1st Job
“I am excited to go in and have some say in how my clinic will be run. We know that Native Americans have a higher rheumatology burden, and I look forward to seeing how I can help, especially with complex cases,” Dr. Qaiser says.
Logistics also factored into Dr. Qaiser’s decision, and the location of the Choctaw Nation was convenient. “I am on a J-1 visa,” she says, “so I had to apply for a job that sponsors a J-1 visa waiver, which essentially cuts down on the employment options—but provides a great deal of help to underserved areas. While many visa waivers are rural, not all are far from big cities. I will be one-and-a-half hours from Dallas and two-and-a-half hours from Oklahoma City. Dallas is particularly important because my husband is doing a surgical residency there.
“The Conrad 30 waiver program, one of the programs under which J-1 international medical graduates [IMGs] apply for a waiver of the foreign residence requirement, makes it difficult for subspecialists because we are competing with primary care for those 30 spots per state. The reality is that most rural places need more primary care and so every state prefers primary care physicians. Overall, the process is onerous, and I will be advocating for changes that render the visa waiver process easier for IMGs.”
Motto Matters
The Choctaw Nation dovetails nicely with her cultural background, says Dr. Qaiser. “It is a community where family ties are close and enduring, and service to community is the norm. I initially got a sense of this when I went for the interview—everyone was warm and welcoming. Indeed, the logo of the Choctaw Nation reads: Faith, Family, Culture.”
As for what types of conditions she will encounter, Dr. Qaiser knows she will treat a lot of patients with scleroderma. “These people suffer immensely and must contend with skin and organs that tighten up,” she says. “Having had mentors who are part of the Scleroderma Research Consortium, I am confident I will be able to help these patients. Compliance can be problematic [because] patients must undergo an echocardiogram and other tests every six months. Fortunately, the Choctaw Nation has solid access to these and provides transport to patients to mitigate compliance issues.”
But sometimes, patients arrive at a later stage of their illness. “Primary care physicians sometimes attempt to help overwhelmed rheumatologists by not referring too many patients. On occasion that does not go well,” Dr. Qaiser says. “I recall a 40-year-old woman who was vomiting blood, short of breath, had swollen feet and had been trying to get a diagnosis. We did a skin biopsy because she had a small rash and, lo and behold, she had vasculitis. After several infusions, she stopped coughing up blood, her breathing improved, and she no longer required oxygen. It was a complete turnaround. … I am so grateful to be able to help her and other patients in physical and mental distress.”
