So, let me get started, I think it's always good to go ahead and start sharply on time. My name is Anand Pandurangi, most of you know me, I've been tasked today with a very pleasant task of introducing formally Anthony Fernandez, Tony is what I call him, and the general program is I will be introducing him, maybe five to seven minutes thereabouts, following which there will be two others who know Tony quite well, who will share their personal perspective of him, Dr. Pratap Narayan and Dr. Sudhakar Shannoy, and then Dr. Fernandez, there you go, okay, Dr. Fernandez, well let me change that, then Dr. Thumpy, now that the award has actually arrived, so then Dr. Thumpy will award Dr. Fernandez, and after which there will be the award lecture on the topic that you see there, the cultural landscape. So, Anthony or Tony has one of the best educational education on the CV that I am now aware of, he is truly internationally trained in that he has a DPM from the National Institute in Bangalore, he has an MD from MMC in Madras or Chennai, he has a FRCP from the Royal College from his training in Wales, and he has of course the American boards in general psychiatry, following which of course he has multiple sub specializations, including in addictions, in forensics, in geriatrics and psychosomatics, is that enough? I think he wants to establish a record. It's been my pleasure to have him, I'm also from NIMHANS, I trained there, did my MD there in Bangalore, so we have the same alma mater, but it's been my pleasure to have him as my resident at the Medical College of Virginia, Virginia Commonwealth University in Richmond, and got to know him during that time and ever since we have been colleagues, at every stage as he became an assistant professor and an associate professor, and now he is a clinical professor of psychiatry, both in psychiatry as well as in neurology, for the last part of his career through the VA he worked in the Department of Neurology, and we've also done a good amount of research or scholarship together, we have published papers together on a number of different topics, we had Dr. Victor Weavig, who is now deceased, a cardiologist who turned into a psychiatrist, and so we were part of the group of people who looked at things like QTC prolongation with psychotropics, QTC prolongation especially in the methadone, patients on methadone, things of that nature, so I'm very familiar with the work Tony has done, he has as many as formal 50 publications peer-reviewed, and a huge number of other types of publications, and more than 100 presentations, including many many invited presentations, I will not belabor all of that, these are listed in his CV, he also has served in the National Guards and continues to be part of that, so he has not only provided service as a psychiatrist, but also served the country as a medical officer in the National Reserves, and has risen gradually in his ranks up there, and like I say, I have to salute him, he holds the rank of a colonel, he has been quite active in a number of community organizations as well, and has been appropriately recognized and awarded, he has more than 20-25 different types of recognitions and awards listed, and this one will be another feather in his cap, so when you know the saying goes that the best thing for a teacher or a guru is when the student excels and does better than the guru himself, and here is one example of that, I'm so proud of Tony Fernandez, he's a family friend, and when my son was going through a difficult time growing up, he was there to hold his hands and emotionally support him, which I've always appreciated, Tony, so whether you look at him from a personal perspective, personal aspects, he's one of the most pleasant guys that I can think of, always a smile on his face, always ready to go the extra yard to help people, he has certainly come through and helped me a lot in lots of different places with logistics, and professionally, he has been recognized highly by his patients, and the various departments where he has worked for his clinical skills, and as an educator by numerous residents who have gone trained under him, and as I mentioned in scholarship, and in community service, so here is a, you know, psychiatrist, well, very well rounded, I would say, so without going into any further details, his CV is quite extensive, I have it here, and many of you, of course, are very familiar with him, they are, he is your friend and colleague, I am so happy that the committee on IMG Georg Georgian award chose to recognize him this year, it was five years back that I received the award, so, you know, that makes me even prouder, and I'm going to invite now Dr. Pratap Narayan to come and say a few words about Tony from his personal perspective. Thank you, Dr. Pandurangi. Unlike Dr. Pandurangi, none of you probably knows me, because I live a life of relative professional anonymity. Tony, however, is somebody that I've known for the last 38, 38 years, that's right, and counting. I first encountered Tony when I joined residency at the National Institute of Mental Health and Neurosciences, and we happened to be on the same clinical rotation, and the fascinating thing that struck me the most about him was his immediate welcome to me, whom he didn't know at all, and we hit it off from the very first moment, and what impressed me next was his ability to lean on a door or a window and fall asleep standing, which he did on numerous occasions because he got tired easily those days. I think he still retains that ability to fall asleep, which is one of the reasons why you will see that he almost never gets bored. He's always cheerful, he's always smiling, and I believe he's now developed the ability to sleep with his eyes open. So Tony and my association, Tony's and my association has lasted numerous years across different arenas. I have moved, I moved from India to the U.S. He went from Nemance to Madras, from Madras to, I believe he went to Pondicherry in between, and then he went to the U.K., and then from the U.K. he came to the U.S. I started my residency with Dr. Pandurangi before Tony did, and Tony heard lots of good things about the program and particularly about Dr. Pandurangi. He interviewed at my program in Florida and at MCV and decided to go there, and the rest is, of course, history. As a person, Tony is extremely generous. He has always been very welcome, welcoming, and he's always willing to share both whatever resources he might have, but more of himself and his time with whoever needs it. He has been of immense assistance to a lot of people, and in our discussions his stance always is that he would like to pay it forward because people were nice to him in his professional growth. He also would have probably got another board certification had there been one in mental health humor. He has the most extensive collection of jokes, about 70 to 80 percent of which are pretty horrible, but he is extremely consumed by his own mirth, and his infectious laughter induces people to laugh with him even at the most terrible jokes. His son Matthew is here to be at this prestigious occasion, and I'm sure he will attest to that. Tony and I have been associated professionally. We have done many, many presentations both in the U.S. and in Europe. We partner on a fairly regular basis at the International Association of Law and Mental Health, and we have been to the World Psychiatric Association meetings as well. Initially, I don't believe Tony was very interested in forensic psychiatry, and I've been a forensic psychiatrist for my entire career, but sometime during the course of his stay at the VA in Richmond, I believe he started getting interested, and at this point, I believe he's more renowned as a forensic psychiatrist and a substance abuse specialist than any of his other specialty areas of expertise. He's a very enthusiastic guy. My daughter calls him the Energizer Bunny in my circle, and he is. He just goes on and on. He is somebody I've known that can manage with very little sleep, and he's always there as a solid source of support and encouragement to one and all. Everybody that knows him, both casually as well as intimately, will attest to the fact that he usually tends to be very, very giving. He's a very compassionate person. He has won numerous awards, and he's probably one of the most self-effacing people I have seen because whenever we discuss these awards, he usually makes a joke saying that, well, I guess I conned them into giving me something. I don't know that I really deserved it, but no, I'm here to tell you, you actually have deserved everything you've got and more. So having said that, I could think of no better person than Tony for being the recipient of the George Tarjan Award. He has been an immense source of strength and support for the IMG caucus of the APA, and has had the opportunity and the willingness to mentor a lot of new international medical graduates, many of whom are now earlier career psychiatrists. Rather than go into a theoretical discussion of how much he has done, I'm going to invite Dr. Sudhakar Shenoy, who is a living example of being one of the beneficiaries of Tony's big heart. Dr. Shenoy. Thank you. Hello, everybody. Good afternoon. It is such an honor to be on this stage and also in this room because I was super lucky to get mentored by four different George Tarjan Award winners. I could not have asked for a better set of mentors, and I will list them. Three of them are here in this room. First one, Dr. Anand Pandurangi. Second one, Dr. Rajesh Tampi. Third one, Dr. Machery Kesavan. And finally, Dr. Anthony Fernandez. Very quickly, my story began in 2012 and 2013 when I was coming to the APA to present a poster from Bangalore in India. Don't know anyone in the US, did not know any physician in the US. And then I happened to meet Dr. Fernandez at the Indo-American Psychiatric Association's session. And at that point, I introduced myself. I told him who I was, what I was presenting on. And then I said, I'm considering doing USMLE, but I have no idea what to do or how to go about this. So his response to me was, I was just like you. And he said, the first thing you need to know is to find a teacher or how to find a teacher. Now, I will take you around and introduce as many people as possible to you. It will be up to you to make use of those connections, how you approach them, how you go ahead and pursue whatever you want to pursue. In other words, that reminded me of what my mom would say, like, you know, I can take the horse to the water, but I can't make the horse drink the water. And I think that was exactly how I felt at that point. And he, you know, put that in my brain saying, I can show you, I can point you where to go, I can tell you this. And then I had to follow up, which I did. And I continue to do that even today. And sometimes I use that to tell my mentees and my students, like, you know, this is how you would want to approach something. So that's where my mentor-mentee relationship began with Dr. Tony Fernandez. Going on, I got into a residency program. At some point, I would call him and say, you know, I don't know what rotation or, you know, like, how am I doing in this rotation or something. And he would say, it's fine. There will be some ups and downs, you know. You just continue to push through. And I matched into Springfield in Illinois, SIU School of Medicine, and he was in Virginia. But still, you know, he continued to keep up with what he was, you know, mentoring me. And, you know, if he missed my call, he would call me later or over the weekend, and he would continue to guide me. That continued mentorship. Like, he wasn't somebody that just did that for, like, one instance or two instances and let it there, you know. He continued that relationship with me just because of his pure passion and interest to continue to teach and be a mentor. Going further, I finished child psychiatry fellowship, and, you know, I asked him about jobs. And he was there to answer my questions. And now I sometimes ask him about, you know, I'm in an early career phase, and I continue to ask him questions, and he answers. So this has been my relationship with Dr. Anthony Fernandez. One key thing I will mention is last week, actually last weekend, me and Dr. Tapan Parikh, who's taking pictures, we both were able to conduct an event for the Indo-American Psychiatric Association in Illinois, in Chicago. And both of us invited Dr. Fernandez to see if he can come and visit us. And we knew that this is happening on the weekend before APA, and he has to be here this weekend. We'll be asking him to travel a lot. And, you know, if you want to take a guess, did he show up? Yes, he did. He did. And he came. He blessed us with his presence. And he said, I like mentoring younger folks. So we offered to, you know, get the tickets. And he said, no, no. I'm just happy you guys are doing this. So he comes there, gives a great talk, and back on the plane within a day. Now, that is the kind of commitment he has for teaching and mentorship, and thankful to him. And I say that on behalf of every mentee that he has mentored, and they are across the United States, and he continues to mentor people even in other countries, because they were looking up to him during all the other training that he had done in the UK and in India and stuff. So I've seen him, you know, getting phone calls from all across the world. So given that story, I want to bring this quote that says, the mediocre teacher tells, the good teacher explains, the superior teacher demonstrates, and the great leader or great teacher inspires. And that is who he is for me. And this also exemplifies what, you know, I look for in a teacher. With that, the last thing that I will mention that what is the most important thing that you learned from Dr. Fernandez is the concept of passing it on. He will make sure to tell me every now and then that, Sudhakar, your job is not just to make use of this, but to go on to pass it on to other people when you can. It's a cycle. And I keep thinking about it, because this is part of the Indian culture, too, where we use the word guru-shishya parampara, where the teacher is teaching the student. And then later on, when it's time, the student becomes the teacher and passes on that collective knowledge. So this is something that I see in many of the George Sturgeon Award winners and teachers. Last, I will leave you with this quote, that I had the fortunate experience of training and learning psychiatry with Dr. Panduranga and Dr. Fernandez in Richmond before my residency days. So I would say this. Virginia is for lovers, right? Well, Virginia is for loving teachers. Thank you so much. So good afternoon, everyone. Thank you for being here for the George Sturgeon Award. And it's my distinct pleasure and honor to give this award plaque to Dr. Tony Fernandez. And there is no better person to receive the award. What was said here is just a small part of who Tony is. So Tony, congratulations, and I think you are truly deserving of this great honor. Thank you. I need one picture of this head. Wow. Oh, my life is flashing in front of me with all those wonderful, nice comments from my teachers and my mentees and my colleagues. It's a very special day for me, and it's my lifetime work that has gone on on the IMG caucus and for international medical graduates that's being recognized. And I feel so honored to have received it. I want to thank the APA and the George Sturgeon Award Committee. I want to thank Dr. Pandurangi for presenting all those wonderful comments about me and for Dr. Rajistambi for the award. My thanks to the IMG caucus leaders, Raman Marwaha, as well as Vishal Madan, who did outstanding work for several years along with me in the IMG caucus. I qualified as a psychiatrist in the fall of 1986, and it's been quite an exciting journey. I'm humbled by all that is happening today. There's no better honor than to be acknowledged by one's peers. I have a lot of people to thank for. First, my family. My dad, a retired emeritus professor of psychiatry who is 90 years young, and my late mom, Janaki, who passed away in 2004 at the age of 72. My three younger brothers, for all they taught me growing up. I'm grateful to my sons, Andrew and Matthew, who taught me about love, compassion, and to be a better father. Matthew, my youngest son, is here. He's a finance analyst. And Andrew, my son, couldn't make it because he's in residency training as a first-year resident. I have to thank my teachers, my mentors, my colleagues, and friends, and all of my patients. I have a long list here. And I'm not going to read that list. And I've categorized them by countries where I trained and worked and collaborated. And I'm sure I've forgotten a few names. I've listed it by alphabetical order, as you can see. My topic today is talking about navigating the cultural landscape for professional success. I have a long list of people as an international medical graduate. Much of it is observations from my own personal journey. And some of it is what I learned from my mentors and colleagues. I hope to discuss how, in my professional journey, I navigated these opportunities and challenges. I'm so happy that I have a few members that I met in other sessions earlier today, Dr. Singh, who asked some very interesting and provocative questions. And I hope he will partake in some of the discussions that we have today, because it pertains to culture, language, communications, that I'm going to focus on today's talk. Looking back, I should say that the seeds of my cultural adaptation were sowed early in life. I was born in Chennai in 1960 to a Christian father and a Hindu mother in the most culturally diverse country in the world, India. No other country has the diversity of religions, language, and culture that India has, and the rich history of welcoming, accepting, and adapting to change through centuries of invasions, conflicts, and occupation. My parents met in medical school and were from different parts of India. They spoke different languages. Some of you who live in India know about the language barriers in India. And there could not have been a starker contrast to their views on religion and culture. Yet they were able to look beyond these differences, fall in love, get married, and raise a family. The 1960s was a time when India, a young nation post-independence, was making its mark in the international world with industrialization and education. Although the country had a secular constitution that guaranteed civil rights and liberties to individuals, religious and cultural differences ran deep. It was against this background that I had to navigate my way through high school and college. And everyone knows middle school, high school is the most challenging part of life. I must give my parents the credit for exposing me to both cultures and helping my brothers and I overcome some of these challenges at critical points in our lives. My cultural adaptation, therefore, began early in childhood. I was educated in a Christian school where the majority of my classmates were Hindus. My medical education was a college where we both had international medical graduates and students from every corner of India. So when I became a physician, it was no surprise that I gravitated to psychiatry, the specialty which gave me a unique understanding of motivation and culture that impacted illness behavior. So I have no conflicts of interest in this presentation. I'm going to define who an international medical graduate is, just to set the stage for the discussion for today and talk about all the challenges that one has to face as an international medical graduate. One of the consequences of, and I'm going to go through the cultural adaptation stages and discuss the factors influencing cultural adaptation and how to navigate the cultural landscape and APA's role in facilitating the integration of IMGs. One of the consequences of globalization is the changing landscape of international higher education. Over the past two decades, there have been a major increase in the number of international students from 1.9 million in 1997 to about 6.1 million in 2019. And then we know the COVID epidemic hits. There were some changes there. Even students who are motivated to develop intercultural competence by studying abroad face several challenges that prevent them from benefiting fully from that experience. Examples of these challenges include language and communication difficulties, cultural and educational obstacles affecting their adaptation, socialization, and learning experiences, psychological distress, social isolation, immigration, and of course, there's visa problems that international medical graduates coming to the United States have to deal with. So who is this IMG? IMG, for the purposes of the American medical system, is a physician who received his basic medical degree of qualification from the medical school located outside of the United States and Canada. So if you're a US or a Canadian medical graduate, you are not an IMG. The location of the medical school and not the citizenship determines whether the graduate is an IMG. US citizens who graduated from medical schools outside of the United States and Canada are also considered IMG. Non-US citizens who graduated from medical schools in the United States and Canada are not considered IMG. They are US medical graduates. So let's focus on the IMG who comes to the US. This slide shows the specialties pursued by IMGs. The majority of them seek internal medicine. 10% of them are pediatrics, 7% family medicine, 6% neurology, 6% surgery, and 19% all other specialties, including psychiatry. So where is psychiatry here? 3%. So where are they coming from? The IMGs are coming from all over the world. And this slide talks about them coming mainly from Canada, followed by India and Pakistan, and then by countries in the Middle East. And this is the data from the ECF-MG database. Now let's move to the NRMP. The National Residency Matching Program is a private not-for-profit established in 1952. And this was to optimize the rank audit choice of applicants and program directors for clinical training in the US. The NRMP is not an application processing service. Rather, it provides an impartial, within quotes, an impartial venue for matching applicants and programs preferences to each other using an internationally recognized mathematical algorithm. And Dr. Singh alluded earlier today it's a very difficult process for IMGs to navigate this NRMP algorithm-based process. The first residency matching program, 1952, 10,000 internship positions were available only for 6,000 graduating US medical seniors. And we are looking at today's data. Shows the exponential growth, 19th consecutive annual increase, and the discrepancy between the total number of applicants and the positions. So we have 39,205 positions and about 47,675 registrants. So you can understand the enormous challenge for the IMG. So this talks about the 2022 most recent active applicants residency match. A total of 42,549 active applicants participated. Non-US citizen students and graduates of IMG schools constituted 18.5% of all applicants in the match. The second largest group after US MD medical school seniors. US citizen graduates of IMG, graduate IMGs, accounted for 11.9% of the applicant pool. Of the 5,048 US IMGs who submitted rank order list programs, 3,099 matched at a match rate of 61.4%. Out of 7,865 non-US citizen IMGs, the match rate was 58.1%. So this table provides, I've just marked the column and the row for psychiatry. And it provides a summary of the total number of applicants and positions for selected specialties. A total of 2,560 applicants preferred psychiatry or rank that program first, among whom 390 were US IMGs and 281 were non-US IMGs. 128 non-US IMGs matched and 212 US IMGs matched. And the psychiatry positions were 1.25 applicants who preferred the specialty. And this is another way of looking at these dates. You know, in our MP program, we have a number of applicants who, you know, in our MP database, gives a tremendous amount of statistics. And it's very difficult to separate how much of it is US IMGs and non-US IMGs, but they try to do their best. And this chart shows the percentages of US IMGs and non-US IMGs who matched to their preferred specialty. Overall, 54.8% of US IMGs matched. And as I stated earlier, 53.5% of non-US IMGs matched. The match rates were almost equal for US IMGs and non-US IMGs for psychiatry. Let's look at the summary statistics and the trend data for different applicant groups as shown in the figure above. So you see the seniors of US medical schools, the match rate is 92.9%, and has always remained in that 92% to 95% range. The seniors of US DO schools, pretty much the same at 91.3%. But for foreign-trained doctors, it is 59.4%. Let's look at the summary statistics of the US MLE Step 1 and 2 scores. On average, the non-US IMGs, international medical graduates, have to score...are scoring about 9 to 10 points higher in both Step 1 and Step 2. So we are talking about IMGs working harder, scoring higher marks, IMGs working harder, scoring higher marks, and applying for these specialties. So where are these IMGs looking for residency position? What kind of programs are they looking for? The top five list psychiatry as the top five for US IMGs, but not for the non-US IMGs. Of course, the training in India and in foreign countries is more towards, you know, internal medicine. So we see a whole lot of applicants from international medical schools applying for categorical positions in internal medicine and paediatrics. So once they graduate, these guys are working. 30% of practising physicians in the US are IMGs. 27% of practising psychiatrists are IMGs. And a third of the psychiatry residents in the US are international medical graduates. So now I've given you a sample of the enormity of the problem the IMG faces to come to this country, qualify in these exams, and then apply for residency positions and areas where they focus their work on. So I'm going to move to the second part of the presentation about this cultural adaptation of the IMG. I'm sure you're familiar with this slide, which talks about the several stages of cultural adaptation. It's been a very popular topic for many, many years, especially in the culture arena of psychiatry. And we talk about the honeymoon phase where immigrants are excited and enthusiastic about their new environment, focus on the positive aspects of their new culture, feeling a sense of adventure and exploration. Moving on to the culture shock stage, which involves a range of emotions, including confusion, frustration, homesickness, and even depression. A stage of adjustment, and they begin to develop a sense of belonging and start to feel more at home in their new environment. And the final stage of cultural adaptation, or the mastery stage, and not everybody reaches this stage, they fully embrace this new culture. Navigate with ease, feel confident and comfortable in their new environment. And these are the stages. It doesn't mean that you progress from one stage to the other. Oftentimes, you just move between these stages, depending on the kind of challenges and opportunities that you face. So why am I discussing this language and communication? Because this is a very important area in culture. Cross-cultural adaptation theories and empirical research confirm the critical importance of foreign language and communication skills and transitioning to the host culture for a successful academic and social life. Improving our understanding of the role of foreign language, proficiency in communication, and students' adaptation is important, as the number of international students in higher education worldwide is on the rise. The increase has been accompanied by a growing number of publications on this topic over the last decade. Previous reviews of the literature have identified foreign language proficiency and communication as predictors of students' adaptation and well-being in various countries. It's not only in the US. Here are some of the concepts related to language and communication. Culture is a socially constructed reality in which language and social practices interact to construct meanings. In the social constructionist perspective, language is viewed as a form of social action. Intertwined with culture, it allows individuals to communicate their knowledge, as well as their assumptions about the world, the opinions and viewpoints they share with other people. In this sense, people identify themselves and others through the use of language, which allows them to communicate with their social and cultural identity. Intercultural communication refers to the process of constructing shared meaning among individuals with diverse cultural backgrounds. Based on the research traditions in the language and communication in the student adaptation research area, we view foreign or second language proficiency, the skill of allowing an individual to manage communication interactions in a second language successfully, as complementary to communication. I'm not going to discuss this in greater detail, but these are some of the theoretical underpinnings of language and communication. We have these five theoretical constructs. The Sojourner Adjustment Framework, which talks about maintaining interactions with host nationals, contributing to one's adaptation and facilitating cultural learning. The cultural learning approach to acculturation, where learning culture-specific skills results in fewer difficulties for the individual. Acculturation theory, which talks about assimilation, integration being more important than separation and marginalization in cultural adaptation. The Anxiety Uncertainty Management Theory is the ability to communicate effectively helps ease one's anxiety. And of course, we have the integrative theory of communication that posits that people's adaptation is reflected in their functional fitness and how to internalize the host cultural meanings and communication. So how does one go about cross-cultural adaptation? The term adaptation is used interchangeably with acculturation, adjustment, assimilation, integration. Understood as a state, cultural adaptation refers to the degree to which people fit into a new cultural environment, which is reflected in their psychological and emotional response. In process terms, adaptation is a process of responding to the new environment and developing the ability to function in it. The literature on language and communication student adaptation distinguishes three different types, psychological adaptation, sociocultural adaptation, and academic adaptation. The psychological well-being reflected in their relationship satisfaction with relationships. Sociocultural adaptation is the ability to fit into the interactive aspects of the new cultural environment. And finally, academic, referring to the ability to function in the new academic environment. And I can give you many examples of how these academic environment varies significantly from back home in India, where I come from, and in this country. I'll just bring a non-medical example here. But a friend of mine, a psychiatrist now, came into this country to pursue a philosophical education. And he joined a master's in theology at a university in Florida. So he's a very bright fellow. And he just calls me one day and says, I'm very disappointed with this university. I'm planning on leaving. I said, what happened? He said, I didn't like what the teacher was teaching. And I challenged the professor to a debate, public debate. He said, man, you don't do those kinds of things. So these are the kind of, I'm giving an extreme example. But academic adjustment is very different in this country. And there are ways of going about it. So how does one ease into this cultural adaptation? It is important to note that the process of cultural adaptation can be different for everyone and may take different amounts of time for different individuals. Some people may find it easier to adapt, while others may find it more challenging. Factors that may influence the ease of cultural adaptation include the level of similarity between the home culture and the new culture, the level of support available from family and friends, and the individual's own personality and coping skills. So I've listed a couple of points on the slide. And of course, we'll be talking more about this during our discussion. And when I first joined residency program, my director of residency education is very involved in the residency program, very involved in facilitating cultural adaptation. And we had a 50-50 mix with 50% American graduates, about 50% foreign medical graduates. And the divide was always problematic. On-call schedules were problematic. And people were not flexible enough to cover for each other. So he had started a cross-cultural experiential group where we could discuss some of these issues to understand each other's cultures. And I remember the first thing he told me was, told us was, you need to listen to the radio. It sounded like a crazy suggestion at that time. And he went on to expand it. You have a half an hour drive to work every day. Just listen to the NPR. The NPR will cover a range of topics. And you will get to understand the American culture there. I started listening. And I certainly benefited from that advice because I realized it was a fabulous NPR. I'm talking about the 1990s. Nobody listens to NPR anymore. I don't think we even have an NPR. It's all been divided up into states. So I put that listen to the radio as a second point because right now, Facebook, Instagram, and LinkedIn have taken over. And young people like Sudhakar are adept at navigating the way through the social media platforms. But that's the future. And Dr. Rao was another one of those leaders in international medical graduates. And she's an early career psychiatry rep. And it's an honor to have you here as part of the presentation, ma'am. So watching TV to stay current with what's happening, feeling the pulse of the nation, these are areas that you have to get into to get better understanding about what's happening in the US, what's happening in the US around you. Travel within the US. That opens up your eyes. California is different from Virginia, is different from the Midwest. And you have to travel to learn. That's the best way to open your horizons. Engage in sports and activities. Go to a baseball game. Baseball is America's favorite pastime. And you have to know about baseball. I know with cricket, you can't understand baseball. But you have to make an attempt. At least you can understand the home run. So watch movies. There are so many movies with a psychiatric theme that helps you understand psychiatry, about the culture of the doctor-patient relationship, which is different here. And of course, learn from your children. I've learned most from my children, bringing them up in this country and facing the challenges of parenthood. And navigating their teenage years is certainly a wonderful opportunity if you learn about this culture. Support from friends, family, and community resources can be important to help you navigate this process of cultural adaptation. Joining clubs, organizations, and community groups that align with your interests can also be a way to connect with others. Join the APA. And not only join the APA, stay in the APA. I joined 1994. And I get a lot of it, a lot of what I need from the APA. Mentorship, professional advice. It's not only about my CAB and my malpractice insurance. You get a lot more. And you have to be engaged. In order to be an agent of change, you've got to be part of this organization. Here in the last couple of slides, I'm going to talk about APA and the opportunities that are available here. This is the best place to find mentors. Sudhakar would never have found a mentor if he hadn't come to the APA, met so many people, and established those connections. And so that's a fantastic opportunity to come and meet people, participate in educational activities, participate in research, present in grand rounds locally at a university and case conferences, present at regional and national meetings. And there are so many meetings that you could attend, depending on your subspecialties and area of interest. Publish in peer-reviewed journals. And if you don't know how to publish, find a mentor who will get you there. Rajesh Tampi has mentored so many young residents. Every year at the APA, he's got about five or six presentations going on at the same time. And I'm so honored that you're here, Rajesh. And he has included me in a couple of those workshops that we've had. And those are the kind of things that can happen only at the APA. And I'm going to talk about Dr. Kamalika Roy's area of APA and advocacy. And she has done a tremendous amount of work in this area and has been a very vocal advocate for IMGs, pursuing so many different areas. So you can do this at the state level, at the state level. The legislative section of state societies has an advocacy group. And that's part of the larger national group. And you attend the advocacy opportunities at APA meetings every year. We have several of those sessions. Attend the APA Federal State Advocacy Conferences. The next one is in October 15 to the 17th in Washington, DC. And as a result of advocacy of APA, in December 2022, Congress passed the Consolidated Appropriations Act of 2023, which gave significant funding for critical mental health and substance abuse programs. Support for APA legislative priorities include 100 more psychiatry match slots by 2026. 100 more is not going to solve the problem, but it's a step in the right direction. So in conclusion, cultural adaptation is a complex and multifaceted process that involves adjusting to a new culture and a way of life. It can be challenging for immigrant doctors, but it's also an opportunity to have personal growth and development. Understanding it and seeking out support from friends, family, professional, and community resources can help IMGs navigate this process and find a sense of belonging in their new home. I'm so encouraged to see the next generation of psychiatrists. Today, we have an IMG medical director, an IMG assistant medical director, an IMG president-elect. And the work to get these people in these positions started off 30 years ago with the hard work of several doctors here. And one of them just walked in, Dr. Vann, also one of my mentors. Dr. Vann was the first Indian-American psychiatrist to be nominated for the post of president for the APA. And he set the ball rolling. And after that, we haven't stopped. And every election, more and more immigrant IMGs, international medical graduates, have been in leadership positions at the APA. So without further ado, I'm ending my presentation right now. And I'm opening it up for discussion. I was told by the audio guy that anyone asking questions should speak clearly into the microphone because it's a recorded session. So they want you to speak into the microphone. I'll take questions. But it's mostly a discussion. I want you guys to contribute to the topic. Thank you, Dr. Fernandez. I have a question. Looking back, what do you think helped you to build your identity? And if you had to go back in time, what did you do differently to build your identity? It's not an easy question to answer, but I'll try. My identity has always been an international medical graduate because I knew I can't become an American medical graduate. You're always going to be in that identity. But when I came to this country and I met a lot of international medical graduates, and I gravitated to some of them who I thought will be able to assist me in my own professional growth. Having said that, when I came here, you're navigating this visa issue, this residency program. Many of my contemporaries and colleagues from the UK, when they came over to the US, they all got into programs in Yale and Boston and all that. I chose Richmond, Virginia because of mentors like Dr. Pandurangi. I knew that he's got my back. He's going to show me the way. Because no one will teach you these things. There's a lot of stuff that we have to learn in this country's self-learning. But if you have a teacher who's available to guide you and navigate you, it becomes so much more easy. And since I was 34 when I came here, I already spent the first 10 or 15 years of my life post-medical school traveling all over the world, experiencing different things. But I tell my colleagues here that I made a lot of mistakes in England. And I learned from that experience not to make the same mistakes here. Having said that, there is a great divide between across the pond, as they say. UK is a different experience. America is a different experience. I don't know what I would have done differently. Because I think if I had done anything differently successfully, I might have gotten to the end goal slightly a little faster. But I'm happy with where I am at the moment. You have to be satisfied with your professional career and goals. And I have attained most of the goals that I set for myself. And I think overall, I wouldn't change anything for myself. Some people would say, wouldn't you have been in a better place if you had come here post-medical school. Post-medical school, there was no way to get here. If you go to the U.S. Embassy in 1980s, you'll get a reject on your passport, which will disqualify you from even applying to another school. So I waited until I went to England, where I was a psychiatry resident. I had the money to come over to the United States, and the resources, and by which time, I told you I'd made all the mistakes in England, so I thought I would be able to better navigate this process in America. And I think I did pretty well, compared to someone who probably come directly from India or straight to the United States. Thank you so much. Look, there are most psychiatrists in this room, right? So we can all agree that suffering breeds success, right? Absolutely. Right. So I think your comment about how you made a lot of mistakes in one place, you wouldn't be where you are right now without making those mistakes. And what, in passing the baton on to the next person, as was mentioned before, a lot of the George Tarjan Award winners have a ripple effect, and a lot of people learn from the successes of others only by paying it forward. And I think that you've done an incredible job of doing so. So I congratulate you on that. You need to update your slide deck. It doesn't have TikTok in there, that's one thing. Not yet. But I think one of the challenges that international medical graduates are having right now is fear, and many don't understand that they need to embrace suffering, right? We learn a lot about ourselves through suffering, and we change based off of suffering. And the reason most people pay it forward is because they've suffered. It took me three years to get into the system. I was given offers from people who said, what can I do? The chairman of psychiatry said, what can I do to get you to rank us first in this program? And that was a year I didn't match. And many years had passed where I was given hopes and dreams from people, courtesy interviews that meant nothing, years of work that led to lacks of success. But I wouldn't trade any of those years in the world because they made me the doctor that I am today. I care about my patients. I'm not here for salary. I'm here for patient care. And I think most of the people in this room who have suffered understand the importance of what they're doing with their patients. So, you know, it's one of those things where we are a marginalized group as international medical graduates, but as you mentioned, international medical graduates are not the foundation of the APA. And the reason that they're the foundation of the APA is because they're the hardest working. There's no money in doing this. It's about a cause. And I think that that matters more than anything. So, standardizing and being able to mitigate the damage for those, you know, so that they can have a relative amount of suffering to breed their success is what we're all after, right? So I think by continuing to enhance our advocacy like Dr. Roy is doing, being loud like I'm doing, I think that that helps with the ripple effect. We have 700 programs that have been, 700 positions rather, that have increased since 2013 in psychiatric positions. We've had almost a 50% reduction in ERAS applications for international medical graduates. Why? We all know that usually AMGs, American Medical Graduates, they follow the money, right? So before it was emergency, the balance of the funding for primary care when President Obama was in, there was a lot of funding for primary care. And so all of the American Medical Graduates went for emergency medicine. And so it was very tough for any IMG to be able to get in there. Then there was cardiology. Cardiology and then the advent of PCI moved into cardiothoracics. And so those were very difficult positions to get in beforehand. So we have a mental health crisis now. And so the government is funneling money into psychiatry. And so the American Medical Graduates are going to increase their numbers and increase their applications where the money goes, right? So I think that us trying to enhance the amount of experiences for our international medical graduates to even the playing field is necessary. I had a lunch with one of my my co-residents who is now working in Georgia. He built a program from the ground up in Guthrie. And he has over the last three years been trying to get IMGs into the program. And every time an IMG opens their mouths, they get a denial. And that's just not right. So we need to do a better job of being able to advocate in positions where we are being marginalized. And the only way to do so is to enhance our numbers and work as a collective. This room should be full. This room should be full. I had no excuse though. I get that. I was already signed up before I even met you. I was already signed up because I think that George Tarjan started something that we need to continue. And you know, as I see a lot of you shaking your heads right now, that's good. It's not great. We need to do more. So I challenge you guys to contribute your time in a deeper way. And to everyone who's listening, who this is being recorded to, the IMG caucus is a place where you can go to get the advice you need, to make the contacts. Let's be honest with things, nepotism works. And we need to leverage nepotism in our favor now that we are the foundation, right? Thank you. Dr. Singh, could you, for the purpose of the audience, could you tell us where you work and what your position is right now? I work in Hialeah, Florida, close to Miami. I am working for a federally qualified health center. I am working in two different places. I work outpatient, particularly with the foster population. Citrus Health Network has a contract with them. And I work in the residential facility for severely traumatized kiddos who stay for six months to a year. And I am pioneering a new level of care with Citrus. We are opening up a 30 to 90-day stay, short-term residential, with hopes of reducing recidivism rates for specifically the foster population. So that's what I'm trying to do. I appreciate you. And like you heard from Dr. Singh, these are the areas where immigrant doctors are working. The most difficult, challenging populations are the areas where IMGs work. Dr. Fernandez, congratulations for well-deserved recognition by this committee. I want to say three things. One, an announcement. One, kind of quotation. And third, a question. I want to just say that two of the icons IMGs passed away this year. Syed Arshad Hussain, who has written the first book on IMGs, and Pedro Ruiz. I think we have to pay homage to the two great men, two great people that put us on the map. Thanks to both of them. Pedro Ruiz was a professor in Texas who was the president of the American Psychiatric Association and the president of the World Psychiatric Association. Very distinguished. The second is your statement about upward passing on the gratitude. So we IMGs do a good job. That is, we give to our students and other students, presidents, and they give to them. They don't have to pay us anything. It's important to what the evolutionary theory says. It's important to pass on the gratitude to the previous post-generations. You don't have to pay back to what you gave you, what you got. That's how society works. Keep that in mind. The third is a question, though, two negative things about not just IMGs, minorities. One is intra-ethnic jealousy. It's important. It's recognized as normal, maybe necessary. We compete with each other. Asian, Pakistanis, Indians, Bengalis, and Punjabis. Telanganas and Andras. Kamas and Redis. It's not pathology. It's a social reality. We have to accept it. The second is, I'll tell you a story and I'll ask you a question about this. When Salman and I, we live close by and we work together, and he comes and kind of flashes us his brilliance. At the end of each night when he leaves, I said, holy shit. He is here. He's writing books after books. I don't have anything to write. Show off. I would be so jealous. I was trying to feel so bad about that. Then all of a sudden I realized he's my friend. Anthony Fernandez is my friend. He's not only getting the award. I don't need the award. I'm friends with somebody who is getting recognition. I think it's important for us to appreciate those great men are mentoring us. I think it's important for us to help our mentees. Generational difference. I don't know. I think there is a generational jealousy. My son is doing better than me. Should I be jealous of him? Maybe, but I'm proud of him. Maybe a little jealous. Thank you. What about your question? You had a question you said? I think this is a question that we need to help with this aspect of the intra-ethnic jealousy and inter-generational jealousies and difficulty accepting it. We have to do more work though, not just criticize others. It's normal, maybe necessary, evolutionary psychology so that we humans can move forward. It's purely a tribal need. Thank you. Dr. Gogineni is a very distinguished psychiatrist. Social psychiatry is his area of expertise. His questions and comments are an area that I have little understanding and I cannot answer any of those questions. He's been one of my mentors. I've worked with Dr. Ramarao Gogineni for the last 15, 20 years in the IMG Committee of the Group for Advancement of Psychiatry, GAP. We've published many articles together. The last article was about 10 years ago called A Roadmap to Observerships in the United States. We had written a topic about how to create an observership program in America. Of course, as soon as that article was written, a couple of years later, they canceled observerships across America. We had to pivot. I just wanted to comment on the matter of intra-ethnic jealousy or intra-ethnic biases. For a start, I got married to a Telugu person. On a personal level, I want to set an example. But yesterday, I was very pleased to meet my friend, Mohammad Zishan, a child psychiatrist who is trying to get started with a combined initiative between AAPI or IAPA along with the Pakistani Association of Psychiatrists, which I think would be wonderful to get started with. So the progress is slow, but it's there. The other thing I wanted to comment on, there are two of you, but I don't see a lot of women here. That's one of the problems. 50% of the APA are women, correct? Exactly. We need more women. Where are they? Are they all caught up with that multitasking, self-sacrificing kind of thing that you have to balance your domestic life with your leadership aspirations? There, I think a lot of us are getting stuck. I just wanted your opinion on that, without the bias. The Indo-American Psychiatric Association has had women in leadership for a long time. So we are a different culture, where women have a very special place in India. We have leaders who are women, Indira Gandhi, and the Calcutta lady, Banerjee, is also. So yeah, but APA is behind. Having said that, we are catching up. Congratulations, Tony. Well-deserved award. I'm sorry I got late. That's a good comment, but I would also say there are way too many things at the same time, even within the same group. The Indo-American Psychiatric Association is having their scientific sessions right now. I was there. I go from there to Pakistani Psychiatric Association. I was there. They had invited me, and then I have to rush, and these are not nearby. And then you got to walk, and then take the bus. And for a strange reason, San Francisco is so cold. Today, I didn't even go to watch the breakers marathon, because it was so cold, and there were not too many people probably naked running today. That was my point of view. I didn't see it. You're in the wrong place. Having said that, we need to really ask the APA. Even yesterday, your session was at the same time when there is a session, Indo-American Psychiatric Association sessions, at the same time. I was ready to tell APA, they got to program it in such a way they don't split it. When I gave my award lecture for the George Tarzan, same time in the opposite room, Raghu Rao was giving a talk, and then, you know, why can't they put it two different times that the same audience gets split? Okay, so naturally that people cannot be here. Okay, so, and having said that, coming to the substance, I came late, so I didn't listen to everything. Replying to Dr. Guggeneni's comment, intra-ethnic jealousy can be very constructive, because people can, you know, you can aspire to do better, but the one thing that you don't want to do, there is always a saying, why, you know, they say about Tamils, they can say the same thing about any other minority, you know, that they can never get to the leadership, because if one guy climbs, the other guy is pulling his leg. So they're all pulling one another's leg that nobody can reach, so, which is true of, you know, so that we all can be constructive, but then, you know, and thank you, yes, I'm the first one to run for presidency, so I was the first sacrificial lamb or the guinea pig, but the good thing is, the general, all the, you know, our membership got used to some of the strange names that most people can't pronounce, especially with my name, which is true. Sometimes one of my secretaries has hung up when somebody asked for my name, my full name. Nobody by that name works here. So it's true, now Ramaswami Viswanathan is a mouthful, but they got recognized. So one thing I also want to say, now there is no campaigning allowed. What has happened is the number of people voting has dramatically decreased. Viswanathan was lucky, he came from a state with a lot of membership and, you know, New York has a lot of different branches, and he won by less votes than what I lost. So that's the story in the APA. So, but having said that, the threshold is so low, if we really organize ourselves, we can have multiple people, because there are multiple qualified people. The international medical graduates have done very well, let it be academics, let it be administration, we are always a good administrators in general, and then clinical, and then teaching in every branch, and then many places the public sector cannot function without international medical graduates. The main problem is many of them don't join the APA, they don't want to pay their dues, so the number of people who are really members is so small, so that is the reason that we are not really seeing that good results. And anyway, very good, wonderful, and congratulations, it's always a pleasure. Thank you, Dr. Van. How many countries have you been to? I was wanting to make that announcement. I've been to every country in the world, all the UN countries, and if you go to the Traveller's Century Club, there are 330 countries they define. I've been to 327, I have three left, three islands. Because I'm bipolar. Yes, because I'm bipolar. That's a difficult act to follow, but I just had a couple of comments. I noticed with interest a lot of the suggestions and challenges that were discussed for the IMG population or the membership of APA to implement and perhaps assist with encouraging IMGs to bigger and better things. One of the things that I was very struck by in my professional journey in the United States and now in Canada is that after the initial phase of training and being considered an earlier career psychiatrist, psychiatrists, especially those who are international medical graduates don't really have a sense of being supported and have people that they can approach for issues that arise in our professional lives. For example, I was sued, and there's no shame in that. It got thrown out. But when I first got sued, I talked to a lot of my friends. Nobody had any idea what it was like. And so I'm an earlier career psychiatrist, or actually an established psychiatrist, and I'm trying to figure out what do I do next, and the only thing I can think of is speak to PRMS or one of the other groups that are professional insurers. But it would have been a very helpful thing had I had something like a support system within the APA, within the IAPA, within the IMG group. So what I'm going to suggest is that we do a few things with the IMG group. One, we establish ongoing support and a system where people feel encouraged to approach somebody and perhaps even discuss things in confidence. I also think we have to be conscious of the image that the IMG caucus has. There is a sense among a lot of people that I've talked to that it's somewhat of an elitist group, and I think we need to be more inclusive. We need to have the AMGs attend our meetings. We need to have them present so that they are privy to our discussions about our concerns, and they may have their perceptions that we may be able to incorporate into how we do things. If there is no back and forth, I don't think we're going to grow our numbers. I don't think we're going to grow our membership, and I certainly don't think we're going to be able to integrate into the main body as well as we would like. So there are a few challenges still that are going to be faced by the IMG group going forward, and I'm going to throw this out to people like Dr. Shannoy, the young torchbearers of the profession who are going into the future, to see whether they could actually encourage fostering better and more robust identities of the people that come from other countries, to give them a sense of belonging, a sense of support, and a sense of membership and fellowship, and to get them to then carry it forward. Thank you. Quick follow-up before my comment. The follow-up is that Dr. Roy is our minority and underrepresented trustee, so I'm sure she's listening to the points made, and I'm sure we will make some progress in that regard. And she also represents the AMA, isn't it? Yes. So anyway, I'm a child psychiatrist, so I'm going to talk in terms of individuation process. So for some students and the youngsters, I'll say that individuation process is like when you separate from something else and become something else, right? So for example, the first individuation process happens when you're very young. Until then, the baby thinks it's a part of the mother, right? It's the same identity that the mother and the baby have, and the baby then becomes like a different person, starts walking away and all that. So that's first individuation. The second individuation happens during teenage years, right? Like when somebody who's, you know, they are trying to find a sense of identity for themselves. Most people stop there. There is no third individuation process that happens. And I've always thought, and I've read a book that says immigration is like the third individuation process where you come to a different country, you find different aspects of yourself where you, you know, become an amalgamation of who you were and who you want to become. And going back to Dr. Fernandez's lecture, my question to you is, I've always struggled with what parts of me to retain from India and what parts of me to Americanize. You know, that's something that I've always gone back and forth about. I joke about it in some, when I talk to other friends, I say, you know, I go from the question like, which part of India are you from to which part of you is from India, right? So can you comment on that? How do I, you know, is there ever a place when I'll get rid of this conundrum? And thank you for your lecture. Before I comment on that, Dr. Raman Marwaha, the president of the IMG caucus is here. He had a competing session right now at the same time. And Raman and myself have worked over the last several years, and he's done fantastic work for the IMG caucus. And he's right now the president, and he's working with a deputy rep and a rep. And most of what we discussed today, you know, these guys are the torchbearers. They're doing all this work, you know, and thank you for coming and finding the time. Is that again, congratulations to Dr. Fernandez and for the amazing work that you've done and keep on doing and will keep on doing. I know with IMGs, and yes, sorry, we had the IMG caucus meeting at the same time. So there was a conflict and it was at the intercontinental as well. So I think this is where also a recommendation for APA is to try to keep it at different times and not kind of conflicts and competing at the same time as well. But congratulations, and we're all really happy and excited that you are the George Tarjan awardee. Thank you, Raman. Yeah, go ahead. Go ahead. Congratulations, Tony. We are very happy to be here, myself and my wife, Viji. Even though there are conflict in attending other seminars and other things, we prefer to come here. This is our priority. Having gone through many changes in life, I don't have any experience with IMGs, but you have. My question is about change because you are exposed to several cultures, many languages, two different countries, and coming here. I was born in Burma and raised in Burma. I came to India, Chennai, and then went to Delhi, then Kerala. Exposed to several cultures, several languages in school. Then we were in England. Even at age 70, I have the hardest time in going through changes from one stage to another stage. We lost our practice completely. We had to shut down everything and start all over again. We're okay now. My question is, how do you forget the past and grieve through the five stages of the past? You come to the next stage and start all over again without any knowledge. It's like jumping into the water and then do the dog paddling. Start learning everything because of the crisis. It's not a planned thing. How do you go through these changes? Also, you found some common thread among all cultures, all languages, including your own family. What is that common thread that you're passionate about to bring the changes? That's an entirely different presentation. I'll prepare for that next year. Jokes aside, at each stage, you learn something. You're not losing those things that you've learned. You use them in your new experience. That's what happens when you move. You learn from the previous experience. Life throws stuff at you all the time. At this age, do you want something like COVID to destroy your practice? You're thinking about retiring. The sunset years of your professional life. Then something like this happens and you have to pivot. I think you're successful because of your resilience. You've done this so many times before. The fact that you said you're okay now is because of that. You're successful. I don't need to answer the question. You've answered it yourself. Thank you for your comments. What is a common thread that you find among all human beings, all cultures, all languages, and all countries? What is it you're finding? The common thread is you meet people who are willing to help. There are good people everywhere. I have seen a lot of bad people too. You see people and decide whether this is a good person or a bad person. You get that hunch. In my case, I've met more good people than bad people. They've really helped me immensely in my journey. I joined the military in 2011. Being a commissioned officer in the U.S. Army, it's a very high position. Everyone is looking at you. I don't know anything about the U.S. Army. My first day in the U.S. Army was a huge culture shock. I walk into a barracks. Barracks is usually for enlisted folks. I get a letter saying, show up tomorrow is your first drill date. I don't know anything other than the uniform that they've given me. I don't even know how to pin that uniform rank. I run into a guy who's about 300 pounds, all muscle. Excuse me, can I help you? I said, it's my first day in the U.S. Army. He just looks at me and says, first day ever? I said, yes, first day ever. Then I showed him the letter which shows this is Major Fernandez. He said, sir, I'm going to help you. He helped me get ready for the next day's session where I meet a most amazing lieutenant colonel who sat me down for the next couple of hours, told me what I should be doing. I hit all those points over the 12 years that I've been in the military. I got promoted as a full-bird colonel in 2018. Dr. Pandurangi was talking about this earlier. That Army life also, I met some fantastic soldiers. When you meet a not-so-helpful person, just walk away and find the next person who can help you. There are millions of people in this world, and there are millions of good people. I think that would be my approach. I'm not saying my approach is good for everybody, but it kind of worked for me. Thank you. We began right on time. We would like to end right on time. However, Dr. Roy has been waiting. No, I think, Dr. Roy, you can go because I see Matthew got up. That is Tony Fernandez's son, so he can have the last word. There will be two more only. One is by Dr. Roy, and then Matthew Fernandez. I wanted to mention that the proposition that there are competing sessions for IMGs are put together, but I'm going to bring it up to maybe Vishal Madan to see whether we can at least keep the IMG caucus separately because I missed the caucus meeting because of this meeting. We need to make sure that happens next time. I also wanted to emphasize Dr. Shenoy's question. It's a very relevant question. Do we ever get rid of the ambivalence of our identity? That is something probably we should be asking internally, but I would like your wisdom on that. I'm living vicariously through my children, so my ambivalence is always going to be there, and I'm going to deal with it as best as I can. But I know that I'm a combination of Indian and American right now, so I'm an Indo-American psychiatrist. I'm never going to lose my Indian touch. I have embraced the American culture, tried my best to assimilate, and I'm raising kids in this culture who've taught me a lot. So when I see the next generation, I see my happiness through their eyes. So, Matthew, go ahead. Last question. Hi, Appa. That's right. It's nice to see all his colleagues here. I've never been to this type of conference, and I'm very proud of you, so I wanted to say that first and foremost. Earlier, we talked about success and failures and the importance of your failures setting you up to be resilient. I'm curious for you to tell maybe one last story about a time in your professional career where you have failed, what you have learned, and how that has shaped your perspective moving forward. I've failed many times, son. Matthew is my second son. A little bit about him. He's a phenomenal tennis player, and he is a Division I tennis player. Former. Former. He still plays tennis. Former Division I tennis player for University of Richmond Spiders, and he's not a physician. He's a finance guy, finance analyst with a wealth management firm. So, you know, you pick up your pieces and start all over again. I can't say I've had too many professional failures, but I've had professional challenges along the way. So in 1984, I graduated from medical school. My dad had done a WHO fellowship in Johns Hopkins University in 1979, and he was a professor in India in psychiatry, making a decent amount of money and having a nice lifestyle. So when he came back, he says, America is a great place to visit, but who will live there? You know, he didn't like America because he had everything in India. But my exposure to this culture was through my cousins, my aunts and uncles who came from the U.S., and I was always wanting to explore the world, travel. And so I wanted to go to America for a higher education training, but it was just not an option at that time. I earlier talked about how it was almost impossible to get a visa to come to the United States, and you don't want to start off on the wrong foot. So you say, let me wait, establish my credentials, and then give it a shot. That's what I did during my time. That was the most successful way of coming over to the United States. Today, the whole thing is different. You know, people no longer have to go to England to establish their credentials and come across the pond. They come directly to the United States. Many of them succeed, but quite a few of them fail. And the cost of failure is tremendous for some of those guys. So, you know, you will experience failures and challenges along the way, and that's life, and you have to pick up the pieces and start all over again. And I think that's the best approach. Like losing a game in tennis. You know, you lose a game. You say, okay, what can I learn from this experience? Go back to the drawing board, come up with a different plan, and then give it your best effort. That's what I've tried to do in my life, and I recognize the challenges that people in my position face, and I think the best thing is to pay it forward. You know, if someone's helped you, you've got to pass it on to the next generation. And to see the success of your mentees is the most gratifying thing. Have I answered your question? Yes. Thank you, Appa. Congratulations.

Dr. Anthony Fernandez

psychiatry

international medical graduates

mentorship

cultural adaptation

George Tarjan Award

American Psychiatric Association

addictions

forensics

military service

professional resilience

cultural integration

advocacy