Science Friday - Doctor Burnout, International Doctors. June 19, 2020, Part 1

Episode Date: June 19, 2020

A Crisis Of Health In Healthcare Workers Content Warning: This segment contains talk of suicide. For help for people considering suicide, call the National Suicide Prevention Lifeline: 1-800-273-8255 Depression and anxiety are extremely common in healthcare workers, and they have higher rates of suicide than the general public—doctors in particular are twice as likely to die by suicide. That’s when the world is operating normally. Now, healthcare workers are also dealing with a devastating pandemic, and the uncertainty surrounding a new disease. And some healthcare workers are using what little emotional labor they have left to advocate in the streets and online for racial justice.  Joining Ira to talk about burnout in the healthcare industry are Steven McDonald, an assistant professor of emergency medicine at Columbia University Irving Medical Center in New York, and Kali Cyrus, a psychiatrist and assistant professor at the Johns Hopkins University School of Medicine in Washington, D.C. Insights From International Doctors On The Frontlines Of The Pandemic   In March, governors Andrew Cuomo in New York and Gavin Newsome in California put out a call for medical professionals to come to their states to help with the COVID-19 crisis. Many of those on the frontlines aren’t just from out of the state, but from out of the country. International medical professionals are estimated to make up a quarter of working doctors in the U.S.   Journalist Max Blau talks about the role of international doctors in the U.S. medical system and how they have been affected during the pandemic. Then international resident physicians Quinn Lougheide and Muhammad Jahanzaib Anwar share stories from aiding COVID-19 patients in Bronx, New York. PG&E Guilty Plea Sets A Precedent For Climate Change Culpability   In 2018, the devastating Camp Fire wildfire swept through northern California, killing 84 people. Utility giant Pacific Gas & Electric, or PG&E, was deemed to be responsible for the spark that caused the fire. This week, the company pled guilty to involuntary manslaughter for the deaths, marking the first case of its kind. The decision sets a precedent for future legal battles over holding companies accountable for climate change, and how that burden should be split.  Vox staff writer Umair Irfan joins Ira to talk about the PG&E case, plus more on why a second round of COVID-19 lockdowns might not work as well as the first shelter in place orders.   Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

This is Science Friday. I'm Irafledo. A bit later in the hour, job burnout in health care workers. We'll talk about taking care of the people who are taking care of us. But first, there's still a lot we don't know about COVID-19. And doctors are finding recovered patients aren't always out of the woods after they beat the infection. We're just learning about the long-term complications inflicting some of the survivors. Here to talk about that and other science stories from the week is Omer Erfan, a staff writer at Vox in Washington. Welcome back, Omer. Thanks for having me.

Let's start with a story you reported for Vox, and that's a second round of COVID-19 lockdowns, might not work as well as the first time around. Why is that? Well, there are a number of reasons at play. The big one is just that we're in a very different stage of the pandemic right now. Back when the first lockdowns went into effect, we were seeing tens or dozens of cases per day in states and now we're seeing hundreds if not thousands of cases per day. So snapping those restrictions back into a place would take a longer time for those numbers

to start dropping again. The other factor is that once you start locking people in place, there's a lot higher chance of household transmission, basically people transmitting it to people in their own families. And there's also likely to be a fair amount more transmission among the essential workers. So there's likely to be a longer time for this curve to come down. And then finally, people are pretty tired. I mean, they're fatigued by these measures by having to wear masks or to, you know, keep social distance. And it's likely that people are not going to be as compliant this time around.

I know. Here in New York, we're barely getting out of the first lockdown. What places are considering a second round? Right. I mean, it's largely going to be in places that are seeing a rise in cases. Right now there are 18 states, states like Tennessee, Texas, Arizona, and South Carolina. And many of those governors are trying to press ahead with plans to reopen their economies, but some city government officials, mayors and county officials,

want to snap back their own restrictions in their own places, cities like Houston, for instance. But in some of these cases, those cities are prohibited from setting standards that are more stringent than the state government. And so they're trying to resolve that right now, trying to give people some of the leeway to impose their own stricter measures, like mandating, wearing masks or demanding that business is closed. Are there any alternatives that might be investigated to explore?

Well, the thing we could be doing is the thing we should have been doing all along, which is essentially testing, tracing, and isolating the people that are sick. You know, the purpose of the lockdown was not just to slow the transmission of the virus, but it was also to buy time to set up the infrastructure to do the less costly but more sophisticated methods of controlling the disease, basically, finding the people who are transmitting the virus unwittingly, helping them isolate, and then also making it easy for people to isolate. you know, encouraging tactics like work from home or offering unemployment insurance or paid sick leave to make sure that people aren't feeling pressure to go back out even when they may be sick. Let's move on to this other story I began with when we started talking, and that is a lot of patients who have recovered from COVID are dealing with persistent health issues weeks and months later, right? That's right. I mean, this is still a very new disease, and so it's hard to get a picture of the long-term trends just a few months in. but we are starting to see some signs. You know, doctors have also looked at some of our past experiences with other coronavirus like SARS

and saw some long-term effects there. The big ones to pay attention to our things that are dealing with the airways. You know, COVID-19 is a respiratory infection, so that makes sense. Doctors have reported seeing, you know, lung scarring in patients on CT scans. They identify what are called ground glass opacities, basically patches in the lungs that look like ground glass, essentially showing that there's a diminished lung function. And that can persist and that can be permanent. And then similarly, there are other problems that can also be persistent like heart and even neurological trouble because one of the symptoms or one of the signs of COVID-19 is that can cause blood clots that can choke off blood supply to parts of the body.

And if that persists, that can cause some lasting damage. And even people who have to learn sort of how to speak again, having being intubated in a tube down their throat all this time. Right. Just the fact that people are in intensive care, that's not an easy thing to recover from. I mean, it still has a lot of a recovery time that is associated with it. And even in younger people, like even though older people are most at risk, younger people who have been hospitalized and received intensive care can also suffer some of these long-term effects. All right.

Let's move on and talk about a promising treatment for COVID-19. We haven't heard much about it. It's called dexamethosone. Tell us about this. Yeah, researchers at Oxford University in the United Kingdom this week reported some promising results in a fairly large clinical trial of this drug. This drug dexamethosone is a corticosteroid. It's been around since the 1950s.

It's fairly cheap. It's available as a generic, and it's used largely as an anti-inflammatory drug. And the researchers reported that in this trial, they gave this drug to about 2,000 patients that were randomly selected and compared it to 4,000 patients who were given the conventional treatment. And they found that this drug saved the lives of critically ill patients. This is the key finding here.

This is the first drug demonstrated to save lives. And it reduced deaths by about one-third in patients on ventilators, and it reduced deaths by about one-fifth for patients who were receiving oxygen support. However, it had no impact on patients that did not receive that kind of intensive care that weren't receiving breathing support. So it was important to give it at the right time? That's right. This is something that is very useful for critically ill patients, but in earlier stages of the infection, it could potentially backfire. And that has to do with the mechanism of this drug, because this is a steroid. It can actually suppress the immune.

system. So in the early stages of the infection, you want to try to control the virus, but in the later stages, you want to try to control the immune response because sometimes the immune system can overreact and cause a lot of collateral damage. The white blood cells can sometimes start attacking healthy cells, and that's typically what happens in the most more severe cases. So there's kind of a threshold at which point this drug where the trade-offs make sense to give it to people. Does this prevent that dreaded cytokine storm where the body's immune system overreacts and attacks itself? Well, it doesn't necessarily prevent it, but it gives you sort of a counterbalance to that. Because, you know, one of the key phenomenon of this disease is that it can throw the

immune system out of balance. And so by having a drug that can actually tamp down the immune system during the most critical stage of the infection or through a course of it, that you can actually help, you know, gain ground against it. And as this study showed, it saved lives. Yeah. Is there any pushback? Sometimes these studies come out and then they reevaluate that more people see the results and say, just wait a minute. Well, that's one of the big problems with the study. Like, we haven't actually seen the results. This has been one of the key focus points for a lot of researchers who are evaluating this.

The findings were not even announced in a preprint paper. They were announced in a press release. And I talked to a doctor about this, and he was very frustrated because he wants to treat patients, and he says he has no idea how the patients he sees line up with the patients that were in the study. And so a lot of researchers are saying that, you know, this is a good way to build a lot of attention for these findings, but without seeing the actual data, there's really no way to scrutinize and validate them. Now, this drug, as you say, has been around for decades. It's available by prescription. If word about this gets out, are we going to see a run on the drug, do you think? Probably not,

because it's not like hydroxychloroquine, which, you know, was people were trying to take it as a prophylactic to prevent the disease. This is a pretty serious drug. Like we mentioned, it suppresses the immune system. Not only does it make your immune system weaker against the virus, it can make you vulnerable to other infections and other pathogens. So you don't want to take it willy-nilly. And again, as the study showed, it only had an impact on the most severely ill patients. The vast majority of people who get COVID-19 get better on their own or they have a much milder progression of the disease. And there's really no impact that we can detect on those lower courses. Okay, let's shift a little bit and go on to another topic. I know we have just

entered hurricane season, and when you were on the show a few months ago, we talked about how hurricanes have been gaining strength since the 1970s because of climate change. And now I understand there's new research that says something else might be happening. Tell us about that, please. Sure. Some research came out this week that showed that hurricanes are actually slowing down and dumping more rain. And the consequence of that is going to be likely more flooding and more damage from these storms. In the steady, they looked at both historical data and climate models, and they found that between 1961 and 2017, tropical cyclones have slowed down by about 10%.

You know, we've seen some of these giant rainstorms. So there's some evidence that's already happening, right? Yeah, we saw a pretty stark example of that with Hurricane Harvey in 2017. That storm basically parked over Houston and dumped a gargantuan amount of rain and caused a lot of record flooding. And that makes sense because, you know, hurricanes dish out a huge amount of rain. And so if you just hold them in place in one area for a longer period of time, that place is going to accumulate more rain. Wow. Okay.

Let's move on to from rain. Let's move on to wildfires. The largest utility company in California recently confessed to manslaughter. Tell us what was going on there. Yes, Pacific Gas and Electric, which is the largest utility in California. They, this week, confessed to involuntary manslaughter for 84 counts. This was in connection to the campfire in 2018. This was the large California fire that was likely sparked by PG&E equipment.

This ended up being the most destructive and deadliest wildfire in California's history. So the ruling here was basically that PG&E should have done better job of maintaining their equipment. But the problem is that wildfires have been getting worse in the United States and more destructive for a number of different factors, and almost all of them stem from human activity. People are building closer to wildfire prone regions, and that means there's more damage when fires do occur and a greater likelihood of fires being ignited. And also humans are changing the climate. Western forests are starting to dry out and there's more fuel to burn.

The campfire came, you know, at the edge of a huge drought in California and there are millions of dead trees throughout the state. So all of these problems are working together, and yet one company was found liable for the brunt of it, and this is going to be a bigger problem going forward about dividing the pie as far as who's responsible for what when it comes from these climate-linked disasters. You know, it's very rare to hear of a big company admitting guilt about anything,

Yeah, that's right. I mean, there did get, I think, roughly a $3.5 million fine, but they're also facing about $30 billion in liability. The company declared bankruptcy. And, you know, kind of going ahead. I think legislators are going to have to deal with how do you divide the blame here? I mean, you can't really boycott electricity in California. PG&E has largely a monopoly in most of the areas it operates. And people are still going to need power wherever they live. So if you live in a remote mountainous area that has a lot of fire prone trees, those power lines are still going to be running there. So the question, is over the long term, how do you mitigate these risks? And that's a tough question to answer at this point. Let's end on a bit of a bizarre note that researchers have engineered goats that make cancer medications in their milk. What the heck is going on there? Well, they turn these goats into cancer drug-making factories, and goats are an ideal vehicle for this because they're very cheap to make. I mean, they grow very quickly, and they generate a large amount of milk for their size. And so researchers use the embryos of goats that

were engineered to make this drug called cytosimab. This is a monoclonal antibody. Now, cancer drugs, especially some of the more sophisticated ones, there are these complicated molecules and they become very expensive to make. And for a patient, it can cost thousands of dollars a month to get a treatment course

for this. So having an animal that can actually make, you know, kilograms of this stuff per year is actually a huge step forward in terms of making it much cheaper. And so they, you engineered these embryos. They implanted them after five months they were born. And when they started to lactate, they were producing basically about 10 grams of this drug for every liter of milk that they produced. Very cool, Amir. It's always great to have you on and bring us something

different to think about. Great to be here, Ira. Amir Afon is a staff writer at Vox in Washington, D.C. We're going to take a break. And when we come back, we'll talk about the burnout crisis and health care workers. You don't want to miss this. Maybe some of you are some of them. Stay with us. We'll be right back after this break. I'm Ira Flato. This is Science Friday from WNYC Studios. This is Science Friday. I'm Ira Flato. You know, health care workers take care of other people for a living, and that takes a toll mentally and emotionally. Depression and anxiety are extremely common in health care workers. Healthcare workers have higher rates of suicide than a general public. Doctors are twice as likely to die by suicide. It's a staggering statistic.

And that's when the world is operating normally. Now, add into the mix that health care workers are now dealing with a devastating pandemic that we still don't know a lot about, at protests for racial justice where some health care workers are using what little emotional labor they have left to advocate for justice, and what you have is burnout in the industry. Some health care workers via our Science Friday Voxpop app, told us what they are going through.

I am a little bit burnt out, I have to say. I work at Texas Children's Hospital as a medical interpreter, and in the clinical area, we are not seeing very many patients, but our patients are at heart risk, and our families are limited in technology usage, and I have to say that everybody is having a very hard time. I am a health care worker, and I have been a respiratory therapist for 32 years,

I was burned out before the pandemic. I'm sometimes jealous of those who get to stay home, but I'm also very grateful that I still have a job and I'm still working. Yes, I am a health care worker. I am quite honestly just attempting to navigate life and hopefully drive change from within the system. Those listeners were Valerie in Texas, Brenda in Missouri and Kim in Colorado.

Thank you to everyone who left us messages on the Science Friday Box Pop app, and I'm sorry we can't get to all of you. Joining me today to talk about burnout in the healthcare industry are two physicians, Dr. Stephen McDonald, an assistant professor of emergency medicine at Columbia University Medical Center in New York, and Dr. Callie Cyrus, a psychiatrist and assistant professor at Johns Hopkins Medicine in Washington, D.C. Welcome both of you to Science Friday. Thank you for having me. Thanks for having me. Just a quick note, there is some discussion of suicide in this conversation. Let me start asking you both this question, and I'll let Dr. Cyrus answer first. Let me start

with the question I don't usually ask my guests on Mike, and that is, how are you feeling? Well, you asked me a question at an interesting time, you know, amidst all of the joy. Floyd protests and I'm here in D.C. and seeing patients not only on a telosyct platform, but I see patients in the community. And I actually found myself, you know, feeling as a psychiatrist I can name my feelings, a little depressed yesterday. It was pretty hard to get out of bed. I think everything finally caught up to me. So this conversation is quite timely. Yeah. Well, do you feel the same way, Dr. McDonald? You know, as you were speaking and I was reflecting on my own feelings, I'm not a psychiatrist.

so I have sometimes to search for the words that I need. But I'm actually feeling quite energized this week. I think as a black physician in America at this moment, having seen COVID, now thinking about protests, I'm energized on the fact that my voice is sort of mattering for the first time in a while. And I'm feeling like I want to speak loud and bring a voice to these concerns. Well, that's what we hope to do today. And you, Dr. Cyrus, you did say you're feeling.

a bit of burnout, what does burnout look and feel like? Yeah, so burnout for me actually looks a lot like I think what folks consider the definition of burnout is sort of an exhaustion. It feels like the rewards don't compare to the amount of effort that's required to do your job. And it's usually in the context of job. And so you feel kind of strain, you feel a little tired, and it's just, it's really hard to do the things that you would normally be able to do. I see. I see. Stephen, You're an ER doctor, and as I mentioned earlier, there's a mental health crisis among health care workers, the obvious doubling of suicide rate among doctors. I'm wondering, based on your experience, why do you think this might be? Sure.

There's a lot of causes to that elevated suicide rate, I think, among physicians. Unfortunately, I think it's something that we sort of just accept as a society. Like, doctors have a higher rate of suicide, so it goes. and there aren't many institutional reforms in place to correct that. And the things that make for this are manifold. I would say one, at least in the emergency room, where we have notoriously high rates of burnout and also increased rates of suicide,

there's really no control over your schedule. You really have no autonomy. And so to be always beholden to the demands of the sick people coming through the door does not allow you to really tend to any of your own emotional wounds. And so, you know, those can sometimes linger and be variably deep and can cause real trauma and have real psychiatric consequences down the line. And then at the same time, I think there's sort of a lack of, or a mismatch maybe, is the way to say it, between the expectation of becoming a physician

and the actuality of being a physician. And so a lot of us entered this field hoping to elevate other people and improve their lives and to cure disease. And what you find when you actually become an attending physician, you reach the end of your training, is that there's a system that is so stacked against your success that it becomes very difficult, if not impossible, to make the kind of change that you thought you would be making.

And so when you bring that all together in people who maybe already are predisposed to mental illness or not even, then you can get outcomes such as anxiety, depression, and worst case suicide. And then you throw in all the pressures we have now. Right. So then you add COVID on top of that. You add the challenges of being a black physician on top of that and you get even worse outcomes would be what I would imagine. A study came out recently that looked at the mental health toll of COVID-19 on young doctors in China. And they found even in cities that were far from Wuhan, doctors had a sharp drop in mood and a rise in depressive.

and anxiety. Do you think if someone came in and studied you and your peers, they'd find similar outcomes? I mean, absolutely. I don't know if you were made aware of this, but I actually work at the hospital where one of my colleagues committed suicide in part due to the COVID pandemic. Sorry to hear that. And, you know, so that's that on its own is a clear indicator that this was an unprecedented tax on our emotional health in the emergency department. Callie, as a psychiatrist, you're in a position where you're hearing about people's trauma and mental health problems all the time. Does that take a toll on people in your profession? Oh, definitely. I think it relates back to the numbers that Dr. McDonald was discussing about

high suicide rates and physicians. I mean, so there's compassion fatigue. There's also, you know, the caregiver stress of re-experiencing other people's trauma. And with psychiatrists, we tend to have lower rates of, I think, suicide when compared with other rates of physicians, I think some of that just has to do with our lifestyle, tends to be a bit more flexible in schedule. But having to experience other people's trauma, even though you kind of, you find a way around it, you know, we choose to go into psychiatry for our own reasons. I can separate and compartmentalize my trauma and what I'm going to do.

compare it with that in my patients. But it's definitely stressful, you know, hearing the stories of, you know, even when I'm seeing other medical professionals as their psychiatrist of hearing their stories about what's happening in the hospital as it pertains to COVID or the stress of their own jobs, especially as it pertains to seeing black mental health professionals or professionals in general who are talking about some of the stress that has to do with the politics of their medical community. So I think it's probably the worst when you find yourself identifying with the client and you feel like you have some sort of experience, personal experience that also relates to the trauma that they're experiencing. And you start to kind of compare what your experience is compared to

theirs. And I think that that's probably when it's at is worse. Well, that's what that's what's, this was my next question. Do you have to go for therapy because you're giving out therapy to other people? Yeah, yeah. And I, so I will say, I'll use this as an opportunity to kind of, um, poo poo on medical training. You know, as psychiatrists, it's actually not required that we're in therapy, but for psychologists, they're required to be in therapy. And so I've been in my own therapy for years. I happen to be pretty neurotic and pretty open about how neurotic I am. But it's not necessarily a requirement, but I find that it's essential. And a lot of people learn how to be better therapist by being in their own therapy. Well, let me follow up on that. Stephen, how do you cope with it? Are you in

therapy? How do you, how do you see counseling for all the work that you're doing? Absolutely. So when I was actually in medical school, I lost my mother and in residency, I lost my father. And so both of those events actually had kicked me into therapy. So I've been in therapy now for several years and have found it to be a really helpful outlet for managing my own burnout at various points in the hospital and as an emergency physician. I want to move on about talking about a little bit more of your feelings, Scott, I'm talking to a psychiatrist about her feelings. Because, you know, the world isn't just dealing with the COVID right now. You've both been active in advocacy and the protests that have been going on for racial justice. I would imagine this is a lot of emotional work. How do you

navigate that when you're already feeling burnt out? Callie, you can tell us first. Yeah. So for me, I, you know, I've described my experience of feeling burnt out in the past couple days, but I actually feel like, you know, the past couple weeks, I felt quite energized by everything. For the first time, one, folks are really trying to get the voices of black physicians. And so I find that, and this is a positive defense mechanism. So this is, if you get back to, you know, Freud and what we do when we're feeling anxious or depressed, I typically will channel my anxiety into. being productive. And so I ended up making, you know, a couple videos that went viral. I ended up, you know, doing some writing. I felt like I was probably the most active in terms of advocacy that I've been in a while. But I think this is just a show of how emotions really catch up to you because at some point, you know, if you're not, you can't be like that the entire time. And so I think the sadness is now hitting me. But I, for me, the advocacy is a way that helps me sort of channel my as a black physician, feeling like, you know, I have a lot more means than a lot of my clients

and have a voice that people will respect by virtue of just sort of the position that I'm in. And I found that it's been incredibly reassuring and sort of fulfilling is actually, I think, how it's been for me. I'm not sure how it's been for you, Stephen. If I could copy and paste everything you just said into my voice, I think I would do that. You know, I think around the time that coronavirus started becoming a headline and became a real problem for New York City hospitals, I began to actually do some writing and do a little advocacy around physicians. And I was advocating for things that I felt I needed to do my job well. And that actually gave me a sense of purpose and feeling energized and gave me something bigger than. the patient in front of me to focus on, which was sort of essential to my going to work every day.

Like, I needed to feel like in the face of so much government failure and so much failure of leadership, that I was able to combat that as well, not just the individual patient afflicted with a virus. And it's now panning out to be somewhat the same thing in the case of these protests. Like, I want to be doing more than addressing the individual patient in front of me. And so, like you said, channeling my privilege and this platform that I suddenly have to stand on and writing about that. And I actually wrote something in the New York Times this last weekend about the importance of protests as sort of the medicine for both coronavirus and for police brutality and injustice and law enforcement. Let me pursue that a little bit further because I want to ask you if you think there is racism within the health care system that could contribute to physicians of color burning out. I mean, so the answer to that is, of course, in my perspective.

I mean, it's at every level. It's too much to go through all of it in this time. But I think one sort of instructive example, I had a patient probably six months ago who I treated for back pain. He refused to leave the emergency room. And so then security was escalated. and he then refused to leave with security. And so what ended up happening to this gentleman, who's a young black man,

is that he was arrested on the spot for trespassing and was taken away. I then recently, this was now two days after the murder of George Floyd, had two white women come into the emergency room for back pain. They had me, the same doctor. I treated their back pain in the same way. I treated that of the young man. And these women then also,

refused to leave the emergency room. Security was then activated. They then refused to leave with security. And instead of being arrested on the spot for trespassing, both were allowed to file complaints against me and the care I provided with them. And one used particularly nasty, devastating, racist language to discredit any authority I had as a physician and to basically say that I had not treated her appropriately. And so that is on the most granular level, I think, how race operates, like the two patients coming in for the same things and how they were treated completely differently. I'm Ira Plato, and this is Science Friday from WNYC Studios. Last question, because we're running out of time. I want to ask both of you, are there steps that could be taken

that you think would help alleviate burnout for doctors and health care workers, particularly those of color? Who wants to answer that first? I'll go. I'll go. I do think there are steps. And this is talking as someone who has sort of left academia because of feeling burnt out. And I have, you know, one foot in and one foot out for that reason. And so I think the first step is actually hiring faculty of color or of the minority identities. So as a black queer person, I not only, you know, I checked two boxes, found myself sort of torn between going to all the LGBTQI events, starting the LGBTI clubs, also having to be there as a black physician to the minority trainees and not just in my department, but across departments in the entire university. So I think that one, just

actually putting your money where your mouth is in terms of academic institutions and academic medical centers and hospitals and just hiring more faculty of color and from diverse backgrounds just helps on the ground. Stephen, what would your response be? The one thing I would add is that I also need to feel protected in my workplace. I have to say specifically after the 2016 election, there was a really palpable uptick in racist, hateful, homophobic language towards my colleagues and towards myself. And so, you know, in the emergency department, we operate under the obligation to assess, stabilize, and treat anyone who comes through the doors, regardless of creed, ability to pay, color, sex, et cetera. But at the same time, I also need to feel protected at work. And so I

I need to know that my department has my back and that we can find a middle ground where we're able to really treat the people who need treatment, but at the same time where we're able to expel people who are stable to leave but are also bringing in that kind of inflammatory and hateful language. That's all the time we have today. I'd like to thank my guests, Dr. Stephen McDonald, assistant professor of emergency medicine at Columbia University Medical Center in New York, Dr. Callie Cyrus, a psychiatrist and assistant professor at Johns Hopkins Medicine in Washington, D.C. Thank you. Thanks for having us.

We're going to take a break. And when we come back, about 25 percent of doctors are born abroad. We're going to talk to a few of these international doctors on the front lines to get their perspectives on the pandemic. This is Science Friday. I'm Ira Flato, as the pandemic was ramping up in March. New York Governor's Andrew Como and California Gavin Newson put out a call for medical professionals to come to their states to help with the crisis. As it turns out, many of those on the front lines aren't just from out of state, but out of country, international doctors. Up to a quarter of working

doctors in the U.S. have come from abroad. What is the role of international doctors on the U.S. medical system? And how have they been affected during the pandemic? Here to fill in that story is Max Blow. He's a health care journalist based out of Atlanta. Thanks, Max. Hi, welcome to Science Friday. Thanks for having me, Ira. How important a role do foreign-born doctors play in the U.S. Medical Force? They play a vital role, especially in areas that have shortages of doctors, which tend to be rural areas. In the state I live, Georgia, most of the state is defined as a rural area. Many of those counties are classified as medically underserved, either across all specialties or in some specialties. And in many of the places where no other doctors willing to go, it is foreign-born

doctors and foreign-trained doctors who fill in the gaps of America's health care system. Tell us about the pathways that doctors use to come to the U.S. and practice medicine. It's a complicated one that is often made more difficult by the red tape. that exists when a doctor who has trained in another country and work there as a doctor, needs to come over to the U.S. One example of a doctor who I have written about in the past is Dr. Bersengi, who was a Iraqi cardiologist who fled in the 90s from the Saddam Hussein regime and came over to the U.S. In many countries, the medical education you have there does not translate to the medical

education requirements in the U.S. So he had to start his whole medical education over taking classes and doing residency. Typically when you finish medical school, you can either go back to your home country or you can get a visa to practice in a medically underserved area. And he ultimately ended up in rural West Virginia, even to this day now that he's worked his way back to being a cardiologist, part of his practice is still driving. 90 minutes every day to and from a tiny rural town called Elkins where he's the only cardiologist in that area. And so you have the situation where ultimately these doctors who have been

extremely resilient by way of going back through the entire medical education process, ultimately end up in places that no other doctor wants to go. And they are the only foreign doctor or person, some of these communities have seen. just given the demographics of who often live in rural areas in this country. The Trump administration has put travel restrictions and immigration policies affecting all people coming into the country. How have those policies affected doctors? With every new class of medical students and medical residents that come in, those international

doctors rely on what's known as a J1 visa to work in the United States. Over the past several years, restrictions have at times threatened the possibility of those doctors being allowed into the U.S. This year is probably the biggest threat in that regard in the sense that process, both with the Trump administration's continued shutdown or restrictions of immigration, of processing visas and things like that, along with the coronavirus pandemic. Those two things together come later this year when those residents are supposed to be filling a position at a teaching hospital, that's going to mean that as many as 4200 slots will either go unfilled or may have some other alternative person who may not be as qualified in those

slots. So it's definitely going to impact teaching hospitals that rely on residents, and particularly foreign-born or foreign-trained residents to fill in the gaps of health care. Well, Max, thanks for filling us in on that. Thanks for having me. Max Blau is a health care journalist based out of Atlanta. Now I want to bring on two of these doctors to get their perspective on what it has been like to work on the front lines during the pandemic. They're here to speak about their own personal experiences and not on behalf of their organizations. Let me welcome first. Dr. Muhammad John Zab Anvar is a postgraduate resident at the Montefioree Medical Center, Wakefield campus in the Bronx in New York. Welcome to Science Friday.

Thank you. And Dr. Quinn Lohie just graduated from residency. training in Lincoln Hospital in the South Bronx. Congratulations. Thank you. And thank you for having me. Oh, you're quite welcome. Let me begin with you, Dr. Loheed. You both were working in the Bronx, and we know that's an area that had among the highest number of cases and deaths. Give us an idea what that has been like. So I would say it's been, it was crazy. It was a crazy experience. I don't know if that's like a good radio word, but it was like being in a war zone. So it was during the peak of the pandemic, you would go to work. And I would say like every half an hour, if you're like in the ER or in the ICU, every half an hour, you would get a

new admission of somebody that was critically ill that you had to intubate almost immediately. And overhead, there was just constant overheading at least every half an hour, every hour, anesthesia for intubation to 9 bravo, anesthesia for intubation to 6B, 1-2-6 code. So a code like cardiac arrest, like 1 to 6B, 1 to 6B, 1 to 6Code to 5B, just every half an hour. So if you can just imagine like those sounds going off every half an hour, the sound of vents going off just like vents alarming, like catastrophes happening, patients rolling in who critically ill, like it was like the Wild West. It was wild.

I'm sure you must agree, Dr. Anvar. Yes. When we started in March, it was just the beginning of the pandemic. I would say that I was the part of the first COVID team that my hospital made. I was working in a clinic, but they pulled me from the clinic to work at the COVID team. Being first in the COVID, being exposed to the COVID patients as the first one, the first responders in the hospital. I think I agree with Lowy that it was like rapid response, we call rapid response every 30 minutes,

code CSE, patients crashing. I have never seen in my life, my life, like I have been practicing for six, seven years. but their doctors over here who have been working for 30 to 40 years, and they were saying that they haven't seen anything like that. They haven't seen anything like that. Dr. Loheed, what do you think is the biggest medical need right now in the communities you are working in during the pandemic? That's a tough question.

I would say it's a very multifactory. The answer is multifactorial. Right now, the pandemic has kind of a beat. a bit and now we have some cases that are starting to trickle in because of decreased in social isolation. So I would say at the beginning of the pandemic, the things that we needed the most, and if we do have a spike again and what we will need again is going to be our traveling nurses have gone home.

So it's going to be support stuff again. Traveling nurses, respiratory therapists, IV pumps, IV machines, supplies to put into patients, medications. We were short all of those. And if we do get a peek again, it will happen. But I will say that in addition to those things, one of the things that's most needed in the Bronx actually support services for patients that leave the hospital. So one of our biggest difficulties in making sure that our patient population, so just a side note, our patient population in the South Bronx is the poorest congressional district in the United States. And so one of the things that our patients need desperately to keep healthy once they leave is social services.

is. And so we don't have enough social workers, enough social supports for patients once they leave the hospital. And so they tend to fall through the cracks. So they may get discharged, but say they need antibiotics or they need something else to go home, their insurance may not cover it or they may not have proper insurance to get the medication or they may need at home nursing care and they won't be able to get that. And so it's kind of like a crack in the system where we try our best, but then once we need to get you, out of the hospital, we don't have the things that you need outside of the hospital. And I think that's really important. And we've been hearing a lot about that, that the lack of resources in these communities, once they leave, Dr. Anwar, do you see the same thing? Yes, I would like to add that in the hospital, when we're managing these patients of COVID-19, they're getting proper antibiotics, they're getting proper nutrition. But when they leave the hospital, the question arise of their nutrition, their diet,

how it can be healthy, how their lifestyle can be handy, so that they can recover quickly and get back to their normal routine. And hopefully they cannot contract in future or they have not developed the complications of COVID-19. So the resources, their social economic status, how we can improve their healthy lifestyle, and so that they can follow with their proper primary care. A lot of our patients doesn't even have a primary care

because they don't have insurance. So they can follow with the primary care for their medicines, their refills for their nutrition, for their social support. So after leaving the hospital, the fall of the primary care, that has to be very important. And with this COVID-19 pandemic still there, it's really hard to get a proper follow-off for these patients. Let's talk about your individual journeys as international doctors getting to the Bronx. Dr. Let me, Dr. Anvar, let me begin with you first. What was it like? What did it take for you to get here and train in the U.S.?

It's a very long journey. I started, when I complete my med school in Pakistan, I realized that I have to go to US to do a residency. It's a long way to come here. We have to take three exams, USMLE exams that are very expensive. And when you convert the currency foreign exchange is so different. The US dollars compared to Pakistan, Europe is very different. So it's a lot of money that you have to invest coming here, a lot of resources. And then when you come here, that you apply for residency, you do volunteer work, you build up your resume.

It takes at least three to four years of hard work to get into what we all international medical graduates are in here. And then it's not just getting into residency. It's the whole lifestyle change from your own community. You're coming from Pakistan. You come from India. You come from Caribbean. It's the whole changing culture. And you adapt this culture being aware from your family.

members and the residency is very, very tough. It's hours and hours of work, intense work, not just physical, mental, but also emotional work. And you're away from your family, your friends, you just migrated to somewhere else, and you're getting into a system that's totally new. So it takes a lot of time, effort to just get into the residency. And then the whole residency year, three years is a whole lot of, what I can say is difficult times, that all of international medical graduate phase. I'm Ira Flato, and this is Science Friday from WNYC Studios. And Dr. Lohie, did you have a similar experience or was yours different?

It's so expensive, but I would say the most stressful thing is the fact that that's your only option. So in Trinidad, in order to specialize, you have to either go to the U.S. or the U.K. to become a specialist. And we don't have specialists in Trinidad. like we have a shortage of specialists. So there's no training there. You have to come here to be specialized.

For us, it's kind of like do or die. Like if I don't get it, I spend all this money, I spend all of this emotional energy. And then you fail. It's like, it's one of the worst things ever. But to do it, it's an amazing feat. But there's also then the additional stress of everything else that comes after.

So for instance, during medical school, I was deported briefly. I did two years of my clinical rotation. in the US and then I went to Canada for one of my friends' weddings and we have paperwork from immigration that says that we are doing medical school in the United States and I was coming back through immigration and they pulled me aside. They put me in a detention room which was like a white room and they just left me there sitting for like four hours. When it became around the time where I would miss my flight and I went up to them and I had my paper letter in my hand.

You're not allowed to use your phone or electronics in this room. So I had no contact with my family or anybody I was just off the radar. I went up to the immigration officer and I told him, hey, I'm a med student. Like, why am I being kept in this room? And he just told me to go sit back down. And I was so scared by then. I was like, look, I've missed my flight. I don't know why I'm here. I started to cry. He told me you overstayed your stay in the US. And I said, I would never overstay my stay in the US. Like, I have 100% not done that. He said, you did. I have your information in front of me. And I said, well, I have my information here too, and I have never overstayed, and I would never do that because I just want to get through medical school. And he said,

well, I'm not allowing you back into the U.S. And I said, all of my stuff is in my apartment there. So what do you want me to do? And he said, now he's like, do you have enough money to book a flight back to Trinidad? And he said, I'll give you five days stamped in your passport to go to New York and pack up your apartment and leave. And so he let me out of detention. I got to another flight. I call my family. I call my school to let them know what happened. My mom flew to New York. She met me. We packed up my apartment. I went back home. We got an immigration lawyer who looked into my I-94s and stuff and he was like, he doesn't see anything wrong. I didn't do anything wrong. And my mom came back to the US and

actually stopped in immigration and asked them, well, if anything was wrong. And they said, we don't see anything on my documents that I overstayed or anything. But it is written. that he only gave you five days. So we would recommend that she stays in Trinidad for a few months until the air clears. So I did stay in Trinand for a few months. I graduated med school late. But like that is the kind of like mental trauma that we live with on a daily basis. Like every time I leave the U.S.

Am I going to have trouble getting back in? So those kind of things really affect you like mentally. Just the fact that I'm always kind of afraid. Like when they were having the ice raids, I knew that there were some Trinidadians who got picked up in that who were legal. And so I was like worried. Like those are things that are kind of just like a mental worry all the time. Yeah.

I would, my story is not that, but I would like to add some part of it because my name started is Muhammad. So I was always, always, always picked up in immigration and I was given into a primary. Then I go to a secondary. And then I go to a tertiary. And there was a time when I was in Chicago going to my immigration. And the immigration officer was very nice. He was very nice.

But he said, oh, your name is Mohamed Hanber. People usually miss my middle name, John Zaid. Oh, your name is Mohamed Anwar. There's a terrorist with similar name. Let me just check if you are the one. And I was like, okay. Yeah. You could have just run the check and not tell me that you are telling me that I'm a terrorist.

I'd probably be a terrorist. Yeah. We are here to serve the people of the United States. Yeah. It's our benefit is that we're learning, but we are serving the community of the United States. And I think being picked up as terrorists or being picked up as someone who is coming as illegal or overstaying is something that really hurts us. Yeah. I don't know what to say.

I've never heard stories quite like that. And certainly it's not something that we residents of the U.S. would ever think about, you know, when we go to another country of being hassled like that. I want to thank both of you for taking time to be with us. and wishing you all, good luck, wherever you go and whatever you're going to be working on. Thank you. Thank you very much. Thank you so much. Thank you. Dr. Muhammad Jahanzevonvar is a postgraduate resident at Montefiorei Medical Center, Wakefield Campus in the Bronx.

Dr. Quinn Loheed is just graduated from residency training at Lincoln Hospital also in the South Bronx. Charles Berkwurst is our director. Our producer is our Alexa Lim, Christy Taylor, Katie Feather, and Kathleen Davis. BJ Leatherman composed our theme music. One more thing. Our Science Friday Vox Pop app. Yes, we're heading into our fourth month of the pandemic. We want to hear what your kids and teens have been feeling or experiencing because of the pandemic.

That's on our Science Friday Vox Pop app. Have a great and safe weekend. I'm Ira Flato.