Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

A doctor spoke up about problems in his residency, and months later he was walked out in front of his patients. In this episode, Vasilii Khammad, a physician and researcher who came to the United States as a Fulbright Scholar, shares what happened after he and fellow residents raised concerns about their training program. You will hear how the feedback against him was anonymous and never documented, how he was pushed toward a psychiatric evaluation he never asked for, and how he was removed with no chance to respond. You will also hear why no lawyer would take his case, and why residents on visas are left almost entirely on their own when a program turns against them. Khammad explains what he wants other international medical graduates to know about their rights. This episode is based on his article “International medical graduates need real protections,” published on KevinMD. Press play to hear why the doctors we recruit to train here have so little protection, and what he says you should do about it.

Partner with me on the KevinMD platform. With over three million monthly readers and half a million social media followers, I give you direct access to the doctors and patients who matter most. Whether you need a sponsored article, email campaign, video interview, or a spot right here on the podcast, I offer the trusted space your brand deserves to be heard. Let’s work together to tell your story.

PARTNER WITH KEVINMD → https://kevinmd.com/influencer

SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Vasilii Khammad. He’s a physician and researcher. Today’s KevinMD article is “International medical graduates need real protections.” Vasilii, thank you so much for joining us all the way from Russia.

Vasilii Khammad: Hi, Kevin. Thanks so much for having me.

Kevin Pho: All right, so why don’t you just briefly share your story? I think your story is part of your KevinMD article, and you could jump into why you decided to write it in the first place.

Vasilii Khammad: Sure. Well, I’m Vasilii Khammad. I came to the United States in 2019 as a Fulbright Scholar at the Ohio State University. The Fulbright Scholarship, as some of your viewers may know, is a cultural exchange program sponsored by the U.S. Department of State, and my invitation to the country was signed personally by President Trump. By then, I had already finished medical school in Moscow, completed a residency in medical oncology, and was working on my PhD thesis in neuro-oncology.

In 2024, I had a very challenging match season and interviewed at 12 residency programs. There was one particular pediatrics program that left a very positive impression on me. The program director spoke about supporting the African American community and underrepresented groups in medicine, which I personally really respected as a Fulbright Scholar and as an IMG. The residents were incredibly welcoming, and I had a great conversation with the pediatric hem/onc faculty, so I ranked the program high on my match list.

And in March, all the hard work finally paid off. I matched. I was genuinely excited. I started my residency in 2024, threw myself into clinical work, and by September, after getting used to the residency schedule, I started working closely with the peds hem/onc department, joined several research projects, and was preparing several manuscripts, abstracts, and conference presentations.

And then October came, when we had our first meeting between the first-year residents and the program director.

Kevin Pho: All right. So tell us what happened next.

Vasilii Khammad: So several of us shared ideas for improving the program. But instead of being welcomed, those suggestions, to our surprise, were met with resistance. And over time, the residents who spoke up started facing increasing pressure from the program director.

In my case, she began calling me into repeated one-on-one meetings where she questioned my medical knowledge and whether I would be able to successfully complete future rotations. When I would ask her for specific examples, I was pointed to comments that were not in any evaluation system, and no faculty members were identified as having made those comments. Every time I asked what this anonymous feedback was based on, I never got a clear answer.

And what concerned me even more was that during one of those meetings, the program director suggested I should be evaluated for ADHD, and it came completely out of the blue. It was very difficult to hear. You see, I have never been referred to a psychiatrist or psychologist in my life, and no one ever suggested I needed that kind of evaluation, and that was the moment I started feeling that something was not right. I was being told I had a problem that I didn’t recognize in myself, and no one could clearly explain why.

Kevin Pho: Now, from what I understand, you started at this new program in the summer, and up until that first one-on-one meeting in October with your program director when you voiced some suggestions for the program, after that meeting, then some of their concerns started to come up. As far as you know, were you thriving in that program? Were there any warning signs that may have led you to suspect that there was something going on? Tell us what it was like during those first few months.

Vasilii Khammad: Sure. So by that time, things seemed to be going pretty well. I had completed my rotations with positive evals. I scored about the national average on the pediatric in-training exam and was heavily involved in research. As I said, during the interview I had a very productive conversation with the pediatrics hem/onc department, and they knew my background in oncology and research. So right after I adjusted to the residency schedule, I started working with them closely.

We wrote two manuscripts together and about five abstracts, and I was actually getting ready to present clinical cases at an upcoming conference. So from my perspective, things were going pretty well. But as I told you, during the one-on-one meetings the program director just suggested I have issues, and the feedback was anonymous, so it was very hard to understand who exactly made those comments and how this happened, because nothing concrete was given.

Kevin Pho: And you didn’t receive any personal feedback from the physicians during your clinical rotation, correct?

Vasilii Khammad: Oh, actually, we had this electronic evaluation system, and everyone could just look it up and see the feedback that the faculty would give. Even the residents who you worked with could leave their feedback there, and it was pretty good, and I passed my rotations successfully. There was a scoring system that was used to evaluate whether the physician in training could continue further with the program, and I was passing all the needed scores and was just completing one rotation after another without any problems.

Kevin Pho: So according to this story, you suspected that ever since that one-on-one meeting where you brought up some feedback to the program, that’s when it started.

Vasilii Khammad: Oh, it was not a one-on-one meeting. Sorry for interrupting, Kevin. But it was a group meeting. It was the meeting with the residents of the first year and the program director. So not just me, but several other residents also said that there were some things that needed improvement. And I will tell you a little bit later as I continue telling you my story, but those other residents started feeling pressure from the program director as well.

Kevin Pho: So before moving on in your story, what exactly was aired during that meeting? What were some of the concerns that were brought up to the program director?

Vasilii Khammad: So most of the concerns were related to heavy workload, because during night shifts we didn’t have enough staff helping the residents to cover their shifts. Also the changing schedule. Sometimes people would notice that their schedule would be changed about two or three days before the actual rotation took place. There was also concern from the residents who were rotating with us from other hospitals. Some of the family medicine residents were saying that they were not given any clear instructions on what was expected from their work or on how their work was supposed to be evaluated. And those were the main concerns.

From my perspective, I’m an IMG. I haven’t completed my medical residency in the U.S. I was not sure about the medical documentation, so there was not any specific format. And I was just proposing that we perhaps would have some kind of sample or template that we could use that would help us effectively put everything we need on the medical documentation.

Kevin Pho: All right. So tell us what happened next. You mentioned that you and your fellow residents in that meeting were feeling pressure from the staff. Where did you turn to, or did you turn to anyone for some support, help, or anyone in your corner?

Vasilii Khammad: Well, first I tried to speak with the faculty, and from my perspective, it was the logical thing to do, because I am personally a non-confrontational person and I try not to push back when speaking with someone who is higher in the hierarchy. Some of the faculty members who I spoke with were actually sympathetic. They understood that there was something going on, but they all advised me not to push back and to accept the situation as it was and just move forward. And that’s what I actually decided to do. So I didn’t try at that point to connect with anyone else but the faculty. And after their feedback, I just kept my head down, focused on my work, and generally hoped the situation would improve on its own.

Kevin Pho: All right. So you put your head down, so to speak, and continued to work. Did the pressure continue to increase? Tell us what happened next.

Vasilii Khammad: Yeah. So by February things escalated. The program director asked that I should go through the focused review process. For some of the viewers, focused review is a formal performance improvement process when a resident is considered to be failing and is placed on closer supervision. I was also told at that point that I was no longer recommended to participate in conferences or research projects with the hem/onc team, and that was quite frustrating. Also, what was included in the focused review plan was the mandatory psychiatric evaluation for ADHD. So again, I was advised something against my will, and that really kept me thinking, “OK, enough is enough.”

Kevin Pho: So I find it hard to believe that there wasn’t any reason. They put you on this focused review and suggested that you undergo ADHD evaluation. Any specific reason that they gave you to put you on this plan?

Vasilii Khammad: So the main reason the program director named was that she was worried about the testing abilities. There were two pediatric in-training tests. One happened right after I started residency in July, and I didn’t do quite well back then. And usually the pediatric in-training tests would be scheduled for residents regardless of what rotations they are on. Some people were on night shifts. For me, it was the inpatient unit, which was pretty heavy on clinical responsibilities. And it was my first month of the residency overall. So I suspect that I didn’t achieve the scores I was hoping to, and perhaps that kept her thinking that maybe I should be evaluated.

And by all means, the pediatrics program director is an adolescent medicine physician, so some of her work is also related to working with people who have ADHD, and the symptoms sometimes can be related to performance on testing and performance on clinical evaluation. So those are maybe some of the things that come to my mind that can be related to her referrals to psychiatric evaluation and ADHD in particular, because of her professional experience and also because the first in-training exam was not as successful as maybe both of us wanted.

Kevin Pho: So as far as you know, just to be clear, the only deficiency that you can remember was the fact that your in-training exam scores perhaps weren’t as good as you wanted them to be. In terms of patient care, interactions with your other residents and nurses, as far as you know, those were fine.

Vasilii Khammad: Well, to the best of my knowledge, and according to the electronic evaluation system, which I already mentioned, there were no concerns, no problems with previous rotations, and no, let’s call them, suspicious comments about my performance or achievements by that time.

Kevin Pho: So now you mentioned you were moved to act. How did you respond?

Vasilii Khammad: Well, first I tried to gather some information from other residents as well, and I noticed that some of them also were criticized just after that meeting in October. Some of the residents who were also IMGs were the target of some jokes. Some of the residents were speaking with them in a loud voice. They were giving them more heavy workload. There was also one physician, she’s actually American, and she was heavily criticized because of her age and was even encouraged to leave the program. And at the same time, the residents who appeared to have closer personal relationships with the program director, including helping her with family matters and childcare, they seemed to receive preferential treatment.

And then finally we wrote together the complaint to the ACGME. And what stood out was that there was this meeting with ACGME representatives, and the residents who had raised concerns were never invited to meet with those reviewers. Instead, only those who were in preferential treatment with the program director met with the ACGME team.

And by that time point, I felt the culture of the program was driven less by professionalism and more by personal relationships, so I decided to transfer and to see where I could continue my training in a healthy environment. And looking back now, that decision ultimately backfired on me.

Kevin Pho: What happened when you tried to transfer?

Vasilii Khammad: So I met with the program director, and I told her that I had decided to transfer, and to my surprise she appeared to take the news quite well. I was expecting some pushback and questions about why I decided to do so, but in fact she expressed her full support for my decision. She said, “If that’s what you have chosen, then I will completely support you.”

And then April came. I had started communicating with other programs and was doing my shift in the neonatal unit. And after one of those shifts, I was unexpectedly called into a meeting with the program director. And from the very beginning, this new meeting felt different. Two things immediately stood out. First, I was told I couldn’t go alone, and I had to be accompanied by a senior resident. Second, the meeting wasn’t even held in the children’s hospital where we usually met. Instead, I was taken to an administrative building this time, into a formal conference room. And when I walked in, there was the designated institutional official, two faculty members, and the program director, who were already sitting there.

And almost immediately, the program director began reading through a long list of allegations against me, and when I tried to respond and explain my side of the story, the DIO stopped me and said that no explanations or objections would be heard at that time. I was then told to hand over my ID badge immediately. I asked for documents or at least any evidence supporting those allegations, and I wasn’t given anything. And after that, one of the faculty members escorted me out of the building, and I was walked out in the middle of the workday in front of my colleagues and my patients, and I still remember that as one of the most humiliating moments of this entire story.

And later, during the legal process, I learned that preparations for my removal had actually begun several days before that meeting. The decision had been made before I even walked into that conference room. So no one actually expected me to present my side of the story. Everything was already decided for me. And after the day when I just had to give up my ID badge and I was escorted out, I was never allowed to be back into any university building or facility.

Kevin Pho: And at any point during this process, did you engage the services of an attorney or some type of advocate for your side?

Vasilii Khammad: That’s a really good question, Kevin. I would have liked to do that, but because it happened abruptly in the middle of the workday, and I was forced to give up my ID badge, and I was just disconnected from all the electronic systems of my university, I just couldn’t do that. I would have loved to, but I just couldn’t. And no one from the university’s legal office reached out to me. No one responsible for supporting international trainees contacted me either. And since my university access had been revoked, I couldn’t reach out myself. No one explained what my rights were, what options I had, or even where I could go for help.

Kevin Pho: Now, we have a few minutes left in our conversation, and as you replay those events in your mind, would you have done anything differently if you had to go through that again?

Vasilii Khammad: I would say I would try to maybe reach out to any university services that protect IMGs and that support residents, in terms of maybe asking for advice from specific employees in the university who might have had similar examples of situations when the residents do not understand the program director and vice versa. So if anyone had any experience with that, maybe I should have proactively looked for help earlier. But at the same time, I’m realizing now that it could have probably been the same outcome. Even if I looked for that help, the best thing that they would advise would be to again try to keep your head down, try to complete your rotations, do not argue with the program director. And it would pretty much lead to the same consequence.

And after that event unfolded, I tried to look for lawyers, and no lawyer would take my case because I’m a foreign medical specialist on a J-1 visa, so everyone thought that it was very risky to proceed with me, and there were also questions about the immigration status. So even with the best possible environment before these things happened, options for IMGs are pretty much limited, and you have to do it on your own, which I pretty much did.

So I filed an appeal for my case, first through internal university systems. And then when I found that there were actually violations of several federal and state laws, I wrote to the President of the United States, who initially invited me to the country under the Fulbright scholarship. And I received the response from Washington to keep on fighting, to stand up for my rights, which gave me some extra force to keep moving. And I filed several claims, and even filed an official investigation with the ACGME, with federal agencies, and the claims with the state commission. So those are now under review. And maybe in some time I will be able to give you more details as events unfold.

Kevin Pho: Now, to your fellow IMGs that are listening to you on this podcast, from your experience, what kind of advice can you share with them?

Vasilii Khammad: Well, I hope my experience helps to raise awareness of the challenges that international medical graduates and even some American residents can also face. And I hope that it encourages others to stand up for their rights, because no one is above the law. And when you see that something unfair is happening and something unlawful, then you do not just keep your head down, but sometimes you have to speak up. And no one is above the law, not even those in the highest leadership positions. So you should know your rights, keep fighting for what you think is fair, and never give up.

Kevin Pho: Vasilii, thank you so much for sharing your story, time, and insight. Thanks again for coming on the show.

Vasilii Khammad: Thank you, Kevin.