When I was a child, I watched a neighbor struggle after a stroke. He survived, but without rehabilitation he remained trapped in his disability, dependent on others for every task. That memory shaped my understanding of medicine: Survival alone is not enough. Patients deserve a chance to reclaim independence and dignity.
Years later, after completing medical training abroad, I came to the United States as an international medical graduate (IMG), determined to pursue residency in physical medicine and rehabilitation (PM&R). Like many IMGs, I was motivated by the belief that my perspective and experiences in underserved communities could enrich the U.S. health care system. I knew the road would be difficult, but I did not expect to encounter overt exclusion.
In April 2025, I began an observership at a university medical center’s department of physical medicine and rehabilitation. My supervising physicians gave me positive feedback and even agreed to provide recommendation letters, critical for my residency application. For weeks, I shadowed diligently, studied cases, and tried to absorb every lesson.
But one afternoon, a senior physician pulled me aside. His words were blunt: “You have no chance here. We do not take IMGs. We already have enough American graduates, and this program has not accepted an IMG in over twenty years.”
I was stunned. This was not a critique of my performance, but a categorical rejection of who I was and where I trained. Despite his warning, I continued my observership, believing that my work ethic and the support of my other mentors would carry me forward.
What followed was a series of retaliatory actions that left me shaken. I was abruptly banned from clinics without explanation. Staff who had once spoken warmly to me suddenly avoided eye contact. I was threatened with police and even immigration enforcement if I persisted in seeking access to my mentors. Most painful of all, the recommendation letters I had been promised were withheld, cutting off my ability to apply for residency this year.
In that moment, the message was clear: my identity as an IMG, not my abilities as a physician, determined my fate.
The consequences are devastating. Without those letters, my application to residency is incomplete. I must now wait another year, losing time, income, and momentum in my career. More importantly, the patients I hope to serve will wait longer for the care I could provide.
This experience is not just about me. It exposes a structural inequity that has persisted in medical education for decades. IMGs make up nearly twenty-five percent of the U.S. physician workforce. Many practice in underserved communities, rural areas, and specialties facing shortages. They are bilingual, culturally competent, and often willing to serve where others will not. Yet behind the closed doors of selection committees, categorical exclusion of IMGs remains an open secret.
In a state with immense diversity and pressing health care needs, shutting out qualified IMGs is not only unfair; it is harmful. Patients lose when talented physicians are blocked from contributing. Communities lose when cultural and linguistic diversity is stripped from the physician workforce. The profession loses when equity is sacrificed for gatekeeping.
The irony is bitter. In PM&R, the very field dedicated to restoring function and dignity, I witnessed the opposite: exclusion and silence. My patients in underserved communities taught me that survival without independence is not true healing. My experience as an IMG now teaches me that opportunity without fairness is not true equity.
I continue to believe in the vision of rehabilitation medicine: helping patients move from limitation to possibility. That belief will not be shaken by this experience. But I also believe we must shine a light on institutional practices that quietly exclude IMGs and deny them a fair chance to contribute.
I share my story not as a complaint, but as a call for transparency and accountability. Residency programs should evaluate applicants on merit, not birthplace. Institutions should honor their promises to trainees, not wield bureaucracy as a weapon. And as a profession, we must ask ourselves: if we truly value diversity, equity, and inclusion, why do we still tolerate systemic barriers against IMGs?
Survival alone is not enough, for patients, or for physicians like me. We deserve the chance not just to survive, but to thrive, to contribute, and to restore dignity, not only in our patients, but within our profession itself.
Fereshteh Kagar Bafrani is a physician.
