Feeling right at home

Foreign-born physicians filling a need in Delaware
By LULADEY B. TADESSE, The News Journal

Dr. Isaias Irgau fled Ethiopia at the age of 16, soon after the government shot and killed his father in front of his home.

His father was a victim of the civil war in northern Ethiopia, which lasted more than 20 years.

To save himself, Irgau became a refugee, escaping to Sudan, then Egypt, Italy and, finally, to the United Kingdom. But the challenges he faced never deterred him from pursuing a long-cherished dream — to become a doctor and one day return to a peaceful Ethiopia.

Lots of hard work and determination landed Irgau at Bristol University Medical School. He became a fellow of the Royal College of Surgeons of Edinburgh. And in 1991, he applied and was accepted into a surgical residency in the United States, which placed him at Christiana Care Health System in Delaware.

“I actually had no idea where Delaware was, to tell you the truth,” said Irgau, 46. “You have to apply to a central system and they give you a place. I happened to match with Delaware.”

Like many foreign medical school graduates who come to the United States for their residency, Irgau came on a special visa called a J1. Typically, after completion of the residency program, foreign doctors have to return to their home countries for a period of two years before they can practice in this country.

But a shortage of physicians in Delaware, and the rest of the country, is making it easier for foreign-born doctors to postpone their return home. A federal program, which has been in existence since 1994, currently allows states to recommend 30 physicians a year for a J1 visa waiver. It permits them to stay in this country immediately following their residency.

In exchange, the doctors must work in medically underserved communities for a minimum of three years. The physicians may apply for a position at a medical practice or hospital that has been unable to fill a position with an American doctor for at least six months.

“The physicians that have come here have contributed to our community significantly by providing much-needed health care to our community,” said Marilyn Hill, director of physician services, including recruitment, at Beebe Medical Center, a community-based nonprofit medical center based in Lewes.

Providing opportunities

This program has opened up opportunities for doctors to come to Delaware from all over the world, including Canada, the Philippines, Ghana, Korea, China, Peru, Cuba, India and Pakistan. There are currently 65 to 70 doctors in Delaware partaking in the J1 visa waiver program, state health officials said.

“The whole goal of the program is to improve access to care for Delawareans in underserved areas of the state,” said Judith A. Chaconas, director of the Bureau of Health Planning and Resources Management at the state Division of Public Health. “Our goal is that they stay here past their three-year obligation. … Some of them do stay and that’s a good thing — they become members of the community.”

Irgau, who specializes in weight-loss surgery, completed his residency at Christiana Care and worked in Middletown for three years. He and three colleagues later opened a medical practice, Christiana Institute of Advanced Surgery, in Newark.

Last year, Irgau was selected Delaware’s Young Surgeon of the Year by the Delaware chapter of the American College of Surgeons.

But not all doctors from abroad who come to Delaware settle here. And the state continues to face challenges attracting enough doctors, foreign or American, to meet its needs. The number of doctors in the state is not keeping pace with its expanding population, particularly downstate.

“Everybody is concerned about a physician shortage,” said Dr. Brian Little, vice president for academic affairs and research at Christiana Care. “Within 10 to 15 years, we will have a very severe shortage and there will be a lot more competition in all areas.”

Looking for help

There are several reasons for the shortage of physicians in Delaware.

Health-care recruiters say one of the key disadvantages to luring doctors here is the state’s rural environment. The biggest need for physicians is in remote parts of Sussex and Kent counties. Doctors whose spouses are professionals also have to consider employment opportunities for them.

“Physicians typically train in medical schools and training programs that are in urban and suburban locations,” said Paula Roy, executive director of the Delaware Health Care Commission, a state health policy agency. “Unless they happen to have grown up in a rural environment, it’s not even an unconscious decision. They tend to stay in an urban environment.”

Even if a foreign doctor is enticed to live downstate in hope of gaining permanent residency, living in Delaware presents challenges.

“The first six years, I was so busy I could have been anywhere in the U.S. It was hospital-home-hospital,” said Irgau of his early days as a resident at Christiana Care.

The challenge came after he completed his three years in Middletown. He wanted to establish his own practice.

“Building a practice is not easy for anybody. It is a little bit more difficult for somebody who is coming from outside,” Irgau said.

But because he possessed highly specialized skills — he is a bariatric surgeon who uses minimally invasive methods — starting his practice was not as difficult as it could have been.

Plus, he didn’t have to sacrifice too much in terms of his lifestyle. His practice is in Newark, which is closer to larger metropolitan areas, where there are more Ethiopians.

Other foreign-born doctors have opened practices downstate.

“The opportunities are definitely present in lower Delaware,” said Dr. Bhavin Dave, a gastroenterologist in Dover who also worked in Milford. Dave didn’t come to the United States on a J1 visa, but his experience is similar to other immigrant doctors.

Regardless of how international doctors end up in Delaware, they are faced with working in parts of the state where there is not a lot of diversity.

“There are certain people who are less receptive to foreigners,” Dave said. “It is difficult in the beginning. The way I feel in the long run is that if you have talent and patience, things do work out. You just have to constantly do a good job.”

While Irgau is proud of his achievements in Delaware, he and many other doctors from developing countries are concerned and somewhat saddened that they are practicing medicine away from their home countries. Their dreams of returning and giving back to their countries of origin — where there is an even greater shortage of health care workers — are deferred.

“The thought of going to Ethiopia is there, but it’s not as strong as it was when I was young,” Irgau said.

His life is different now. Delaware is home, he is married and has four children, ranging in age from 2 to 7.

One day, Irgau hopes to be part of a medical mission to Ethiopia. He also wants his children, all of whom were born in Delaware, to learn about their culture.

“I am waiting for them to be a little older to take them back,” he said.
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