Madam, The migration of physicians from less-developed countries to countries with a perceived higher standard of living is not a new phenomenon. Pakistan has contributed approximately 10,000 international medical graduates (IMGs) to the US,1 even though it faces a shortage of physicians. This could be seen as a reaction against the Pakistani government's poor management of education system and the corruption associated with its management. Doctors who entered postgraduate training in the US in 1950s and 1960s speak of a time when qualifying examinations were trivial and visa issues were just a formality. They speak of a time when positions were secured through correspondence or telephone and hospital administrators used to receive trainees at the airport. But times have changed now.
From an IMGs perspective, this process has now become an uphill battle, both more expensive and time consuming. According to the latest reports published by National Resident Matching Program (NRMP),(2) last four years alone saw an approximate 25% increase in the number of IMG applicants while the number of residency positions remain almost the same. Alarmingly, the percentage of successful non-US citizen IMG applicants has dropped to a record 42.4%. Just four years back it was 52.4%.(2) Because of the infamous security clearance and the resulting visa delays, many residency-training programmes are now reluctant to entertain Pakistani citizens' altogether. The fear of not being able to "match" has forced IMGs to apply at more programmes, further stretching their budget. In the light of growing economical crises in US, the situation is only bound to get worse. Residency training in US is financed by federal government's Medicare programme. Some now think that taxpayer dollars should not be used to train doctors who are not US citizens particularly when US citizens are unemployed.  But there is still light at the end of the tunnel. Although securing a postgraduate training spot in US is becoming competitive, it is by no means impossible. Directed hard work and perseverance is the key to achieving this goal. Pre-doctoral electives, excellent scores in Usmle examinations, research experience, obtaining advanced degrees, publications and volunteer experience in US hospitals are some of the many things, one can do in order to improve credentials.

Mian Muhammad Rizwan
Prince George’s Hospital, Department of Internal Medicine,
3001 Hospital Drive Cheverly, MD 20785, USA.
Reference
1.Mullan F. The metrics of the physician brain drain. N Engl J Med 2005; 353: 1810-8.
2.Advanced data tables 2008. [Online] 2008 [cited 2009 Jan. 4]. Available from URL: http://www.nrmp.org/data/index.html.