and progress in my career. More significantly, the patients I aspire to assist will have to wait longer for the care I could provide.

This situation transcends my personal experience. It highlights a systemic inequity that has endured in medical education for years. IMGs constitute nearly twenty-five percent of the U.S. physician workforce. Many serve in underserved communities, rural regions, and specialties experiencing shortages. They are bilingual, culturally adept, and often ready to work in areas where others are not willing. Yet behind the closed doors of selection committees, the systemic exclusion of IMGs remains an unacknowledged truth.

In a state characterized by immense diversity and urgent healthcare needs, excluding qualified IMGs is not merely unjust; it is damaging. Patients suffer when skilled physicians are prevented from making contributions. Communities are affected when cultural and linguistic diversity is diminished within the physician workforce. The profession deteriorates when equity is compromised for exclusionary practices.

The irony is harsh. In PM&R, a field dedicated to restoring function and dignity, I observed the contrary: exclusion and silence. My patients in underserved communities educated me that survival devoid of independence is not true healing. My journey as an IMG now instructs me that opportunity lacking fairness is not genuine equity.

I maintain my belief in the ethos of rehabilitation medicine: assisting patients in transitioning from limitation to possibility. That conviction will not be undermined by this experience. However, I also believe it is essential to expose institutional practices that subtly exclude IMGs and deprive them of a fair opportunity to contribute.

I recount my story not as a grievance, but as an appeal for transparency and accountability. Residency programs ought to assess candidates based on merit, not their place of origin. Institutions should uphold their commitments to trainees, rather than leveraging bureaucracy as a tool for exclusion. And as a profession, we must reflect: if we genuinely value diversity, equity, and inclusion, why do we still accept systemic obstacles against IMGs?

Survival alone is insufficient, for patients, or for physicians like myself. We deserve the opportunity not just to survive, but to flourish, to contribute, and to restore dignity, not only in our patients but also within our profession itself.

*Fereshteh Kagar Bafrani is a physician.*