Physician reveals how US exploits J-1 visa doctors for cheap labor—resulting in doctor suicides, medical mistakes, and patient deaths.
Dr. Corina Fratila: In this completely foreign country, I came in pursuing a dream—and you’re let loose in a very high risk, intensive care unit, critical care unit, taking care of all these people being responsible for all these lives—having almost no idea what you’re doing.
Then the night ends up with this person coding, the other person coding, and you end up sticking yourself with a big-ass needle and getting who knows what? You started the shift at eight in the morning, and then you would finish the shift at four, five in the afternoon, the next day. So, that’s 24 plus 10? 34-hour shifts times three, that’s 102 plus in between, of course, you would work regular hours.
Dr. Pamela Wible: 126 hours per week.
Dr. Corina Fratila: About 126.
Dr. Pamela Wible: Were you working with mostly J-1 visas?
Dr. Corina Fratila: I’m Romanian, I had two of my best friends, one was Italian, the other one from Kosovo. People from Germany, from Lithuania, from Serbia. You come here to get training. You come here to get away from whatever political system or whatever stuff is going on at home—to pursue a dream. You come here on a J-1 visa. You end up in this residency program that throws you to the wolves in the ICU. The after you’re done with residency in order to stay and finally maybe build a family, or make a living and be a real doctor, you have to go to an underserved area for seven years where you don’t know anybody. Again, start all over and go through this purgatory in order to eventually be able to go wherever you would like to set up.
My residency program, I thought they were good to me, they were good to my friends. I think it’s just the system. The way they pull somebody out of nowhere and just throw them in the ICU. I thought that was extremely traumatic—that’s extremely irresponsible.
Eating was not at the forefront of anybody’s mind. Or sleeping. Of course, when you were on call in the ICU, you didn’t even hope to sleep. When you’re on call on the regular internal medicine floor, then you would sleep maybe for 15 minutes before a nurse would call you to tell you that patient needs an enema or a Dulcolax. You had to sleep with your beeper, you had to be . . .
Dr. Pamela Wible: Ready to jump.
Dr. Corina Fratila: Ready to jump, yes.
Dr. Pamela Wible: Do you think as a result of this working 126 hours, poor sleeping and eating, and poor supervision for some circumstances that you and others were placed in, do you think patients were harmed by medical mistakes?
Dr. Corina Fratila: How can you even think straight after even after 12 hours of nonstop work. You’ve been in a sleep-deprived state for so long. I don’t even think I know what mistakes I made. I didn’t have time to process all that. I’m sure that mistakes happened not only every day, but multiple times a day.
Dr. Pamela Wible: In the ICU?
Dr. Corina Fratila: Yeah.
Dr. Pamela Wible: Life-threatening mistakes for some people.
Dr. Corina Fratila: Absolutely.
Dr. Pamela Wible: Did you question why this was happening?
Dr. Corina Fratila: I didn’t question it. I just thought I had to survive. I just had to make it. How could I start questioning? This is what I think now—if I stopped and started questioning, I wouldn’t have been able to go on. Then I would have had to go back to my country. My parents would have asked, “Why are you back? What happened to you? Why are you changing your mind after you invested so much in this? Now you’re just giving up?” There was no way. I mean, I had to finish it. I had to start and finish, and I had to go through it. What questioning? This is the system. Who can afford to stop and question? And then, if you start questioning, what options do you have as a foreign medical graduate? “If you don’t like it, go back, okay? You don’t like it? You came here by your volition, you don’t like it? Go back. Who’s stopping you? We’re not stopping you. We have tons of other medical residents lined up. Other foreign graduates lined up to take your spot.”
I think now that if myself or one of my loved ones end up in an ICU, I would consider them dead. I mean, if they’re in such a situation that they’re that sick and they end up in an ICU with fresh residents and interns, I would just close the case. I would be, “Okay, there’s no hope of surviving here.”
Dr. Pamela Wible: How tragic for the resident to be an accomplice in poor medical care, possible death of a patient, and for patients to come to the hospital expecting that they can get good care, yet this is the norm in teaching hospitals.
Dr. Corina Fratila: Yeah, I’m pretty sure.
Dr. Pamela Wible: I know a lot of J-1 visa suicide cases, some fired from residency and deported back to their countries. In residency, people are abused. I just call it abuse and human rights violations. Do you agree? Do you think this is in the realm of human rights violations for patients and residents to be treated this way? This level of sleep deprivation?
Dr. Corina Fratila: Well . . .
Dr. Pamela Wible: Or you think I’m too harsh?
Dr. Corina Fratila: I don’t think you’re harsh at all. I’m surprised that you’re the first person to ever raise this issue. I just learned yesterday that in Japan companies start investigating human rights violations when their employees work over 60 hours a week. So I don’t see in what way working 126 hours or 80 hours a week is not a human rights violation.
Dr. Pamela Wible: That’s two to three full time jobs, right?
Dr. Corina Fratila: Yeah.
Dr. Pamela Wible: A full-time job is 40 hours a week. So 126 hours a week, you’re working equivalent of three full-time jobs in a foreign country with people on the edge of life and death. Does that seem kind of extreme or unusual to anyone listening? Or is it a revelation? Sometimes I feel like when I share this, it’s a revelation to the person who’s reflecting on it. You know like they never thought about it that way.
Dr. Corina Fratila: Yeah, so I think it’s a reflection of the health of this country. A reflection of the culture on health. If we cared (I‘m an American citizen by the way) if we cared about our health, these things wouldn’t be happening. If we cared more about health, we would ask when we have our loved ones in the ICU, in a teaching hospital, we would inquire, ”How much training did this person have? Where is the attending in charge? Where is the person who did a specialty in critical care? Where are they? Why is my father under the care of . . .”
Dr. Pamela Wible: Of a woman who just arrived here from Italy just learning English. Is there a language barrier too?
Dr. Corina Fratila: Of course, yes of course. Especially the first few months . . .
Dr. Pamela Wible: The first few months, somebody here who doesn’t even have a complete handle on English is working in the ICU . . .
Dr. Corina Fratila: Sleep deprived . . .
Dr. Pamela Wible: For equivalent of three full-time jobs, getting paid minimum wage, with American citizens who are probably the ones hooked up to the ventilator entrusting their care to these people. And hospitals allow this, condone it, and make money from it. How do you feel about that?
Dr. Corina Fratila: It’s beyond appalling. It’s like the worst nightmare that you could imagine. And how can there be any physician-patient trust? How can you build a healthy system? How can you have anybody have any trust in healthcare when when the foundation of healthcare is completely rotten? Why would we expect to be healthy? Why would we expect our patients to be healthy? Why would we expect the whole nation to be healthy? When this is the foundation of teaching doctors . . .
Dr. Pamela Wible: None of these people coming here expected to be placed in such an unfair situation, that’s quite scary.
Dr. Corina Fratila: Yeah, it’s traumatic.
Dr. Pamela Wible: So you obviously were caring for people who ended up dying on your shifts.
Dr. Corina Fratila: Sure.
Dr. Pamela Wible: Is there any help when you lose a patient? You have to tell the family. You have to deliver some bad news . . .
Dr. Corina Fratila: There was no support, there was no such thing. You’re supposed to toughen up and just move on with your day. Of course you have people dying. That’s why you’re a doctor. People will die. Right? You’re just supposed to be tough and just move on. Who cares that you’re going to have post-traumatic stress disorder for the rest of your life. That’s not the hospital’s problem. That’s going to be your life. It’s your responsibility. No?
Dr. Pamela Wible: Do you feel like you have PTSD from things that you saw?
Dr. Corina Fratila: Oh, completely. I lost my sleep 20 years ago. And it all roots back to the trauma in residency.
Dr. Pamela Wible: Which has lifelong implications for not just your mental health but probably physical health.
Dr. Corina Fratila: Absolutely. Panic attacks, anxiety, depression. I’ve never had any of these problems before. I didn’t talk about it to anybody because the stigma associated with mental health. I felt if I talked to anybody I would be considered weak and maybe I would lose my residency position.
The beginning was very hard because the phone calls, specifically. You know it’s much harder to understand somebody on the phone than it is in person. You can’t really read their lips or you can’t really read their facial expressions. So I remember the first phone call that I got. I got paged when you still used to carry those pagers. So the nurses would page you and then you saw a number you had to call the number back.
The nurse at the other end of the line, who was also a foreigner, somebody from the Philippines would tell you something in her Filipino accent, and that would go into my Romanian ear, and at the end I was too embarrassed to say I didn’t understand. I just said thank you. I hung up the phone. Once I hung up the phone, I realized I had no idea what she just said to me. I had no idea. And I had to somehow figure out what she meant to convey.
Dr. Pamela Wible: How did you do that?
Dr. Corina Fratila: I called the number back.
Dr. Pamela Wible: And . . .
Dr. Corina Fratila: And I got a different person.
Dr. Pamela Wible: With a different accent? Into your Romanian ear . . .
Dr. Corina Fratila: So that first phone call, it’s still a mystery to me. My first phone call as a medical resident, I still don’t know what the nurse wanted to tell me. So I hope that poor patient made it. The one that she was calling me about, that she didn’t die, you know? But, I mean that was my first instinct. To just pretend like I understood, say thank you, hang up and then realize it—I was lost.
Dr. Pamela Wible: Probably not the only one who’s feeling that way.
Dr. Corina Fratila: Most likely not the only one. Most likely one of the thousands.
If you are a physician struggling and need confidential help, please contact Dr. Wible here.
I worked for a long time as a pulmonologist and intensivist. I can tell you that this story aligns with my observations. Much of what happens in US ICU’s is “critical care theater”. Especially in hospitals with under-served populations and administrators who view the ICU as a “cost center”. Abusive immigration practices involving physicians and nurses to create “workplace captives” are commonplace. Forced medical repatriation of undocumented indigent patients is commonplace. Without medical enterprise liability and with physicians who absorb the blame for everything, it’s sad and inevitable.
It’s not just J1 visas who are abused
Yes, I’ve been addressing the human rights violations in medical education for years; however, foreign doctors face a unique set of stressors within medical education deserving of investigation.
This is also a problem in other countries. I am an American MD training in a wealthy European country, and I have seen a number of other foreign docs threatened with termination and/or having their visas pulled if they do not appease their employer.
I was suddenly given HR documents (last month) stating that I would have to work for up to six months making less than 20% of my normal salary, or I would be fired and lose the visas for my family. Fortunately I was able to consult with an attorney from the residents’ union and quickly determined that both the threat and the HR paperwork were completely illegal. As a result my contract and salary are remaining intact, but had I not been urged by both fellow residents and attendings to contact legal representation I might have been intimidated into sharecropper labor just to try to somehow keep myself and my family in this country, where we are integrated and building our lives.
The experience of the past month and a half has been scary and unsettling for my family, demoralizing for me, and it has beaten the ever loving shite out of my sleep schedule, such as it is/was. I feel so much empathy with these foreign physicians in the US, the whole thing makes me angry and ill at the same time. I was not considering harming myself through this experience, thank goodness, but I could see how someone could get to that point if they did not have the support elements in place that currently bless my life… it felt (and actually still feels) pretty damn dark.
“Fortunately I was able to consult with an attorney from the residents’ union and quickly determined that both the threat and the HR paperwork were completely illegal.” That’s the answer. Organize, unionize, and sue.
Oh Corina. Dr Fratila. I get it. Thank you for speaking up. Thank you for being real.
YESSSSS I agree with Lisa 100% — Courageous Corina!!
I think that the abuse of junior doctors has been going on for many years and in various countries. Practising medicine should be done while not tired, while able to concentrate and do the job properly. This is certainly a human rights issue. For patients this is far too dangerous.
I nearly killed a patient when I was a medical student. The anaesthetist asked me to do intubation and I had never done that before, nor practised on any simulation. The tube went the wrong way. Luckily the surgeon and anaesthetist realised and put it right. I had to go to see the patient after the operation and he was doing well, I was relieved to find.
I escaped from medicine as soon as I had my degree. This was in the UK and many years ago in 1979.