On any given Tuesday, or Friday or any other day in rural America, you might mosey by singing katydids and chirping crickets or see eagles soaring in the sky and snakes slithering through the grass. Some communities might only have a single gas station and a school basement that doubles as a church. Towns might have one hospital with an emergency room a fraction the size of big cities. 

Despite beautiful scenery and affordable homes, a prairie, mountain or desert life can feel isolating to physicians working in rural and underserved areas. The risk of solitude is greater for international physicians who did more than relocate from their hometown or state – they uprooted their lives to live in a completely different country. Overcoming isolation as an international doctor in rural and underserved areas can be a formidable undertaking. The result, however, could energize your career, personal life and overall wellbeing.

Overcoming loneliness

If you have always preferred solitude, you may not have built up the range of social skills necessary to interact with new people – particularly close-knit residents untrusting of outsiders. On the other hand, if you’re generally a people person, suddenly being unable to form meaningful connections can be disorienting and destabilizing.

Let’s first acknowledge you are not alone. Americans across all fields and social statuses report declining numbers of friends. According to a recent article in the New York Times, “Between 1990 and 2024, the percentage of college graduates who reported having zero close friends rose to 10% from 2%.” 

Of course, losing friends because you went your separate ways is different from having friends and not being able to connect with them because you’ve moved to a new country. It’s normal to want friends nearby. Start by reaching out to your network in your home country. Find out which friends from high school, college or your neighborhood have also moved to the States. You can also contact people from programs you’ve completed in the US, such as observerships and residencies or from previous conferences you attended.

Send a brief email or direct social media message that reminds them who you are and conveys your wish to connect: “We met four years ago at the PracticeLink Career Fair. I’m practicing in Spokane, Washington and am feeling a little stir crazy. I wanted to reach out and try to reconnect. Give me a call. I’d love to catch up.”

Overcoming perceptions

Introverts are often labeled as loners because they can be so reserved. However, where introverts tend to listen more than talk when they’re in a crowd, loners avoid crowds altogether. Both prefer to observe more than be seen and let their compassion reflect in their deeds, but outside of patient care, those who isolate themselves don’t always reflect on how their actions are perceived. 

Personal reflection is important when trying to change how others perceive you. One person’s perception can easily become town gossip, spreading faster than a barn fire. The good news is that reports of kindness spread just as fast. Make an effort to learn the names of your neighbors, the checkout person at your local grocery store and the cashier in the hospital gift shop. Help them to pronounce your name phonetically and avoid “being too busy” for courteous exchanges. 

Take a breath before making a social decision, don’t feel pressured to move too quickly and align yourself with a wingman—an ally who accepts you for who you are and you can trust to have your back—to “rescue” you when things get overwhelming.

Overcoming feeling different

International physicians who are self-conscious of being different or feel left out might see themselves as “the odd man out.” But isolating yourself just makes these thoughts a self-fulfilling prophecy.

One of the reasons the US has ten heritage-awareness months is to educate and celebrate different ethnicities – from Greek Americans in March to Black Americans in February.  

Not so long ago, scores of immigrants came to the US believing they needed to assimilate by hiding their cultures. As an international physician, you might have been expected to adopt the “American way” of interacting with patients and their families or handling certain procedures and paperwork. 

While certain protocols in healthcare are important, there is beauty and value in what you bring from your home country, professionally and personally. If there’s little leeway to introduce something medical from your home country, start with a dish or dessert for a team potluck.

Also, trust your recruiter. Rural hospitals seek physicians they believe will not only be a good fit within the organization but also in the community. Additionally, communities are usually happy you’re there and will do what they can to keep you. Knowing that, take a step forward. Every town has a Chamber of Commerce, a collaborative of small businesses that supports local economic development through networking. Once you join a meeting or mixer, you’ll see how welcoming everyone can be.

Overcoming worry

The Tagalog phrase, daga sa dibdib, is a memorable way to describe worry or fear. The literal translation is mouse in the chest. Visual connotation aside, the point is when something has you extremely worried, you can feel it in your chest. If you’ve cut yourself off because you’re preoccupied with something else, find someone you can trust to talk about it. If you’re concerned about money, find a financial adviser. If you’re concerned about something clinical but don’t want to discuss it with your supervisor, contact your attending from residency. If it’s personal or something else really weighing on you, reach out to a psychiatrist.

Overcoming regret

After your physician site visit, perhaps you imagined you could be happy with visa sponsorship and a decent salary. But with being so far from the people and places you love, maybe now you think you can’t find true happiness. Thoughts like that can make you feel helpless and full of regret. 

It’s important to look forward to what you’ve gained rather than dwell on the past and what you’ve lost. Consider what aspects of the people and places from your home country you long for and try to embrace what you might find similar in the US. For instance, if you’re from Italy and miss the majesty of the Alps, a cursory comparison to Aspen in Colorado could feel inadequate. Even so, Aspen has a lovely Hallmark-esque main street and stunning mountain views. Don’t compare the two. Just enjoy each experience for what it is.

Overcoming failed efforts

When first coming to a rural community, you might have tried to dive in headfirst into several hospital initiatives and local events. Maybe you tried, but for whatever reason, didn’t feel like any of it was a success. As a result, you decided to not only stop trying but stop being present altogether. 

To move forward, try to reignite that motivation to get involved. This time, however, find a way to be useful in a way that maximizes your skills. If you’re a plastic surgeon on a committee to host an event for National Breast Reconstruction Awareness Day, don’t volunteer to design the poster, develop the menu, write the press release, take photos and promote everything on social media. Instead, offer to do one thing in which you excel or that you really want to try. Maybe you just take photographs. It’s also OK to simply show up and mingle. Don’t wear yourself out trying to insert yourself with everybody or in every department.

Overcoming fear of standing out

If you subscribe to the idiom of the nail that sticks out gets hammered down, your isolation could be a strategy to avoid criticism for being too different or conspicuous. Another way to look at it is you ARE different, and you were hired both because of the differences you bring to the organization as well as the commonalities that make you a good fit. If you isolate yourself, you’re taking away an important part of what the recruiter and hiring managers saw in you.

The reasons international physicians isolate themselves are endless, and so are the benefits and opportunities of joining in. Whether your solitude is a coping mechanism or unintentional, it can keep you from forming meaningful connections and adversely impact your professional growth and physician quality of life.

Think about what will comfort your heart and find the motivation to begin interacting with the town and your coworkers. There’s a Korean phrase, ti-ggeul mo-a tae-san, that translates as you can make a mountain by collecting specks of dust. It means small things can build into something, possibly something big. 

For more information on quality of life, specifically practicing as an International Medical Graduate, visit the PracticeLink Resource Center.