Can You Go Home Again?

It’s a nice feeling to be so well trained in the States, but it’s difficult to do what you are trained to do when you return to a situation lacking resources, said Dr. Santini. For example, although he was trained with a great deal of teamwork in how to choose and perform the appropriate surgery, the lack of trained nurses and speech pathologists in Puerto Rico was problematic; he had to cover all the bases himself. That limits your time and, of course, in the end limits your ability to apply your training, he said.

Dr. Santini would like to see more training for nurses, speech pathologists, and radiologists-in other words, the whole team on which multidisciplinary care depends.

But the greatest difficulty he has now is the lack of other resources, specifically equipment and technology. It takes a protracted amount of time for the health insurance companies to pay for lasers and CT/MRI scanners, for instance, which makes it impossible to offer his patients cutting-edge care.

The struggle can be somewhat lonely and disappointing. You have the expertise and, as years pass, your feeling of disappointment grows as you continue fighting with the system to get what is best for your patients, he said. Referring patients to the States just begins the same kind of struggles with insurance companies that they face down here.

Another problem is the medical-legal aspect of care. In Puerto Rico we are expected to treat patients and obtain outcomes as they do in the US, he said. No grassroots organizations or nongovernmental organizations serve as advocates in this way. Many physicians are flying to the States for better training but also flying away from the problems here, he said.

Dr. Santini would welcome counsel from someone in the United States, perhaps a program director or someone well placed in a specialty society. He feels that many international physicians and surgeons facing similar challenges would also appreciate such counsel, and he encourages US otolaryngologists to be open to such communications to help with similar feelings of isolation and frustration.

The specialty societies have international members also. It would be easy and so helpful for someone to call and ask, ‘What do you need in your country?’ If you are interested in contacting him, write to Dr. Santini at santinimd@gmail.com.

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References

1. Gaviria M, Wintrob R. Foreign medical graduates who return home after U.S. residency training: the Peruvian case. J Med Educ 1975;50:167-75.
2. Adebonojo SA, Mabogunje OA, Pezzella AT. Residency training in the United States: what foreign medical graduates should know. West Afr J Med 2003;22:79-87.
3. Srivastava R. A bridge to nowhere?the troubled trek of foreign medical graduates. N Engl J Med 2008;358:216?9.

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