In 1993, Bengi Melton, M.D., a Turkish psychiatrist, had an adventure that
changed her life dramatically. She was backpacking in Europe and while in
Greece met by happenstance a fourth-generation Texan touring the world. A
romance sprang up. They decided to marry. In 1997, Melton moved to Houston and
eventually joined the ranks of the many American psychiatrists who hail from
Not all psychiatrists practicing in the United States who come from other
countries make the leap from Turkey to Texas or come because of romance, of
course. But no matter where they come from or why, they too have intriguing
stories to tell. So Psychiatric News decided to focus on the stories
of Melton and four other psychiatrists who immigrated to the United States
within the past 10 to 15 years. The other four are Vadim Baram, M.D., a St.
Louis psychiatrist who emigrated from Ukraine to the United States in 1995;
Vladimir Bokarius, M.D., Ph.D., a Los Angeles psychiatrist who emigrated from
Russia in 2001; Gonzalo Laje, M.D., a Maryland psychiatrist who emigrated from
Argentina in 1999; and Saima Shafiq, M.D., a New Jersey psychiatrist who
emigrated from Pakistan in 1994.
Although each of these psychiatrists' stories is unique, some common
threads run through them, notably a steely determination to succeed in spite
of numerous obstacles.
Before Baram left Ukraine, he had a master plan not only to do a psychiatry
residency in the United States, but also to establish himself professionally
here after residency. "I put a lot of effort into it," he said."
It took about four years for me to get through all the certification
exams and to find a residency program."
Shafiq came to this country with her husband, also a physician from
Pakistan. "We came over after medical school to finish our
specialization in different fields. I chose psychiatry for a number of
reasons. I was always interested in it. The residency has reasonable working
hours, and I had two small children at the time. And of course the job market
is very good."
Laje was training in psychiatry in Argentina when he seriously began
considering coming to the United States. "My interest was in clinical
research. At that time I was working on anxiety disorders, and I got in touch
with an American psychiatrist, Michael Lebowitz, and he was kind enough to
invite me to spend some time with him at his Columbia University anxiety
clinic. Initially my idea was not to come to the U.S. to stay; it was to go
back and set up some clinical research in Argentina. But I really liked it
here and decided that I wanted to stay."
However, simply liking the United States was not enough for a foreign-born,
newly minted physician, such as Shafiq, to adapt easily to this country or to
transform established physicians from other countries, such as Bokarius, into"
American" psychiatrists. They had to overcome daunting hurdles
beyond those faced by American medical graduates who desire to become
There was cultural shock, for example. "When you come from a country
like Pakistan, which is basically third world, and psychiatry and medical care
are not as good as in the United States, you face certain handicaps,"
There was language. When Baram came to the United States, he said, "I
was able to read English, but in regard to English comprehension and talking,
it was a challenge."
Laje found that the language unique to psychiatric intervention had to be
honed. "Although I had a pretty good English background, the subtleties
of the language in psychotherapy sometimes got in the way," he recalled."
The vocabulary, the way people said things, what they meant with the
use of certain words—that took an extra layer of thinking."
As for the U.S. Medical Licensing Examinations that graduates of foreign
medical schools, as well as graduates of U.S. medical schools, have to take to
be accepted into a psychiatry residency program, Laje did not have any problem
with them, but he knows many medical graduates from other countries who
"The exams in general do not ask strange, obscure questions,"
he said. "They are very reasonable. The issue for a foreigner is to read
them fast and to be able to answer the questions within the allotted time
An obstacle for Melton, who was already an established psychiatrist in
Turkey, was the need to repeat a psychiatry residency in the United States if
she wished to practice here. This meant once again reading basic science,
going through the routine of being an intern, and taking call, as well as
working with classmates who were fresh out of medical school and a little
younger than she was. "But I did it," she said. "I did what
I had to do."
To work as a specialist in the United States, Bokarius also had to do a
residency here. But he thought, "Why should I do a neurology residency
again? I want to broaden my horizons. What would make me a better pain
specialist?" Psychiatry, he decided, would be a good addition."
And I'm so glad that I did it, not just because I broadened my
horizons, but because I got a beautiful new specialty."
Yet even after they became licensed or board-certified U.S. psychiatrists,
Baram, Bokarius, Laje, Melton, and Shafiq encountered new obstacles (see
Collegial Advice Offered).
Some were similar to those facing U.S.-born early-career psychiatrists.
Baram was eager to establish a private practice, but found that a
psychiatry residency had done little to prepare him for the business aspects
of such a venture.
"It seems like all psychiatrists should know research, right?"
Laje asked. "But the reality is that it is a sort of specialty. You have
to learn the language; you have to learn statistics, methodology. It's a steep
learning curve. [Also] my particular research area is genetics. I had to learn
genetics. So this was an extra layer of things to learn postresidency and to
integrate with my clinical experience."
"I always wanted to combine some research, teaching, and
practice," Bokarius reported. "But it's difficult. I don't think
it's difficult just in the United States; I think it would be difficult in any
Still other challenges they faced, and are still facing, derive from being
"Currently there is a war going on in Pakistan, and most of my
patients are very interested in knowing where I'm from and what is happening
in Pakistan," said Shafiq. "So it's difficult maintaining a
boundary. I do answer their questions. But I try to be brief and come back to
the reason why they are in my office."
Even with all the career challenges they are facing, Baram, Bokarius, Laje,
Melton, and Shafiq are engaging in an array of professional activities and
thriving in their chosen subspecialties (See
International Medical Graduates Make Widespread Contributions).
Shafiq works as an adult and child psychiatrist at a
community hospital in Denville, N.J. Melton is an assistant professor of
psychiatry at Baylor College of Medicine and a staff psychiatrist at the
Veterans Administration Hospital in Houston. Baram has a private geriatric
psychiatry practice in St. Louis, is doing a little teaching at St. Louis
University, and occasionally sees patients in a community clinic. Laje is an
adult and child psychiatrist and an associate clinical investigator at the
National Institute of Mental Health (NIMH). Bokarius is an attending
psychiatrist at Cedars-Sinai Medical Center, a private Los Angeles hospital;
medical director of a small corporation involved in consultation services in
psychiatry and pain; and a licensed acupuncturist. He learned acupuncture in
Russia and uses it to treat pain patients.
Baram, Bokarius, Laje, Melton, and Shafiq are reaping rich satisfaction
from their work.
"I work at least 80 hours a week," Baram reported. "I am
running a big practice with the help of a friend.... There is plenty of work
in the field of geriatric psychiatry.... I hope to get some other
psychiatrists to join my practice."
Also, since Baram is the only Russian-speaking psychiatrist in St. Louis,
he treats numerous Russian-speaking patients and finds such work especially
gratifying, he said.
"I love psychiatry!" Shafiq exclaimed. "It is emotionally
draining, but it gives you satisfaction in seeing your patients get better,
get back into the workforce, be more productive."
"My mentor at NIMH is phenomenal. We have some results, and we have a
couple of patents. It has been extremely rewarding for me to do these cool,
state-of-the-art things," commented Laje.
"In addition to the more tangible rewards that I receive from my
work, one is to practice more Westernized psychiatry," Melton remarked."
[Also,] being from a different culture helps me understand patients
from other cultures. In Texas, we have a huge Hispanic population and large
African-American and Asian ones.... And I feel that I'm finally back to where
I started, back home in academic psychiatry—to teach and continue to
learn. This is what I really enjoy."
So, just as countless immigrants to the United States find their American
dream, so do many immigrant psychiatrists, as the stories of Baram, Bokarius,
Laje, Melton, and Shafiq reveal. ▪