Foreign-Born Physician-Scientists

I read with great interest the recent Special Section on Brains and Borders (28 May, pp. [1277][1]-1288). Being a foreign-born physician on a J1 visa, I have experienced firsthand the advantages, but also the obstacles and perils, of coming to the United States to train for a career in science. There is an aspect that was not considered in the report: the foreign physician-scientist. Foreign nationals holding an M.D. degree may come to the United States as trainees in basic science with a postdoctoral appointment, or as residents and fellows in training programs approved by the Accreditation Council for Graduate Medical Education. A large percentage of individuals who start on the clinical training path enter the United States on a J1 visa, sponsored by the Educational Commission for Foreign Medical Graduates (ECFMG). This pathway requires that upon the completion of training, the foreign trainee must return to his or her country for two years, and he or she will not be eligible for any other visa until the requirement is met. This policy truncates the individual's career at a critical moment: when one can apply for mentored research grants, but one has not advanced enough to apply for a first independent grant. The result is that that these trainees have very limited options to succeed in their transition to an academic position either in their home country (because they will not have a mentor on return who can support applications for grants) or the United States (because of the 2-year absence). The NIH has recognized that there is a decline in physicians training for a career in academic medicine. Permitting foreign-born physicians to remain in the United States as a physician-scientist after training could possibly reverse this unsettling trend. A waiver for the successful physician-scientist to stay in the United States would enhance his or her ability to conduct independent research and embark upon a career, either in the United States or in the home country. From the perspective of the foreign individual's country of origin, most of them would be better served if the trainee advances to the point at which he or she can compete successfully for funding at the international level. Returning to a developing country as a physician-scientist with no clear source of funding is not particularly beneficial for the country or the individual. Moreover, successful scientists from developing countries serve as important links for the promotion of science in their countries of origin and may foster international collaborative research. I am now in my fourth and final year of training in medical genetics and am involved in several exciting and successful laboratory research projects. My mentor would prefer for me to continue my projects, apply for additional funding, and publish all of my relevant findings. However, I will have to interrupt my research projects and training and look for a position in a difficult job market in Colombia, in the hope that in two years I may pick up where I left off, rebuild some of my research projects, and develop a career as a physician-scientist. [1]: /lookup/doi/10.1126/science.1101304