The first Indian medical student — a lady named Anandibai Joshee — graduated in 1886 from Women’s Medical College in Philadelphia, but it was only in the 1970s, that Sharma’s generation of foreign medical graduates, as they were then called, thronged into the country on student visas to do their postgraduate training.
This generation was faced with discriminatory practices. For instance, the examinations they had to take were different from the ones taken by homegrown students. Finding a medical residency was a challenge — it took Sharma two years to find one. She had been refused several times solely because she was a foreign medical graduate (now called international medical graduate).
Initial roadblocks like these led Sharma and many others to join the American Association of Physicians of Indian Origin (AAPI), which represents a large network of 35,000 doctors nationally, and nearly 10,000 medical students and residents. As president of the Bay Area chapter of AAPI, Sharma’s efforts are directed to ensure that the concerns of minority physicians, especially in the Bay Area, are heard in organizations such as the California Medical Association (CMA).
“When things happen in your life, you can either choose to ignore it, or you do something about it,” she says of her involvement with AAPI. “Initially it may not work, but somebody has to do it.”
But the medical profession has undergone a transformation with the rise of HMOs and skyrocketing healthcare costs. The climate for Indian doctors is changing — both Sharma’s generation and second and third generation Indian American doctors educated in U.S. medical schools.
To manage the changes brought on with the emergence of HMOs, AAPI is working with the U.S. Congress to pass the Patient’s Bill of Rights at the national and local level. It will afford patients increased choices in determining who they want to go to for care, as well as remove the current hassles that doctors have to go through to get medical procedures authorized. Sharma realizes that there has to be a system to keep patients in check too, because patients want unlimited care, but are unwilling to pay for it. She suggests a two-tier program — a basic package that the state or the federal government or both should provide to all, and beyond that, if a patient needs a program providing more care, the option to buy more coverage.
As the medical world undergoes such difficult decisions, the federal government’s attitude toward immigrant doctors also seems to have changed. There is no longer the same kind of doctor shortage, and IMG’s now have to contend with decreasing residency programs as well as stiff competition for jobs. In many instances if they cannot find a job after they complete their postgraduate training, they have to leave the country, and reapply in two years. As a result, the number of Indian medical graduates entering the U.S. has fallen.
Hence the very nature of the phenomenon of Indian doctors in America is fundamentally evolving. The first immigrant Indian doctors were living their own version of the American Dream. A new generation of Indian doctors will prosper in America, but most of them will be U.S.-born and so integrated into the mainstream of American society. As they make their mark in a more competitive and problem-ridden medical world, their motivations, and their lives, will be completely different.
Sharma’s pioneering generation is, in that sense, a piece of cultural history.
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