Challenges Faced by International Women Professionals
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《精神病学术期刊》
During the first half of the last century, female physicians of international origin arrived in the U.S. in significant numbers, predominantly from Western Europe. During the second half of the last century, they came from almost every part of the world. Most of these female physicians were not trained as psychiatrists in their country of origin, nor did their medical schools offer an education in psychiatry during their medical school clinical training that was equivalent to clinical training in the U.S. In fact, only select international medical schools offer opportunities to receive postgraduate psychiatry training. However, female physicians entering psychiatry training in the U.S. present a wide spectrum, varying from being directly out of medical school to practicing other medical specialties in their country of origin prior to arriving in the U.S. For international women, the decision to pursue psychiatry is not a simple task. Training opportunities usually have to be balanced with the needs of their spouses and the needs of their families. Opportunities to train in the U.S. are available based on academic credentials such as scores on USMLE and the Clinical Skills Assessment (CSA) Exam, visa status, ability to communicate in English, and clinical experience in the U.S. For international physicians, most opportunities to train in psychiatry as a specialty exist in the U.S., especially since most training programs offer more training positions than can be filled by American medical graduates. Several female physicians pursue psychiatry to balance career and family needs and to pursue their interest in child psychiatry. Empirical data indicates that the majority of female physicians arrive in the U.S. with their spouses.
Conflicting demands (some of which are derived from within their own culture, and others are external) are often made on these women to receive appropriate training, provide financial support to their families, and fulfill the cultural expectation to carry out their domestic responsibilities, and they constantly juggle between family and career, which frequently leads to tremendous stress. Male psychiatrists, on the other hand, can leave the bulk of responsibility for running the family and household to their wives. Most international women do not have professional women as role models and mentors during their professional training in their country of origin. This often leads to self-imposed as well as culturally imposed expectations to be a superwoman and do it all. While some international female psychiatrists have succeeded in cultural adaptation, managing time, and receiving professional satisfaction, others have compromised by not pursuing leadership positions and sacrificing promotions and financial opportunities.
To our knowledge, a systematic study of challenges faced by international female psychiatrists is currently unavailable. There are, however, data on studies of female practitioners in Australia, London, and Denmark (1). In these studies, key issues that affect the professional and nonprofessional lives of women included job satisfaction, balancing work and personal life, autonomy, availability of flexible work hours, fair remuneration, and having a voice in decision making. Key nonprofessional issues included self-care, time for relationships with a partner, children, family and friends, and time management to allow pursuit of nonmedical interests. These conflicting demands made on female professionals diminish their job satisfaction and lead to stress and imbalance in their lives (1). A supportive family, an understanding work environment, and changes in culturally based self-expectations of female professionals can lead to more fulfilling and well-balanced professional and family lives for women. Another study (2) identified specific pressures at work and at home experienced by general practitioners and their spouses and concluded that a female physician’s workload and decreased interest in her family are important stressors that affect her entire family unit. Other stressors include time pressure, hours on call, lack of support, and amount of paper work. Many women bring work home and spend time away from home at meetings, and family life is constantly interrupted by telephone calls. This study also identified role conflict as a major stressor for female general practitioners (2).
Some international female psychiatrists enter their training in the U.S. at an older age. Culturally, their prime responsibility is to enhance the career of their spouse and raise their children. In cases where the husband is unable to find a job equivalent to his training, the woman becomes the prime breadwinner, yet career goals do not have a priority in her life.
Younger international women are less pressured culturally. They pursue their career goals while raising young children, and their husbands share the responsibility of household and family. International female physicians are not usually comfortable leaving children in day care centers. They invite family members from their country of origin to live with them to help raise their children until they reach school age. This arrangement presents challenges within the extended family setting. Usually the family member that arrives in the U.S. to assist the young family is the woman’s mother or mother-in-law. Conflicts may arise at various levels, and issues of control, autonomy versus dependency, and envious feelings must be managed. International women tend to push their spouses to success rather than to enhance themselves to their best potential. This maintains the hierarchy in which the man holds a superior position in terms of power, control, and authority. In cases where these women surpass their spouse’s accomplishments, family discord is likely to occur.
International female professionals of Caucasian origin can merge with the mainstream U.S. professionals with ease, while others struggle for far longer periods to obtain equal opportunities.
I originated from India and arrived in the U.S. in 1970 with my husband. I knew no one in this vast country. I had earned my medical degree in India, and it was my family’s expectation that I would train further and become a pediatrician or an obstetrics/gynecologist specialist. These specialties were widely accepted for female physicians in India.
Female physicians rarely opted to compete for a psychiatry training position during the 1970s. My husband, who is also a physician, was sponsored by a hospital in the U.S. on an exchange visitor visa (J1 visa). I entered the U.S. on a spousal sponsorship. It was important that my husband finish training while I became familiarized with the cultural ways of this society. My first observation was that the people in this society consisted of primarily Caucasians, who were in the majority, and African-Americans, who were in the minority. There were very few people who were the shade of brown that I am. From the disembarkation forms that I filled out at the airport when I first arrived, to the employment applications that I would later complete, I had to check my ethnic identity as "other." The struggle to know "who am I" and "where I fit in" created a conflict that remained with me for a long time, consciously as well as subconsciously. I felt comfortable with other immigrants, no matter which part of the world they originated. I began to identify with the trials and tribulations of minorities in the U.S. My first close friend in this country was a highly educated African American woman, with whom I remain friends to this day.
In my day-to-day life, I saw my role as to help enhance my husband’s career goals, and only when he completed his training did I begin my own.
Many years later when I told my story to American female medical students, they questioned why I would sacrifice 5 precious years of my life not practicing medicine, although I was fully qualified by the exams that international physicians are required to pass prior to being accepted into training programs. My answer was clear and succinct. I was raised to be a wife and a mother. My internal values were to practice my profession only after my culturally accepted role was fulfilled. Perhaps younger international female professionals may not feel the same way today.
When I began my training in the U.S., I had a 2-year-old child. Daycare was unacceptable to us, so we invited my mother to come stay with us to help with our child.
I chose to pursue psychiatry, a specialty that my extended family in India had never imagined that I would think of pursuing. For several years, I did not tell my family that I was a psychiatrist. I knew they would be disappointed. On one of my visits to India, I informed them about my specialty and educated them about the role of a psychiatrist. My grandfather said, "I thought you will be a real doctor." My husband’s internist colleagues of international origin said to him, "I thought your wife had more brains than to think of being a psychiatrist!" I felt that I was in a minority group within the medical profession. I had learned from other international physicians to apply for residency training in inner city programs since large academic centers would not offer a position to an international physician. I followed their advice. I trained with some terrific American male psychiatrists who became my role models. They offered me an opportunity and identified my ambition, enthusiasm, and motivation to excel.
They reinforced my strengths and guided me throughout my career. I was offered the position of residency-training director and medical student clerkship preceptor, in my own training program, within 1 year after completion of my training. One of my mentors had warned me that I would face many challenges in this position. It was a young program that required vision, structure, and hard work to attract and recruit the best and the brightest of applicants. I accepted this challenge, nevertheless.
I had a Chairman who had vision, and he provided tremendous support. In no time, our program received full accreditation for 5 years without any citations. I attended my first meeting of the American Association of Directors of Psychiatric Residency Training (AADPRT) in 1979, where I observed that the majority of training directors were Caucasian, and few were female. This was an exciting as well as intimidating experience. I felt very different and isolated. I attended every AADPRT meeting, and, subsequently and eventually, I noticed that the scenario was changing: diversity among training directors had increased. I have been a training director for 25 years, one of the longest tenures of any training director and the first among international psychiatrists. I sat on my medical school’s executive and academic councils for many years as the only woman who was both international and dark skinned. I began to accept myself as a triple minority. I observed intently, listened, and rarely talked in these meetings. I knew my colleagues considered me mature and wise. I learned a great deal about academia by listening and reflecting on the process of these meetings.
To date, I have trained over 400 American medical students and more than 100 international residents, many of whom are women. I have observed first hand the differences and unique challenges that female professionals face. I understand their trials and tribulations since I have experienced them myself. As a result, I’ve identified creative and culturally sensitive ways of training them.
IMPLICATION OF THESE EXPERIENCES FOR PSYCHIATRIC EDUCATION
1. Culture plays an important role in the training and education of residents and medical students. It is critical for international as well as American trainees and educators to be aware of beliefs, values, and differences among people from different cultures. It is reflected in the trainees’ learning styles and adaptation to stressors in the training program. Female trainees of international origin face many stressors that are unique to them.
2. Educators may have cultural exchanges through focused discussions among trainees. Female trainees should be provided female faculty as mentors who can guide them in managing their multifold responsibilities. Listening to difficulties, gentle probing, and support go far in assisting the female professional develop her career. Some female mentors, however, may expect more from their female trainees and send messages such as: "I did it, you can do it too. " Such messages should be discouraged.
3. Female international trainees, with support and encouragement from experienced educators, must be taught to develop the perseverance and patience that is necessary to reach leadership positions.
4. Female international trainees should be advised to keep their primary goal in mind and not become disheartened because of obstacles. As one of my mentors told me, "Keep a thick skin and move on."
5. Female international trainees who are willing to share and educate their colleagues about their cultural belief system, values, and differences tend to feel better accepted by the host culture and less isolated.
REFERENCES
Kilmartin MR, Newell CJ, Line MA: The balancing act: key issues in the lives of women general practitioners in Australia. Med J Aust 2002; 177:87–89
Rout U: Stress among general practitioners and their spouses: a qualitative study. Br J Gen Pract 1996; 46:157–160(Nalini V. Juthani, M.D.)
Conflicting demands (some of which are derived from within their own culture, and others are external) are often made on these women to receive appropriate training, provide financial support to their families, and fulfill the cultural expectation to carry out their domestic responsibilities, and they constantly juggle between family and career, which frequently leads to tremendous stress. Male psychiatrists, on the other hand, can leave the bulk of responsibility for running the family and household to their wives. Most international women do not have professional women as role models and mentors during their professional training in their country of origin. This often leads to self-imposed as well as culturally imposed expectations to be a superwoman and do it all. While some international female psychiatrists have succeeded in cultural adaptation, managing time, and receiving professional satisfaction, others have compromised by not pursuing leadership positions and sacrificing promotions and financial opportunities.
To our knowledge, a systematic study of challenges faced by international female psychiatrists is currently unavailable. There are, however, data on studies of female practitioners in Australia, London, and Denmark (1). In these studies, key issues that affect the professional and nonprofessional lives of women included job satisfaction, balancing work and personal life, autonomy, availability of flexible work hours, fair remuneration, and having a voice in decision making. Key nonprofessional issues included self-care, time for relationships with a partner, children, family and friends, and time management to allow pursuit of nonmedical interests. These conflicting demands made on female professionals diminish their job satisfaction and lead to stress and imbalance in their lives (1). A supportive family, an understanding work environment, and changes in culturally based self-expectations of female professionals can lead to more fulfilling and well-balanced professional and family lives for women. Another study (2) identified specific pressures at work and at home experienced by general practitioners and their spouses and concluded that a female physician’s workload and decreased interest in her family are important stressors that affect her entire family unit. Other stressors include time pressure, hours on call, lack of support, and amount of paper work. Many women bring work home and spend time away from home at meetings, and family life is constantly interrupted by telephone calls. This study also identified role conflict as a major stressor for female general practitioners (2).
Some international female psychiatrists enter their training in the U.S. at an older age. Culturally, their prime responsibility is to enhance the career of their spouse and raise their children. In cases where the husband is unable to find a job equivalent to his training, the woman becomes the prime breadwinner, yet career goals do not have a priority in her life.
Younger international women are less pressured culturally. They pursue their career goals while raising young children, and their husbands share the responsibility of household and family. International female physicians are not usually comfortable leaving children in day care centers. They invite family members from their country of origin to live with them to help raise their children until they reach school age. This arrangement presents challenges within the extended family setting. Usually the family member that arrives in the U.S. to assist the young family is the woman’s mother or mother-in-law. Conflicts may arise at various levels, and issues of control, autonomy versus dependency, and envious feelings must be managed. International women tend to push their spouses to success rather than to enhance themselves to their best potential. This maintains the hierarchy in which the man holds a superior position in terms of power, control, and authority. In cases where these women surpass their spouse’s accomplishments, family discord is likely to occur.
International female professionals of Caucasian origin can merge with the mainstream U.S. professionals with ease, while others struggle for far longer periods to obtain equal opportunities.
I originated from India and arrived in the U.S. in 1970 with my husband. I knew no one in this vast country. I had earned my medical degree in India, and it was my family’s expectation that I would train further and become a pediatrician or an obstetrics/gynecologist specialist. These specialties were widely accepted for female physicians in India.
Female physicians rarely opted to compete for a psychiatry training position during the 1970s. My husband, who is also a physician, was sponsored by a hospital in the U.S. on an exchange visitor visa (J1 visa). I entered the U.S. on a spousal sponsorship. It was important that my husband finish training while I became familiarized with the cultural ways of this society. My first observation was that the people in this society consisted of primarily Caucasians, who were in the majority, and African-Americans, who were in the minority. There were very few people who were the shade of brown that I am. From the disembarkation forms that I filled out at the airport when I first arrived, to the employment applications that I would later complete, I had to check my ethnic identity as "other." The struggle to know "who am I" and "where I fit in" created a conflict that remained with me for a long time, consciously as well as subconsciously. I felt comfortable with other immigrants, no matter which part of the world they originated. I began to identify with the trials and tribulations of minorities in the U.S. My first close friend in this country was a highly educated African American woman, with whom I remain friends to this day.
In my day-to-day life, I saw my role as to help enhance my husband’s career goals, and only when he completed his training did I begin my own.
Many years later when I told my story to American female medical students, they questioned why I would sacrifice 5 precious years of my life not practicing medicine, although I was fully qualified by the exams that international physicians are required to pass prior to being accepted into training programs. My answer was clear and succinct. I was raised to be a wife and a mother. My internal values were to practice my profession only after my culturally accepted role was fulfilled. Perhaps younger international female professionals may not feel the same way today.
When I began my training in the U.S., I had a 2-year-old child. Daycare was unacceptable to us, so we invited my mother to come stay with us to help with our child.
I chose to pursue psychiatry, a specialty that my extended family in India had never imagined that I would think of pursuing. For several years, I did not tell my family that I was a psychiatrist. I knew they would be disappointed. On one of my visits to India, I informed them about my specialty and educated them about the role of a psychiatrist. My grandfather said, "I thought you will be a real doctor." My husband’s internist colleagues of international origin said to him, "I thought your wife had more brains than to think of being a psychiatrist!" I felt that I was in a minority group within the medical profession. I had learned from other international physicians to apply for residency training in inner city programs since large academic centers would not offer a position to an international physician. I followed their advice. I trained with some terrific American male psychiatrists who became my role models. They offered me an opportunity and identified my ambition, enthusiasm, and motivation to excel.
They reinforced my strengths and guided me throughout my career. I was offered the position of residency-training director and medical student clerkship preceptor, in my own training program, within 1 year after completion of my training. One of my mentors had warned me that I would face many challenges in this position. It was a young program that required vision, structure, and hard work to attract and recruit the best and the brightest of applicants. I accepted this challenge, nevertheless.
I had a Chairman who had vision, and he provided tremendous support. In no time, our program received full accreditation for 5 years without any citations. I attended my first meeting of the American Association of Directors of Psychiatric Residency Training (AADPRT) in 1979, where I observed that the majority of training directors were Caucasian, and few were female. This was an exciting as well as intimidating experience. I felt very different and isolated. I attended every AADPRT meeting, and, subsequently and eventually, I noticed that the scenario was changing: diversity among training directors had increased. I have been a training director for 25 years, one of the longest tenures of any training director and the first among international psychiatrists. I sat on my medical school’s executive and academic councils for many years as the only woman who was both international and dark skinned. I began to accept myself as a triple minority. I observed intently, listened, and rarely talked in these meetings. I knew my colleagues considered me mature and wise. I learned a great deal about academia by listening and reflecting on the process of these meetings.
To date, I have trained over 400 American medical students and more than 100 international residents, many of whom are women. I have observed first hand the differences and unique challenges that female professionals face. I understand their trials and tribulations since I have experienced them myself. As a result, I’ve identified creative and culturally sensitive ways of training them.
IMPLICATION OF THESE EXPERIENCES FOR PSYCHIATRIC EDUCATION
1. Culture plays an important role in the training and education of residents and medical students. It is critical for international as well as American trainees and educators to be aware of beliefs, values, and differences among people from different cultures. It is reflected in the trainees’ learning styles and adaptation to stressors in the training program. Female trainees of international origin face many stressors that are unique to them.
2. Educators may have cultural exchanges through focused discussions among trainees. Female trainees should be provided female faculty as mentors who can guide them in managing their multifold responsibilities. Listening to difficulties, gentle probing, and support go far in assisting the female professional develop her career. Some female mentors, however, may expect more from their female trainees and send messages such as: "I did it, you can do it too. " Such messages should be discouraged.
3. Female international trainees, with support and encouragement from experienced educators, must be taught to develop the perseverance and patience that is necessary to reach leadership positions.
4. Female international trainees should be advised to keep their primary goal in mind and not become disheartened because of obstacles. As one of my mentors told me, "Keep a thick skin and move on."
5. Female international trainees who are willing to share and educate their colleagues about their cultural belief system, values, and differences tend to feel better accepted by the host culture and less isolated.
REFERENCES
Kilmartin MR, Newell CJ, Line MA: The balancing act: key issues in the lives of women general practitioners in Australia. Med J Aust 2002; 177:87–89
Rout U: Stress among general practitioners and their spouses: a qualitative study. Br J Gen Pract 1996; 46:157–160(Nalini V. Juthani, M.D.)