A Tale of a Legal Immigrant

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immigrant-clipart-immigrants2The elusive debate about handling illegal immigration has plagued many US presidents in modern history and will likely continue to remain an issue for decades to come. Analysts talk about amnesty while the other side wants to send immigrants back to their countries. It strikes me that this is even a debate. To me, illegal immigration is simply illegal and should be treated like any other illegal actions that are penalized by civilized nations. Instead, the debate should truly focus on legal immigration and how to identify the country’s needs for the working power.  This will make it easier to recruit and retain honest and hardworking immigrants; those who will add to the substance of this great nation and help keep it on the pinnacle of world progress. It astonishes me that despite the great and growing need for immigrants to work in various types of jobs from labor to professional, the road of legal immigration continues to be full of challenging obstacles.


I came to the US in 1997 after three attempts to obtain a visa. I am originally Syrian, and Syrians never get a visa to the US easily; a political message that existed long before 9/11 and the current Syrian crisis. Ironically, on my third attempt, I had the least amount of reasons to be approved. I was given a visitor visa to attend one internal medicine residency interview. Luckily, I was registered with the National Resident Matching Program. Foreign physicians, according to this program, will need several interviews to ensure a spot in a residency program. Suffice to say, I did not get into a residency program that year. 


Because of the expenses of traveling again to the US and the difficulties obtaining another visa, I decided to stay until the next year. I volunteered as a research “fellow” at an eye institute in Boston. My mentors helped me to legally extend my non-immigrant visa until I got accepted in an internal medicine residency program. I was offered a position outside the matching program. Some insecure residency programs take advantage of foreign medical graduates because they are fearful of not filling all their spots if they wait until the match day. Foreign physicians are often easy targets because they are new to the system and also insecure about waiting until the match day. I admit, I was insecure.


I applied for a type of visa called “J-1 visa” because my residency program decided not to allow any other type of visas that year. My three years of residency in Chicago were years of oppression. It was a mini-dictatorship. Many dos and don’ts. Many supervisors were waiting for the foreign resident to make a mistake. Or, perhaps, this is how we all felt because of our insecurities. Being from Syria, I was used to dictatorships, and I managed to escape any trouble in the first two years. 


I became a star in the eye of my program director. He talked to me about becoming a fourth-year chief resident after graduation.  Then I made a big mistake. I verbally accepted his unofficial offer.  But, I also I signed a contract with another program and kept looking for my dream of joining a nephrology fellowship. Although, clearly, my intention was to join a nephrology fellowship after my chief residency. I admit that I should have told my program director about my contract with the other program early on, but he never made me comfortable. When he discovered this conflict, he presented it to the residency committee to discuss an appropriate corrective action. He confronted me on busy day when I was on call. I felt sick as if I committed a crime. Thoughts were flying around inside my head. Everything that I had worked so hard for was flashing right before my eyes.  I could not put my mind at ease until I found out the decision of the residency committee. Would this happen to anybody other than a legal immigrant? Would this happen to an American graduate?


The residency committee decided to send a letter to my future nephrology program director telling her the whole story.  This could have left me without a fellowship.  Fortunately, my years of hard work and my good reputation paid off. The committee’s decision was to send a letter to Loyola after I started my Fellowship.  That was a valuable lesson in professionalism that I will never forget. 


After September 11, 2001, I felt alienated. People were asking me why Arabs hate America. What happened was astonishingly catastrophic and beyond my imagination. It was unpleasant and frustrating to me to live through that period. I could not answer their questions despite knowing the answers. I knew that Arabs do not hate America nor hate Americans. Yet, I knew the frustration that overshadowed the Arab youth as well as the history of the Middle East.


Immigration laws changed significantly after 9/11. I had to have my background checked by the FBI when I left the country. This process took at least 20 days. Two of my friends who were finishing their fellowship were denied re-entry into the US for no credible reason. I was engaged, and I was supposed to go back home to get married. We had to postpone the wedding several times. This placed a hardship on our relationship, and we got very close to breaking up. I finally convinced the nephrology program director to allow me to take my first and second year vacations at the same time. Luckily, everything went as planned and we were able to marry.


A few months later we were expecting our first baby. During the time when I was getting married, I should have been looking for a job. I was on that J-1 visa, which would have forced me to leave the country after I completed my fellowship, unless I chose to serve three years in a medically underserved community. There is a program in each state called Conrad State-20, which allows foreign graduate physicians to adjust their visa status and later on become permanent residents if they serve in these communities. The only problem was that the deadline to apply to this program in most of the states was between September and October of every year. I started looking around mid-October. Obviously, there were no jobs for me. 


That year the Conrad State-20 program expanded by adding 10 more spots in each state. Arizona was one of the states that offered additional spots that year. I found a job in Phoenix, which just so happened to be medically underserved. The entrepreneurial employer wanted me to work as an internist most of the time and as a nephrologist occasionally. He also wanted me to be on call every other night and weekend covering several hospitals and occasionally covering nephrologists at other local clinics. The compensation was minimal. This demonstrates what foreign graduates get exposed to…abuse!  I would have never considered this job if I had a choice, but I did not. I accepted, and I applied for one of those additional spots in Arizona. Luckily, my application did not go through. 


Later, I was contacted by a physician in Georgia as well as a physician in Farmington, NM. My phone conversation with the physician in Farmington was very positive, so I agreed to visit the Four Corners area to explore this job further. Applying for that job meant that I would have to be unemployed for at least 6 months after graduation and that I will be submitting an application for the next year’s state-30 program. I could only extend my visa until I took my nephrology board exam in November of that year. Looking back now, it never occurred to me that if I waited a few more months I would have been able to explore many other jobs that start recruiting for a J-1 visa physicians in June and July of each year.


I signed the not-so-ideal contract with minimal salary. I was attracted by the nice call schedule, the medium sized practice, one hospital, and the fact that I would be working mainly in nephrology. Certainly, I was hoping that the productivity bonus would also be good. The only drawback was that I had to travel out of town for 3-4 nights every six weeks away from my family to see patients in the Indian Reservations. The two physicians in the group seemed nice. I acquired an immigration attorney who charged me a fortune to guide my employer and I through the paperwork. It was the lowest point of my live. I was married with a newborn; yet, I was unemployed and could not work according to immigration laws. I was a legal immigrant, you know! I used up all of my savings and maxed out all of my credit cards. I eventually had to move in with my single brother in Massachusetts.  I will never forget his genuine kindness and hospitality. I had four brothers in the area and they tried to make my life easy, but nothing can be easy when you cannot financially support your family.


Shortly after I submitted my application for the New Mexico state-30 program (and after all the state deadlines for that year had passed), I received a letter from one of the physicians in the group.  I was informed that the other physician who recruited me was planning on leaving one month after I joined the practice. I was told to keep the matter in the utmost confidence and that they are “doing me a favor” keeping the terms of my contract the same.  However, I was going to do more work and be on call and travel out of town more often, all while being paid the same. There goes my nice call schedule and mediocre salary. 


After I started, there were two fake interviews with two nephrologists that where given unsignable contracts.  Suddenly, it was decided that we should get a nurse practitioner instead. At that time, I realized that there was no true intention to hire a third physician. We hired the nurse practitioner with the blink of an eye. Honestly, adding a nurse practitioner to our practice did not decrease the work load, improve the call schedule, or decrease the amount of phone calls.


At the end of the year, it was time to review my income and my possible bonus. It was then when I realized that I will never receive any significant bonus. My employer simply notified me that almost fifty percent of my productive work would not count towards my productivity bonus because it is billed under the practice name. After a period of inner outrage, I decided, once again, to be quiet since I have already started my immigration paperwork. The only good thing was that my employer was very helpful with my immigration application.


After more than three years, our practice grew significantly and it became more than what could be handled by two nephrologists. My employer started again recruiting for a third associate without any luck.  She talked to me about becoming a partner in the practice after I finished my immigration process. I agreed initially, but later on, she started giving me misleading figures about the practice income. She delayed meeting with the accountant. From previous experience, I knew she was not serious, yet I did not want to cause her any harm.


It was clear to me that I could not continue with this practice any longer. I gave her far advanced notice of my resignation. Looking back, maybe it was too advanced. My purpose was to give her adequate time to try to recruit another nephrologist. Once again, my honesty and naïveté failed. She decided to extend my contract with a minimal increase in my salary. I initially refused because I was aware of the practice income and how much I should be making. She threatened me with termination prior to finishing my immigration paperwork if I did not sign a contract with her terms. I did not want to ruin the culmination of all my efforts over the past four years just for few thousand dollars, so I signed the contract.


It took eleven years for me to get my permanent residency approved. I strived and persevered to stay and work legally. There are other stories of suffering of legal immigrants. One was abused by his employer who refused to assist him in his legal immigration process to keep him employed for mediocre salary and deny him the freedom of choice. Another was denied reentry to the US when he went on vacation to his original country. The excuse was that the FBI lost his paperwork. He wasted more than six months of his life before he was simply re-admitted to the US without any explanation. Legal immigrants are taken advantage of, betrayed, deprived of bonuses, stripped of the legal right to negotiate and the freedom of choice, and essentially are punished for their honesty and hard work.


According to the USCIS, at one point there was about 650,000 pending legal immigration petitions, with probably an even larger number of legally working foreigners waiting to be eligible to apply. On the other hand, reports estimated the number of illegal immigrants to be between 12 and 20 million! The number of available immigrant visas is about 360,000 per year, which are often not fully consumed by the USCIS. The process is by no mean transparent and it involves several poorly communicating governmental agencies. The system is flawed and broken. Many legal immigrants are stuck in a limbo for years without answers, answers that they deserve after paying their taxes and playing by all the rules; while others take short cuts. Isn’t it time to simplify and clarify the legal immigration process and treat those hardworking individuals respectfully?  Or, should the debate continue to focus on how to make it easier for the illegal immigrants?


Originally written in 2007

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