One Quarter of US Physicians and Surgeons are Foreign Born
Dr. Fatima(1) immigrated to the United States from North Africa with her husband and three young children. Growing up in Libya, she had seen her brother struggle with severe scoliosis. Her love for her brother made her decide at an early age to dedicate her future to helping children with chronic health issues. A natural at math and science, she threw her young life into her studies and eventually became a pediatric ophthalmologist specializing in pediatric cataracts and glaucoma. After five years living in the Midwest, her husband had settled into his research position at a nearby university and their children were well on their way to becoming Americanized.
But Fatima had begun to feel increasingly uneasy. Her son was transitioning from grade school to middle school. She was uncomfortable with the way American girls dressed and the way they were allowed to interact with the boys. Many of the things about American culture that had fascinated her started to bother her. In stores, restaurants, or just walking down the street, there were always subtle cues that reminded her she was different. She hadn’t developed any significant friendships, and despite a solid marriage and being surrounded by wonderful colleagues, she was starting to feel isolated and lonely.
Dr. Fatima was experiencing what culture experts call “encapsulated marginality.”(2)
A quarter of the nearly 1 million physicians and surgeons working in the US are foreign born.(3) Hospital systems are beginning to understand and address the needs of this growing segment of healthcare providers.
Encapsulated Cultural Marginals
Cultural marginals are individuals who straddle two or more cultures.(4) Some cultural marginals experience persistent emotional and psychological strain because they fail to reconcile the differences between their new surroundings, their former home, and their own sense of self. Cultural competency pioneer Janet Bennett calls marginals who struggle to integrate “encapsulated marginals.” Predictably, there is a direct relationship between the likelihood of becoming encapsulated and the degree of differentiation between the cultures being straddled.(5)
Encapsulated marginality is a state of mind that searches outside of the self for validation and orientation, seeking clarity for expectations and relying on external sources for acceptance and belonging. It is very painful for whoever experiences it, and it can consume enormous amounts of cognitive and emotional energy. Left unaddressed, it can lead to withdrawal, feelings of isolation, feelings of alienation, depression, anxiety, and burnout.
Fatima was busy with her patients at the Midwestern hospital where she worked, but her heart was still tied to the norms and cultural standards of Libya. Her husband was creating friendships around American sporting events and gatherings, and her children were beginning to dress, act, talk, and even think like their American peers. She felt left behind. She was straddling two cultures but not feeling fully connected to either. She had become an encapsulated marginal.
Constructive Cultural Marginals
Conversely, there is subset of cultural marginality called “constructive marginality,” a state of mind in which marginals create their own identity and shift between cultures fluidly. Constructive marginals are more likely to hold their own internal sense of authority, their own standards for success and well-established sense of agency.
To adapt into a culture, one must walk with the assumption that one has a place, that one belongs, not necessarily that one fits in. Fatima might well imagine that a woman from Libya could carve out a life in a place established by European immigrants. To do so, she would be required to develop constructive assumptions while embracing complexity, contemplating nuance, and making abstract connections. In other words, she would have to become Self-Authoring.
Supporting Cultural Marginals
Eventually, with the help of Fern EPC coaching, Dr. Fatima objectified her thinking and started to see a way out. She started to see that her thinking had become simplistic: either she fit in, or she didn’t. Elements of her new country were either good or bad, and so on. She also started to see that she had been seeking validation, orientation, and approval from outside of herself. She began to see and own her counterproductive assumptions and began to trend herself toward more complex thinking and, ultimately, constructive marginality.
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Fern EPC specializes in helping physicians and healthcare executives stretch into the higher levels of complex thinking that can help mitigate culture shock and shift encapsulated marginals toward constructive sense making.
(1)Not her real name. Details of her life have been changed to protect her identity.
(2)Cultural Competency Pioneer Janet Bennett
(3)Migration Policy Institute, mig.rationpolicy.org, 2021
(4)From Janet Bennett
(5)Migration Policy Institute, mig.rationpolicy.org, 2021