Immigrant and minority physicians at the frontline of pandemics [PODCAST]

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“It is no secret that we started off combating COVID-19 with disadvantages. Lately, news is rampant with coverage of the paucity of ventilators, hospital beds, and N95 masks. But it is important not to forget the deficits in our workforce. Last year, the American Medical Association estimated that our nation faces a projected shortage of up to 122,000 doctors in the next decade. In the midst of this, 27,000 physicians are DACA recipients, and a myriad of international medical graduates suffer the disquiet of whether or not they will get timely visas or green cards. As I think of these doctors, some of whom are my own colleagues and are fellow minorities in medicine, I cannot help but consider the repercussions to public welfare if their status was rescinded.”

Natalie Moreno is a medical student and can be reached on Twitter @NatalieAMoreno1.

She shares her story and discusses her KevinMD article, “Immigrant and minority physicians at the frontline of pandemics.”

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Natalie Moreno. She’s a rising fourth-year medical student, and she wrote the KevinMD article “Immigrant and minority physicians at the frontline of pandemics.” Natalie, welcome to the show.

Natalie Moreno: Thank you for having me.

Kevin Pho: So before we get into that article, I was wondering if you could share your story and your journey to where you are today.

Natalie Moreno: Sure. Well, long story short, my full name is Natalie Eileen Moreno. I am applying into general surgery this fall. Actually, I am a first-generation medical student. My mother is a waitress, and my dad took about 10 years to get his college degree, but I learned a lot of my work ethic from them. My mother was actually an undocumented immigrant and now has become a legal resident, but they always taught me the value of hard work, and they taught me how to survive.

And so with each challenge I had applying to medical school, I was a reapplicant. I just focused on what I could do to progress and move forward and who I could seek out for help. Thankfully, now I am a fourth-year at the University of Michigan, and I have the opportunity to apply in surgery. So I’m looking to see how I can close gaps as a surgical educator and researcher so that I can further advocate for those who, you know, are marginalized within medicine and the medical community. So that’s a little bit about myself.

Kevin Pho: Wonderful, and congratulations on your journey thus far, and best wishes on your residency application next year.

Natalie Moreno: Thank you.

Kevin Pho: So let’s get into the KevinMD article “Immigrant and minority physicians at the frontline of pandemics.” Can you tell me the story behind that article and why you decided to write it?

Natalie Moreno: Yes. So I myself am Hispanic. My mother’s Mexican, and my dad is Salvadoran. When I matriculated in medical school, and even in college, I always noticed that I was one of the few minorities in the group. What I found was that oftentimes there was this misconception that minorities were essentially riding the wave. From my own readings I’d done, I realized, well, we’re not doing that. We are making very valuable contributions. So I wanted to highlight some of those important contributions.

And so I thought, well, it’s important to know that Jewish immigrants were the ones who invented the polio vaccine, and thanks to them, you know, we don’t have to suffer the sequelae that Roosevelt did, being confined to a wheelchair. And I thought, well, that’s very relevant, because we are facing a pandemic right now. And then going back to 1918, thinking of the Spanish flu, it’s important to note those things as well, the role that minorities had. There was a group of Black nurses that really spearheaded a movement that, you know, opened doors for people now.

And so I was really passionate about getting that story out and highlighting contributions from people of different minority groups and different immigration statuses, to show we have a lot to contribute. We are one of you, and it’s important to level the playing field and not marginalize, you know, the experiential and intellectual heft that these physicians and health care providers have to bring, especially when we are in such dire need of as many people as possible.

And I say this in the article: We don’t really have the luxury right now to lose physicians, you know, to lose nurses, because of immigration status. I mean, right now, I think at least 27,000 DACA recipients make up our physician workforce, and we have a very dire need to prevent the gap in provider-to-patient availability in the future. So that’s what motivated me to write this article.

Kevin Pho: I think one of the things that struck me in the article was what you said about the historical contributions of minorities and immigrants throughout the years, through all the pandemics over the past century. And you mentioned some of the challenges that they face even today in terms of their immigration status, for instance. Can you share more details in terms of the challenges that they’re facing today?

Natalie Moreno: Sure. Some of it could depend on immigration status. So, for example, colleagues of mine who are DACA recipients, students, residents, fellows, and doctors, you know, at any point could lose their DACA status, and that is something very scary. It’s very easy to take for granted when you are a U.S. citizen and you don’t have to worry about that.

And then also, in terms of immigration status, there are many physicians who can’t get timely visas, and they’ve been here for 15 years. I read that in an article. I don’t remember which journal it was, but somebody had been here for that amount of time, and she said, “I face the uncertainty of having to uproot my family and move back to Southeast Asia right now because I cannot get a visa on time, because COVID has hit and everything has slowed down.” And so I thought, you know, that is very unfortunate for her and for others who are in the same boat. They have a lot to contribute to us, and I think we owe it to them to help them as well.

Kevin Pho: And what are some of the ways that we can address these challenges going forward?

Natalie Moreno: I think one place to start is that we have to acknowledge that there is a hierarchy of privilege, and there is a hierarchy of power. And so all too often, those who are at the bottom of the hierarchy cannot project their voices up to those who are higher up, or they can, but there is no reception up there. So it is the prerogative of those who are higher up in that hierarchy to advocate for those who do not have that privilege. So those in leadership, within specialties and within associations, should use their voice to advocate, dismantle barriers, and dismantle misperceptions, and really step in and use their power to advocate for us.

Kevin Pho: And let’s take a step back. So over the past few months, can you share with the audience something that you’ve been curious about or something that you’ve been passionate about?

Natalie Moreno: Actually, I mentioned earlier that I’m really interested in becoming a surgical educator. That is one of my long-term goals, in addition to doing research. The reason I said that is because during the COVID pandemic, one of the things I had the privilege of doing was creating what I called a Surgery for Breakfast series.

The sad thing is that nowadays, those medical students who are just starting their clinical rotations may not have a substantial surgery rotation, so really a lot of what they’re learning is virtual. To address that, I collaborated with physicians, and I recruited residents. I made these PowerPoints and made these oral exam-type cases that would be covered for the general surgery oral exam at the University of Michigan. In addition to that, I also covered high-yield topics such as tubes, lines, and drains, pressors, anything that would help a medical student hit the ground running. So I did that to continue surgical education, and knowing my limitations as a student, I recruited, you know, the heft from attendings and residents.

But one of the other things I had in mind was thinking of who comes into medical school without social capital, who cannot afford resources like Boards and Beyond and Pathoma, and where are the resources that help students with clinical decision-making? Because those resources, like Pathoma and Boards and Beyond, cost money, but in addition to that, they’re more targeted toward preparing for shelf exams. So what I aim to do is try to close the gap in social capital by providing a free resource to the students at U of M, which also helps students in clinical decision-making.

So what do you do if somebody has post-op oliguria? How do you think of that? And don’t think of it, you know, just as taking a shelf exam, where you’re looking at these kinds of buzzwords. I’m thinking, how do you work that up once you’re in clinic? What do you look for? What are the sequelae, and what do you want to do?

So that was something that I worked on for about a month and a half, two months, during the pandemic. Thankfully, you know, a lot of the faculty and a lot of the residents were very supportive, and now they’re becoming surgical modules, which will be available to students who are current and to the incoming classes. So that’s one way in which I was really happy to close the gap, and I’m looking to advance this when I become a resident. So that’s one of my passions: just using education to close the gaps in social capital and level the playing field for surgical education.

Kevin Pho: And my final question: What’s your take-home message for the KevinMD audience?

Natalie Moreno: My take-home message, especially right now with the current events, with COVID-19 highlighting a lot of disparity, not just within health but within the workforce: Really, for those of you who have power and have privilege and have, you know, a voice, use that voice to help those who are missing at the table. Use it to advocate, you know, for your co-workers and for your patients, and think about, you know, what you could do to bring someone else to the table.

At times, people look like they’re doing OK, but especially for those who are in marginalized groups, you want to take the time to ask questions: How are you doing? What can I do? Rather than reinventing the wheel yourself, take the initiative to ask, you know, what can you do, and then call others to action as well.

Kevin Pho: Well, thank you so much for sharing your story and your insight on the show. We have Natalie Moreno, who is a rising fourth-year medical student, and she wrote the KevinMD article “Immigrant and minority physicians at the frontline of pandemics.” Natalie, thank you for joining me on the show.

Natalie Moreno: Thank you.

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