APPNA—NAMA (North American Medical Association) The Rise and Fall of NAMA
The lack of NAMA’s participation in APPNA is a major concern. In 2015, the Long Range Planning Committee (LRPC) appointed a Task Force to look into the reasons behind the perceived lack of interest by North American physicians. Some members fear that without NAMA, APPNA may not be able to sustain as a relevant organization in North America. Therefore, it was desirable to take action. In order to start a meaningful discussion on the issue in 2015, LRPC decided to first conduct a root cause analysis. A mass email questionnaire was sent to more than three thousand members on March 6, 2015. Answers to the following questions were sought in a straw poll. About forty members cared to respond.69
1. Is the current APPNA social culture a misfit environment for second-generation physicians?— Responses: Yes 76%, No 24%
2. Does the diverse group of physicians (NAMA) who have graduated from different medical schools have nothing else in common but heritage?—Responses: Yes 68%, No 32%
3. Would it be better to provide programs of interest to secondgeneration physicians to work for the community at large under
APPNA rather than isolating them in a group?—Responses: Yes 88%, No 12%
4. Does the change in the governance of APPNA that incorporates the second generation and makes it attractive for them to play leadership role would work?—Responses: Yes 80%, No 20%
5. APPNA has no medical student section. Would it be helpful to attract the future physicians by giving them student membership
and involving them in charitable work like Free Medical Clinics and APPNA Medical corps?— Responses: Yes 90%, No 10%.
6. The Reasons behind the apparent lack of NAMA’s interest in APPNA: In your opinion, what are the three major reasons that led to NAMA’s disqualification as a component society of APPNA? In response to this question, more than thirty (30) members chose to express their opinion. A representative narrative of most of the comments is summarized below.
Dr. Attaullah Arain (IL), a senior member of APPNA said, “It is important for them (NAMA) to remain connected to their roots. APPNA is a good way to connect with their land of origin, and they should recommend ways how APPNA could serve them better.” Dr. Ahmad Saeed Khan (AZ), another senior physician felt, “these are very different people who grew up in different culture and they think differently than their parents. Their interest is very different too. They may not find a fulfilling experience in current APPNA.” Dr. Rashid Hanif, (MD) said, “APPNA is seen as a social organization with its focus in issues related to Pakistan only. That limits the options for these physicians. (Also) The way ‘uncles’ run organization is probably another reason for their lack of interest.”
Dr. Humayun Chaudhry, DO (NY), an academic physician and the President of Federation of State Medical Boards shared the following, “Second-generation physicians need to be shown value for their membership and participation. They will typically not join for the sake of joining or networking. APPNA needs to demonstrate added value beyond CME (which they can get anywhere, including online) and entertainment programs (which they can attend on their own). The second-generation physicians also do not see value in many of the vendors in the exhibit hall, who offer clothing and jewelry that can be obtained elsewhere more affordably. They are (also) turned off by the aggressive and relentless campaigning of physicians seeking higher office, and by the occasional displays of incivility at membership meetings.”
Dr. Fatima Hassan (MI) said, “APPNA meetings are the avenues where physicians get together and socialize. Unfortunately, these meetings do not attract AMGs (American graduates). One reason could be lack of structure and focus on socialization only. Another reason is lack of marketing of APPNA activities catering to local communities as well as charitable activities across the world……”
Dr. Mona Karim insightfully expressed, “I was active in NAMA in late 90s/early 2000s while in medical school and training. I think there are several reasons it has not been attractive to American graduates. Firstly, most of us don’t primarily identify as Pakistani. Those who are more religious are usually heavily involved in ISNA or other Islamic organizations rather than ethnic ones. Those who are more cultural have many friends who are Indian/Bangladeshi etc. and broadly identify as South Asian/desi. Secondly, the culture of APPNA can be very cliquish and gossipy. I only went to APPNA meetings with my parents but on my own, never felt comfortable there…Thirdly, the social events at APPNA are geared toward a native Pakistani audience. Many of us are not familiar with current Pakistani singers or have little use for buying expensive “joras” if we are not attending many Pakistani events. It was fine to go with our parents while we were young and meet some of their friends’ children there. But all my friends stopped going once they had jobs and were independent of their parents… Also, APPNA got a reputation as a matchmaking venue, so once many of us were married, it made no sense to attend anymore.”
Dr. A Khan commented, “NAMA doctors do not have alumni structure like old Pakistani doctors. They do not know each other like older cohorts from various med schools in Pakistan.
There is no kinship or camaraderie among them. They are just too busy in studies and residencies. They are just like other young Americans, lost and confused and alien to Pakistani crappy culture of poor religious understanding on the part of archaic parents.”
Dr. Azhar Majeed (CA), another North American graduate said, “The politics our ‘uncles’ play is prohibitive. We don’t belong to any of the APPNA Pakistani medical alumnus. Many of us young physicians have large student debt and are self-made. We live in large cities. We are not the wealthy APPNA docs of small towns who have nothing better to do than gossip and hear music programs once a year. We are starting our careers and families. We are American Muslims involved in Muslim American fabric of America.” Dr. N. Shams, shared, “APPNA is too focused on Pakistan (and) is a social club for first generation Pakistanis.” Dr. Farhat Osman (OH) said, “Young North American graduates have many other obligations. Belonging to APPNA is not their priority. APPNA is committed to improving conditions in Pakistan which they cannot relate to. American graduates have huge loans to pay off and this becomes their priority.” Dr. Ghazala Kazi (MD) optimistically said, “These young people are busy in establishing their professional and personal lives and don’t have time for these activities. They will return.” Dr. Zahida Siddiqui, shared, “My children actually love it. I think it must be that they (American graduates) are just starting up in life and don’t have time yet.”
Re-Engaging NAMA
A straw poll led by the task force on NAMA asked: “What is the most important advice would you give to attract second-generation physicians?” It was the last and 7th question of the Straw Poll that task force on NAMA conducted. The responses were very insightful.
Dr. Erum N Ilyas said, “I have attended APPNA meetings since the early 1980s (parents are Naseem Khan, MD and Khurram Hanif, MD). NAMA seemed to rise and fall in this time period. My husband and I attempted to attend NAMA 4 years ago (2011) and the meeting had been cancelled due to lack of interest. We, of course, still attend APPNA (regardless of NAMA) and look forward to it every year but I think a revitalization of NAMA may be truly possible recognizing that now is the time to attract the attention of the 2nd generation of physicians that are now ready to give back. APPNA sells itself—it is easy to convince our friends to attend now that our children are older and looking for social outlets while we are looking for opportunities to enrich them culturally and academically.”
Dr. Fatima Hassan, being one of the North American graduates, offered solutions. “Bring AMGs in leadership positions to attract others and develop trust. Do not separate them out and cut them and leave them on their own. We need to change ourselves. We should not expect them to change and sing Pakistani anthem with us when none of us know a single verse of American anthem. Cut down on show off rich cultural parade at annual meetings and focus on healthy, constructive activities involving all age groups and variety of physicians. I don’t mean to say that there should not be any social and cultural activities but these should not be the sole focus of the meeting. I think in coming years there will be less and less number of Pakistani physicians coming to USA. We will need AMGs to keep this name alive.”
Dr. Nadeem Kazi (AZ) commented, “APPNA never offered anything which is interesting to the American Pakistani graduates. Start engaging them in a leadership position. They may want local American artist for the annual conventions. Start local program(s) through their alumni (Medical schools) to engage them in local social project(s). Involve them in committees as chair and co-chair.” Dr. Ahmad Saeed Khan (AZ) suggested, “Involvement in fulfilling experience (charitable work in USA and Pakistan). Getting them involved in activities, which they may find fulfilling, fun and enjoyable. Giving them opportunities to develop their own projects and programs. Giving them leadership role as much as possible.” Dr. Ariba Khan recommended, “they should be involved in activities with APPNA and not isolated as NAMA. they should have a representation in
APPNA leadership.”
Dr. Mujtaba Qazi (MO), a north American graduate and an established ophthalmologist, who has been contributing to the mainstream APPNA and served as St. Louis (MO) chapter president (besides serving on numerous committees) has valuably suggested: “Automatically include medical students as NAMA members, waiving APPNA /NAMA membership fee. Use Pakistani Student Associations or MSAs in Medical Schools to identify members, using Free Medical Clinics and APPNA Medical Corps as activities to promote for participation.” He further shared his feeling that sounds like a speech for his fellow NAMA members, “As first and second-generation physicians of Pakistani heritage, we are seeking a professional organization that will offer opportunities: (1) to expose our children to our Pakistani heritage and culture; (2) for us to provide medical services and expertise to our local community and to Pakistan. With respect to the latter, there are multiple opportunities for service through APPNA, including through the various philanthropic projects organized by APPNA members, by volunteering in the APPNA Medical Corps, and by participating in medical education and training at medical institutions in Pakistan. APPNA provides a professional platform to develop a network, including among sub-specialties, for transfer of skills and technologies. We are only beginning to scratch the surface of these opportunities for: telemedicine, educational seminars in Pakistan, assistance and advocacy for Pakistani medical students seeking research, residency and fellowship positions in North America, development of volunteer positions and programs for Pakistani-American college or medical students, expansion of APPNA free clinics as off-shoots of APPNA local chapters, and the development of second- generation Pakistani-American physicians and professionals who can serve as an interface between the Pakistani-American community and
American businesses, professionals, and politicians.”
Dr. Mona Karim shared, “The main attraction for the second generation will be the ability to do charity work both locally and in Pakistan. There is a strong desire among the second generation to do good for the poor and unfortunate. I agree you should attract future physicians with student membership and involvement in charity work. Even though I have not attended an APPNA meeting in over 10 years, I have regularly given money towards APPNA’s charitable work. This is what will interest the second generation the most.” Dr. Azhar Majeed pleaded, “Involve us! Don’t treat us as lower than you because we didn’t go to KE or Dow. We want to come to Pakistan to visit and volunteer at nonprofit clinics and help.”
Dr. Humayun Chaudhry, recommended to the NAMA group to “Get involved and get engaged with APPNA to meet and network with new colleagues of your own background (who also graduated from medical schools in North America) with similar interests. APPNA will need to provide leadership roles for NAMA graduates, who can be given funds and shown appreciation to promote activities that they vote to support.”
There were some short and sweet suggestions as well, including the following: “Find a way that the younger generation could claim any sort of ownership for this forum” (Anjum Qureshi); “There is no need for a separate section for young physicians” (Ghazala Kazi); “Involve them in politics and media outreach” (Zahida Siddiqui); “waiving membership charges for few years after graduation and then sliding scale type of dues payable (also) providing them with low interest loans for studies” (Farhat Osman); “No in-fighting, No corruption, and straightforwardness” (Nisar Ahmed); and last but not least, “If we want APPNA to survive, the future is with NAMA” (Dr. Naeem Khan, IL).
Excerpt from APPNA QISSA II, page 188-194, 2016