Interviewee: Monica J. Uceda, MD
Interviewer: Steven Kao
Please tell us a little about your pathway to the field of medicine and then interventional radiology. What prompted you to come to the US? What was the process to match as a resident in the US like?
I graduated medical school in Lima, Peru, about 9 years ago. I initially wanted to be a surgeon and after witnessing first-hand the lack of adequate training in my country, I decided to pursue a surgical career in the US.
I didn’t have mentors or sponsors at the time which made it difficult, but I was persistent. I came to the US with a student visa and attended a Kaplan course in preparation for my boards. I successfully completed the USMLE exams, and started searching for rotations and letters of recommendation. I found my first rotation through judicious use of Google. I was surprised to find that I shared a last name with a vascular surgeon in the same state. I reached out to him and ended up shadowing him. After helping in the practice for some time, I was given the incredible opportunity to direct the research department. With the aid of a lawyer and the sponsorship of the practice, I obtained an H-1 B visa. Unfortunately, a couple of years later when I matched to General Surgery residency, I had to decline it and apply for a J-1 visa through the ECFMG.
Undoubtedly, my two challenging years of surgery training helped shape my personality. I became more resilient than I already was and than I could possibly imagine. I loved operating and interacting with patients. However, I was able to observe dissatisfaction even amongst accomplished surgeons. In the end, I realized I disliked the person that I had become in order to fit in the surgical culture. I took a step back and reevaluated my goals. It was not easy but at the end, I understood that changing your path is not necessarily something negative, it can be as positive as you want to make it.
One of my mentors was convinced my procedural skills and critical thinking made me an excellent match for Interventional Radiology. Not having gone to medical school in the US, I was unfamiliar with this specialty but, the more I read and asked colleagues about it, the more I fell in love with it. At that point, I was certain that this was what I wanted to pursue wholeheartedly. I strongly believe I made the right choice and most importantly I am very happy as a radiology resident.
A few months ago, I found out I will be training as an Interventional Radiology Fellow at Medical College of Wisconsin next year. I’m truly grateful for this opportunity and look forward to working with amazing teachers.
What are some challenges that you have faced as an IMG going into IR?
Although I had to overcome several barriers to get accepted into a residency program and a few applying for fellowship, I do have to say I would do it all over again. The experiences I had throughout my journey made me the person I am now and I’m very proud of myself. I’m determined and confident. On the other hand, I would like for younger generations to have more opportunities and perhaps a less bumpy road in order to accomplish their goals. These are a few of the challenges I have faced as an IMG.
Fear of the unknown: I believe this is a natural human reaction, however it plays against us when applying for competitive residencies (Surgical specialties, Radiology, Anesthesiology, etc). If programs don’t know the school or even the country you are coming from, it is less likely to even get invited for an interview. I’ve also been told by program coordinators that several programs have filters and IMGs are automatically filtered out.
Even if that doesn’t happen and you have good USMLE scores, program directors and faculty will be skeptical of your ability to assimilate in the American system or communicate adequately in English. Embracing the unknown is a step towards a solution to this problem. I believe several residency programs are making an effort to change this and more opportunities are arising every day.
Lack of information: Several IMGs who come to the US have family members who are physicians. My case was different, I came here not knowing anyone and leaving my whole life back in my country. I had to seek opportunities and there is very little information on the internet about this process, training opportunities and networking. SIR is working on several initiatives to help with this such as the international scholarship and mentorship programs and the SIR giveback project. The RFS is also working on this by building an online resource for IMGs where all the information is in one place and by creating relationships with its counterparts in Europe, India and South America. The goal of these initiatives is to both develop and also advertise them. The more information and people you know the better. Networking is fundamental in medicine and, especially, Interventional Radiology.
Unfair immigration system for physicians: Some IMGs have green cards or are American citizens that studied abroad, and these are the best case scenarios. Others, in less competitive specialties, manage to obtain an H-1 B visa, which is an intentional visa and a bridge towards the green card. The rest of us deal with the worst visa a physician can obtain, the J-1 visa. This type of visa was created as a work/cultural exchange and for a short period of time (less than 1 year). As a resident, this becomes very restricting:
- The legal status has to be renewed every year, with annual tedious paperwork and expensive fees.
- A renewed legal status does not mean a renewed visa. The visa has to be renewed every time you’d like to travel outside the US, even with a valid status. Also, you cannot do this in US territory. Waiting times for visa appointments and stamping vary in every country, making traveling and scheduling vacations very difficult. The only exception to this rule is the “automatic revalidation” which allows you to travel with a valid status and an expired visa for vacations to Mexico, Canada and Caribbean islands as long as it is within a 30 day window.
- The most negative part of this visa is the “2 year requirement”. This means that after you have completed your training you are supposed to go back to your country and work there for 2 years before you can come back to practice in the US. Although there are waivers and other visas you can apply to in order to continue practicing in the US, you will need to hire a lawyer and it’s not easy when trying to start a career and finally getting hired for a job after all the years of hard work.
In other fields such as engineering, architecture or business, companies hire immigrant professionals, sponsor an H-1 B visa and they get a contract. It sounds very simple and there has to be an easier way for physicians. We need more involvement in immigration law.
Gender gap in competitive specialties: it is definitely harder to break into the boy’s club. Sometimes these are unconscious biases and sometimes self-imposed obstacles in women’s minds. We need to work not as a group of women or men, but as a society to improve this. There is a big movement now to increase awareness on the benefits of diversity and mentorship. I think we are moving in the right direction. This is also changing as we evolve from the old hierarchical traditional model of training to a more horizontal relationship between trainees and attendings.
Where are you training now? What is your role in the RFS?
I’m the chief resident of the Radiology Department at Presence Health St Francis Hospital in Evanston, IL. I am privileged to train at an institution without fellows or nurse practitioners which gives me the opportunity to perform interventions either by myself or as first assistant. This has allowed me to acquire a substantial amount of hands-on experience which now makes me comfortable and self-assured.
I have been involved in the RFS and SIR for about 3 years now. I’m the past RFS Women in IR Chair and member of the Governing Council. I have participated in several projects and collaborations with other committees. I am currently working on a national trainee survey to better understand the role of women in the IR workforce. This study aims to identify factors, attitudes and perceptions that influence trainees in their decision to enter the IR field and recognize gender differences regarding this subject. Another interesting project I co-created is the Introduction to Research Online Program, a course of 10 online sessions that covered basic research topics presented every other week by interventionalists with experience on research education. I hope to continue collaborating with young leaders to improve education for trainees and inspire them to follow their dreams.
What are some strengths that you have as an IMG in IR? What are some things you would like other IRs to know about IMGs?
Having qualified physicians from any ethnic background will become more important than ever in future decades, when the demand for doctors is predicted to grow dramatically and the supply of new doctors will be far outstripped by population growth. AAMC research has found that patients who are ethnic minorities are not only more likely to see a doctor if he/she is of the same ethnic group as they are, but also more likely to rate themselves as satisfied with the health care that they receive. Increasing diversity will help with the development of future physicians who have a high level of cultural competence to help them serve an increasing multicultural population.
Research shows that socially diverse groups are more innovative than homogeneous groups. They are also better at solving complex, non-routine problems. Simply interacting with individuals who are different forces group members to prepare better, to anticipate alternative viewpoints and to expect that reaching consensus will take effort.
IMGs are absolutely valuable to the medical system and to IR. We bring different perspectives to the table. Our varied cultural backgrounds enrich the decision making process and open a window of opportunities for collaborative improvement.
Do you have any advice you would give to other IMGs pursuing a career in IR?
I left my country with the desire to obtain better education in order to provide higher quality of care to patients. Throughout this time, I faced many obstacles but I continued to maintain a positive attitude. I firmly believe perseverance, hard work, commitment and passion are the perfect combination of tools to succeed despite any adversity.
There is no single formula to success and success has a different meaning for everyone. Here are a few advices that may help you get where you want to be. As a disclaimer, I’m not a 100% good at all of them but I try my best every day.
- Plan ahead and organize your priorities
- Work hard and be disciplined
- Network and brand yourself
- Be patient and persevere “If a door closes, another will open”
- Sit at the table, raise your hand and speak up
- Acknowledge your limitations and learn to say “No” or “I don’t know”;
- Let yourself enjoy your achievements with humility and celebrate your colleagues’ success with honesty
Where do you plan on going in terms of your career and role in the wider IR community? Do you see/foresee any changes in the next few years?
After completing my fellowship training, I hope to further improve my abilities and build an innovative practice. Eventually, I would like to organize mission trips to underserved areas of my country and perform procedures on patients facing extreme poverty. I would also like to train local interventionalists, providing them them with the necessary means to manage sustainable practices.
I would like to continue contributing to the Society of Interventional Radiology on projects that enhance education and promote diversity. I’m planning to participate as a mentor in the Mentor Match program. I also have a particular interest in teaching and this is something I would like to formally pursue in the near future.