They leapfrogged around the world in search of better medical training and for the time being, treat about 900 San Juan County patients every month.
San Juan Health Partners Internal Medicine and Pulmonology Clinic employs five internal medicine doctors and two pulmonologists. Three of the doctors are from India, two of are from the Philippines and two are from Pakistan. Most of them completed their residency in the New York City area before relocating here.
"You go where the opportunity is, where they are willing to teach you and where you are willing to be taught," said Dr. Kristina Balangue, an internal medicine physician with a geriatric care specialty. "I had been to the East Coast and the Midwest, and I hate to be fatalistic or hokey about it, but maybe the next step is to go here."
After graduating from medical school in the Philippines, Balangue worked in Manila, the capital of the country. She moved to America for more advanced training, as did the rest of the internal medicine and pulmonology doctors at the clinic.
She worked at a Harlem hospital while enrolled in Columbia University and then went to Rush University Medical Center in Chicago to study geriatric medicine. She moved to Farmington last year with her fiance, Dr. Nimit Agarwal, who also is an internal medicine doctor at the clinic.
The physicians were hired through a foreign-worker exchange program that allows employers to hire foreign candidates for jobs not sought by American citizens, said Bill Noel, the CEO of San Juan Health Partners. All the physicians are in their second year working at the clinic.
The clinic's doctors originally arrived in America with a training visa to complete their residency programs.
As part of the training visas, the physicians are required to stay in the states and work in an undeserved area for three years. San Juan County badly needed internal medicine doctors to work with Medicare patients, who account for more than three-fourths of the clinic's patients, Noel said.
"Before we brought these doctors in there were some Medicare patients who were having to leave town to find a primary care doctor," Noel said. "If it wasn't for this program we would still be undeserved. Now these guys are all accepting new patients."
San Juan Health Partners also has hired pediatricians and a neurologist as part of the foreign-worker program, he said.
"We get (the doctors) for three years minimum. The good news with these guys is they have looked at getting Green Cards so they can continue practicing in the United States," Noel said. "It looks like the majority of them are seriously considering staying beyond their three years ... And we're really excited about that."
Most American-born physicians gravitate toward a sub-specialty in internal medicine because it can be more profitable to treat specific conditions, Noel said.
"A lot of specialization in medicine has occurred, so we're missing some of the generalists," Noel said.
Internal medicine doctors are the primary care doctors for adults and elderly people. They see well and sick patients, and often must balance treating several conditions at a time.
The doctors think of the themselves as medical detectives and often clump together in the clinic's hallways to discuss a patient's possible treatment, said Dr. Saqib Sheikh, an internal medicine doctor at the clinic.
"It's more inquisitive in nature," Sheikh said of internal medicine work. "It's always a detective's work in the field of medicine, but more so in internal medicine than other aspects.
"Someone comes to you and says they have been losing weight for four months ... You have 20 (diagnoses) on the table."
Sheikh is from a small farming community in central Pakistan. He graduated medical school in Lahore, Pakistan, a metropolis with 10 million people. He worked as a surgeon and house doctor for two years in the city after he graduated medical school while he studied for the exams needed to transfer his degree to America to enroll in a residency program.
He also studied at Columbia University with several of the doctors who work in the internal medicine clinic in Farmington.
It was difficult to leave countries with dire needs for health care professionals. But the desire for better training brought them across the globe, he said.
"There is no question the need will be there always," Sheikh said. "One thing that always occurred to me was: Am I doing the best I possibly could here (in Pakistan), probably not."
Sheikh helped create a website that helps Pakistani students connect with agencies and contacts who can help place the students in medical programs in America. It's his way of staying involved with Pakistani medicine.
"You can still guide people back there and still have more impact academically by creating resources here and making them available to people back home," he said. "That is a key thing for me."
Balangue agreed, saying it's common for people from her region to travel for academic experience.
"In south Asia you have an acceptance of people who migrate to receive further training," she said. "Exposure to the training here has benefited a strong contingent of Filipino doctors. And I also think my colleagues have enriched the medical discourse here."
Plus, the need for more health care professionals crosses cultures and continents, she said.
"Whether you are in a developed country or a developing country, you are dealing with a great scarcity in health care in general," she said. "That was so surprising to me, that you have that scarcity in health care wherever you are."
Ryan Boetel: firstname.lastname@example.org