It was 1981. Rahman was fresh from completing an internship and residency in New Jersey. He’d also completed requirements for immigration from Pakistan to the United States, a journey he’d been planning since he was a child. He and Afshan had been married nearly two years and had a baby son.
He was looking for a place to practice his passion: internal medicine.
The Rahmans didn’t stay in Texas long. Back in New Jersey later that year, Rahman saw in an issue of Journal of the American Medical Association an ad for an internist in rural East Tennessee.
“This place looked beautiful, and I told my wife, ‘This is the same place you wanted to come,’ “ Rahman said.
Loudon had mountains, a waterfront, lush green fields and forests. It had a small-town feel, people with strong family values and a sense of community.
What it didn’t have was enough doctors.
Or anyone from Pakistan. Or anyone, even, from India.
Rahman was at the forefront of a national trend: foreign-born physicians who complete medical school overseas and come to the United States for internships and residencies, then settle in areas where few primary-care physicians want to work.
Now, foreign-born doctors commonly fill the gaps in poor, rural communities, especially in Appalachia and the South; in poor neighborhoods of large cities; and in Veterans Administration hospitals, where the hours and comparably lower pay are unlikely to entice many American-born doctors.
Some come with work visas that originally were designed to draw physician researchers doing work deemed to be in the United States’ “public interest.” The requirements for those visas were amended in 2002 to include practicing physicians, an attempt to replace a discontinued government visa program and stem what public health officials feared would be a shortage of primary-care physicians.
Others come on J-1 “exchange visitor” visas that once required foreign-born doctors who had completed their education to return to their home countries for two years before applying for U.S. immigration. Now a waiver to the J-1 visa lets primary care doctors instead choose to serve three years in an area the government designates as needy. Afterward, they can apply for U.S. citizenship and practice anywhere they want.
Some doctors view these stations as a sort of indentured servitude. They do their time and move to bigger cities, often with higher ethnic populations.
It was Knoxville nephrologist Naseemul Siddiqi, from India, who took that call and introduced the Rahmans to other South Asians in the area.
But in Loudon, the Rahmans were the only ones.
“People had told us, ‘Don’t go to the South; it is strange,’ and things like that,” Rahman said, “but our experience was completely different. We found people very friendly in the South.”
Rahman’s practice, in downtown Loudon, is in a low, 1970s-era office. Rahman shares it with another internist, from India, but initially shared it with an OB/GYN—the town’s second South Asian resident, who came six months after Rahman.
For years, the community hospital was right down the street, and Rahman made rounds there every day and was on call many nights. Now, the county hospital, Covenant Health-owned Fort Loudoun Medical Center, is in a new, modern building in nearby Lenoir City and able to attract specialists of every type.
Four years after moving to Loudon, the Rahmans built a home, a grand Tudor-style house on Fort Loudoun Lake. That’s where they used furnishings, food and tradition to bring their homeland to their friends, neighbors and three children, now all young adults.
The Rahmans’ older son, Ayaz, in medical school, was born in New Jersey but remembers no other home besides Loudon. Their daughter, Aisha, who just graduated from law school, was born in East Tennessee, as was their younger son, Haseeb, a college student in Missouri. They’ve been to Pakistan to visit only a few times; though the Rahmans still have friends and extended family there, their immediate families all have immigrated to the United States.