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With and without the white coat: the racialization of southern California's Indian physicians

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With and without the white coat: the racialization of southern California's Indian physicians

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Content WITH AND WITHOUT THE WHITE COAT: THE RACIALIZATION OF SOUTHERN
CALIFORNIA'S INDIAN PHYSICIANS
by
Lata Murti
A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(AMERICAN STUDIES AND ETHNICITY)
May 2010
Copyright 2010 Lata Murti
For my men in white coats,
Dad and Dave
ii
Acknowledgments
Having only my name appear under “by” on the title page to this dissertation
seems misleading and selfish. From its very beginning, this project has been a
collaborative and collective effort that came to fruition only because of those mentioned
here.
Were it not for all of the Indian doctors who generously allowed me to interview
and observe them, this project would never have advanced beyond an idea in my head.
Despite grueling schedules and workloads, these doctors each carved a couple of precious
hours out of their lives to give me their undivided attention. During the many isolated
moments of writing, when I considered abandoning the project altogether, I thought of
the many doctors who placed their trust in me and in this project and I kept going. I
thank them all for letting me tell their stories.
I am also deeply indebted to my dissertation committee co chairs: Dr. Pierrette
Hondagneu-Sotelo and Dr. Jane N. Iwamura. Their unwavering faith in me and my ideas
gave me the confidence to propose this project and see it through. Without their patient
guidance and constructive criticism, neither this project nor I would have reached our full
intellectual capacity. I hope that one day I too will be able to mentor graduate students
with the same scholarly insight and compassion.
Drs. Leland T. Saito and Priya Jaikumar also provided guidance and support as
members of my dissertation committee. Seeing their names listed together with those of
Dr. Hondagneu-Sotelo and Dr. Iwamura makes me feel like I had a “dream team” of
professors helping me advance my scholarship.
iii
Dissertation funding from the John Randolph and Dora Haynes Foundation as
well as the University of Southern California allowed me the time and financial freedom
to conduct fieldwork throughout Southern California, and to begin my writing. I greatly
appreciate their investment in my research, and I will always fondly remember “the
fellowship years.”
I will also always admire the patience of Lexi Shiovitz Rubow, Sandy Grabowski,
and Michelle Har Kim for tasks I find to be difficult and frustrating: transcribing recorded
interviews and formatting theses. I thank them for their help with both, and for their
interest in this study.
My colleagues Edward Flores, Glenda Marisol Flores, Emir Estrada Loy, and
Hernán Ramirez read and commented on numerous early drafts of the chapters contained
here, and I am very grateful for their careful readings and critiques. They helped me
realize just how beneficial a writing group can be during the dissertation years, not only
as a source of feedback but also as a source of motivation and encouragement. I look
forward to reading their dissertations very soon.
I am lucky to have many supportive colleagues turned friends in my life –so
many, in fact, that time and space will not allow me to list them all here. Sarah Stohlman
and Nicole Willms never tired of reassuring me that I am indeed a sociologist. Stephanie
J. Nawyn, Melissa Fujiwara, Carolyn Dunn, Suzel Bozada-Deas, Banu Kavakli Birdal,
and Nicole Hodges Persley have been wonderful role models, showing me that
dissertating women can indeed wear many hats at once and wear them all well. James
McKeever, Jennifer Kwon Dobbs, Anton Smith, Haven Perez, Edson C. Rodriguez,
iv
Laura S. Fugikawa, Robert Eap, Cathy Schlund-Vials, James Thing, Jungmiwha Bullock,
Margaret Salazar, Deborah Alkamano, and Karen Yonemoto helped me keep up the
strength and persevere. Nisha Kunte, Anjali Nath, and Sriya Shrestha generously shared
their insights and knowledge of literature related to my dissertation. Thanks to everyone
mentioned in this paragraph, I know what building an intellectual community is all about.
My community also includes those who helped to nurture my soul so that I could
continue to nurture the dissertation: Eun “Erin” Suh Bolton, Teresa Wang, Sheela Rao,
and Rucha Tadwalkar were my biggest cheerleaders. Dawn Fries and Tal Peretz kindly
provided emergency child care and “book deliveries” whenever I asked. They are the
best “neighbors” I've ever had.
Also providing child care, often for many days in a row and at a moment's notice,
was my mother. Words cannot express my gratitude for her love, help, and generosity. I
know I could not have finished writing this dissertation without her support.
Nor could I have finished writing without the support of my father, the inspiration
for this dissertation. He assisted me in every stage of its development, often dropping
everything to answer my many questions regarding his experiences, opinions, and
knowledge of U.S. medicine and health care. My love of learning and passion for writing
began with him. And so, I dedicate this dissertation, to him.
I also dedicate this dissertation to my co-author in life and in love, David M.
Cochran. This project belongs to him as much as it does to me. Were I to list all of the
ways he helped me realize my dream of completing a dissertation and earning a Ph.D., I
v
would fill another two-hundred pages. I am amazed by everything he is and everything
he does, particularly in nurturing our growing hope and joy, Aivia “Ivy” Cochran-Murti.
vi
Table of Contents
Dedication ii
Acknowledgments iii
Abstract viii
Chapter 1: An Introduction to Southern California's Occupational Citizens 1
Chapter 1 Endnotes 26
Part I: From Culturally Endowed Healers to Suspicious Brown Aliens:
The Variability of Occupational Citizenship
Chapter 2: “Patients Tell Me Indian Doctors Are the Best”:
Southern California's Culturally Endowed Healers 28
Chapter 2 Endnotes 57
Chapter 3: “They Didn't Want Me to Get Ahead”: Occupational Discrimination 58
Chapter 3 Endnotes 82
Chapter 4: Without the White Coat: The Gendered Occupational Citizenship
of Southern California's Indian Doctors 83
Chapter 4 Endnotes 109
Part II: Of Caste-Based Denial and Career-Based Consciousness:
Generational Differences in Racial Perspectives
Chapter 5: Re-caste-ing Race: How Southern California’s Indian Immigrant
Doctors Interpret Racism 110
Chapter 6: “When You're Out in the Workplace, Just Assimilate”: Resisting
Racism through Generational Distancing 144
Table: Interviewed Doctors' Specialties by Generation 147
Chapter 6 Endnotes 165
Conclusion: Racializing the American Physician 166
References 175
Appendix A: On Methods 193
Appendix B: Interview Guide 196
vii
Abstract
This study examines the role of occupational status in the racialization of Indian
physicians in Southern California. Since the liberalization of U.S. immigration policy in
1965, the number of first and second-generation Indian doctors in the U.S. has grown to
nearly seven percent of the nation's physician workforce; however, Indians constitute less
than one percent of the total U.S. population. Overrepresented in one of America's most
prestigious professions, Indians are more visible in U.S. medicine than in the U.S. at
large.
Previous scholarship in immigration research, Asian American Studies, and the
sociology of occupations has paid little attention to these professional non-white
immigrants and their racial experience in the U.S. Asian American Studies in particular
has focused primarily on the racial-ethnic identity formation of economically
disadvantaged non-white groups, under the assumption that professional Asian
Americans’ class status and occupations in the sciences effectively shield them from
racist harm and preclude their engagement in racial politics.
This research shows that Indian doctors’ high occupational status and class
privilege provide them only partial, situational protection from racism. They have what I
call occupational citizenship --access to most of the same rights and privileges as whites
only when perceived as being both professionally successful and economically beneficial
to the U.S. They are clearly marked as occupational citizens during clinical interactions
with patients, when they are in the white coat. But outside of this context, they are
subject to racist treatment from colleagues, staff, health care institutions, and the general
public. The particular forms of racism these doctors face, as well as how they interpret
viii
this racism, have as much to do with their gender, immigrant generation, and perception
of others’ race and class, as with their own professional class status.
These findings are based on fifty-two interviews with first and second generation
Indian doctors in Southern California as well as participant observation at the monthly
meetings of two regional Indian medical associations. I also observed seven Indian
doctors at work, noting their interactions with patients, staff, and colleagues. Southern
California represents an ideal case for understanding the racial formation of Indian
physicians in the U.S. because of its large but dispersed population of established Indian
physicians, and its overall diversity of race, ethnicity, and class.
ix
Chapter One:
An Introduction to Southern California’s Occupational Citizens
As a brown-skinned American, I seldom escape the question: “Where are you
from?” My usual response –“My parents are from India”—often leads to another
question: “Oh! Do you know Dr. (insert any Indian surname here)? He’s from India!
And he’s just wonderful!” These exclamations, in various forms, have become a
common refrain in my life, one I have heard in every U.S. region where I have lived:
upstate New York, rural Kansas, the Kansas City area, and Southern California. And
although I usually do not know the specific doctor being named, one of the few Indian
immigrants I do know well is indeed a doctor: my father.
Why are there so many doctors from India in the U.S., and why do non Indians
immediately associate Indians with medicine? Also, what explains the praise that these
doctors, unlike so many non-white Americans, receive in public? Are Indian doctors also
the victims of U.S. racism? These are questions I often asked myself while growing up
and hearing my father both recount the racial prejudice he regularly experienced and also
express gratitude for his professional acceptance and success. As a graduate student of
race and ethnicity, I hoped to find the answers to these questions in sociological literature
on Asian immigrants in the U.S. But the majority of this literature, when it discusses
Indian physicians at all, provides only partial answers. It notes the general reasons for
the large number of Indian doctors in the U.S., such as the shortage of health care
workers in the expanding post-World War II health care economy (Choy 2003: 3, 64, 99;
George 2005: 49-50; Portes and Rumbaut 2006: 4), and the lack of professional
opportunity these doctors faced in India (Portes and Rumbaut 2006: 75). It also presents
1
them as contemporary immigrant success stories (Helweg and Helweg 1990) –ideal
examples of Portes and Rumbaut’s concept of selective acculturation, or the adoption of
only those mainstream, white-American practices that result in socioeconomic mobility
(Portes and Rumbaut 2001: 54, 102).
However, as Choy (2003b) and Espiritu (2003) argue in their studies of Filipino
immigrants, reducing immigration to ideal types and patterns ignores the immigrants
themselves, with their deeply felt experiences of success and failure (Choy 2003: 4, 7;
Espiritu 2003b: 36). Espiritu notes that these experiences, in the voices of those who
lived through them, are often missing in sociological literature on immigration (18).
More than a decade has passed since Lisa Lowe’s call to see Asian Americans as a
heterogeneous community, responding to the multiple contradictions of their U.S. lives
through the formation of hybrid identities and cultures (Lowe 1996). Still, many Asian
Americans, particularly those with professional careers, remain oversimplified in the
scholarship of Asian American Studies and immigration studies. Both fields have mainly
focused on the racial experiences of economically disadvantaged non whites, under the
assumption that professional Asian immigrants’ class status and occupations in the
sciences effectively shield them from racist harm and preclude their engagement in racial
politics. Koshy (2001) writes:
[I]ncoming middle- and upper-class Asian immigrants’ … class status
often insulates them from the harshest effects of the experiences from
which the antiracist discourses of the civil rights movement derive,
and their educational (generally in the sciences) and career paths
often bypass the arenas where the politics of race is engaged in a
sustained way. (192)
2
After reading this statement for the first time, I immediately thought of my father,
whose daily professional interactions did not always insulate him “from the harshest
effects of the experiences from which the antiracist discourses of the civil rights
movement derive.” Although not always the direct victim of these effects, he saw their
impact on the racially diverse community of patients, colleagues, and staff with whom he
worked. In interacting with this community, he could not afford to “bypass the arenas
where the politics of race are engaged,” and, while he himself did not engage these
politics “in a sustained way,” his experiences inspired me to do so. Koshy’s words
became a challenge. I wanted to know if my father’s experiences were unique, or if other
Indian doctors in the U.S. had also experienced race in more complicated ways than
Koshy and others acknowledged.
This study is my attempt to correct the overly simplistic representation of Indian
physicians’ racial experience in the U.S. From May 2006 to November 2007, I studied
the Indian medical community of Southern California, interviewing 52 of its first and
second-generation members –that is, doctors who grew up and completed medical school
in India before moving to the U.S. (the first generation) as well as doctors of Indian
descent who grew up primarily in the U.S. (the second generation).
1
I also observed the
monthly meetings of two of the three Indian Doctors’ Clubs (IDOCs)
2
in the region, and
shadowed seven of the interviewed doctors at work –noting their interactions with
patients, staff, and colleagues. Three main questions guided my research:
3
1. What are the professional motivations, histories, and narratives of post-
1965 Indian physicians in Southern California, and how do they vary
according to immigrant generation and gender?3
2. How do Indian physicians interpret their inter-ethnic relations with staff
and patients in various professional contexts? And how do these
interpretations affect both the physicians’ gendered ethnic identities and
their perceptions of non Indians’ gendered ethnic identities?
3. How do Indian physicians interpret their relationships with patients in
terms of the traditional Western doctor-patient hierarchy of patient
submission to physician authority, and how do these interpretations vary
according to the doctors’ immigrant generation and their gender?
My study revealed that Indian doctors’ occupational status defines their U.S. lives.
Indeed, it was the first generation’s primary motivation for immigrating to the U.S.,
which actively recruits International Medical Graduates (IMGs) to fill physician
shortages (Boulis and Jacobs 2008: 29, 43, 196). The doctors’ occupational status
becomes their master identity in the U.S. and accords them a significant amount of
authority over patients of all races and ethnicities. But outside of clinical spaces, and
among those who share some of their occupational knowledge and expertise, the doctors’
non-white racial status and gender define them more than their profession, which does
not visibly mark them as the highest medical authority in the room.
Indian doctors’ high occupational status and class privilege, therefore, provide
them only partial, situational protection from racism. They have what I call occupational
4
citizenship --access to most of the same rights and privileges as whites only when
perceived as being both professionally successful and economically beneficial to the
U.S.
4
The social prestige attached to their occupation --assumed to bestow noble ideals
of healing, not harming, to all its practitioners (Dickstein and Hinz 1992)—generally
legitimates their presence in public contexts and accords them an honorary white or
model minority status. These doctors are clearly marked as occupational citizens during
clinical interactions with patients, when they are in the white coat. But outside of this
context, they are subject to racist treatment from colleagues, staff, health care institutions,
and the general public. The particular forms of racism these doctors face, as well as how
they interpret this racism, have as much to do with their gender, generation, and
perception of others’ race and class, as with their own professional class status.
I situate the concept of occupational citizenship at the intersection of three areas
of scholarship: studies of immigration, Asian American Studies, and the sociology of
work and occupations. In the next three sections, I show that Indian doctors’ racial
formation –the processes by which they have come to be characterized as a non-white
minority (Omi and Winant 1994)-- is more complicated than any one area maintains.
Understanding and explaining these doctors’ inclusion and exclusion in white America
requires a dialectical framework built upon the theoretical foundations of sociological
studies in all three areas.
Assimilated But Not Fully Accepted: Studies of Immigration
Traditionally concerned with the assimilation of recent immigrants, sociological
studies of immigrants measure the social acceptance of these immigrants according to
5
their parity with native-born whites, particularly their socioeconomic parity. Classic
assimilation theories, based on the early twentieth-century experiences of European
immigrants, predict that professional immigrants quickly experience social equality with
white Americans (Alba and Nee 2003: 21, 24, 28; Bacon 1996: 11; Burgess 1925: 56;
Gordon 1964: 80-81; Park 1926: 9, 18). The ethnic identity of these white immigrants
becomes merely symbolic (Gans 1979; Waters 1990: 7) as they begin to identify with
their white-American peers and experience social citizenship in the U.S. –what T.H.
Marshall described in 1949 as “a share in the full social heritage and to live the life of a
civilized being according to the standards prevailing in the society” (Marshall 1964: 78).
Studies of middle-class Asian immigrants in the U.S. have shown that they are
also quickly achieving, if not surpassing, socioeconomic equality with their white-
American peers, succeeding in traditionally white professional institutions and settling in
predominantly white suburbs (Purkayastha 2005a: 1; Tuan 1998: 7, 30-35). Compared to
many other non-white immigrant groups, Asian immigrants appear to be “honorary
whites” –destined, like the European immigrants of the early twentieth century, for full
membership in the white-American mainstream (Bonilla-Silva 2006: 179, 180; Kim
1998; Tuan 1998: 31). While poorer non-white immigrants are at risk of assimilating
into the underprivileged Black and Latino segments of U.S. society, middle-class Asians
appear to assimilate into the white middle class sector, at least socioeconomically (Portes
and Zhou 1993).
Nevertheless, Portes and Zhou’s segmented assimilation theory (1993) as well as
several studies of middle-class Asian immigrants (Espiritu 2003b, Kibria 2002, Park
6
2005, Purkayastha 2005a) argue that despite their structural assimilation into the white
middle class, these immigrants’ ethnic identity remains strong and they do not experience
full social citizenship in the U.S. As mentioned above, studies of U.S. immigrants hold
up middle-class Asian immigrants as models of selective acculturation, retaining cultural
values, practices, and communities that help them resist downward assimilation into the
non-white poor but adapt to the norms of white America’s educational and professional
institutions (Portes and Zhou 1993; Portes and Rumbaut 2001: 54, 102). In this
conceptualization of Asian immigrants, the immigrants themselves appear to be the
principal agents of their socioeconomic destinies, selectively assimilating and
maintaining their ethnic cultures so as to avoid racial prejudice and discrimination.
An underlying assumption of segmented assimilation and selective acculturation
theories (which are, after all, rooted in the theory of classic, straight-line assimilation) is
that the success of socioeconomically well-adapted immigrants results more from factors
internal to the immigrant community than from factors external to it. While both theories
emphasize the social context and reception of the host society as being integral to an
immigrant group’s trajectory of assimilation, the host society often receives marginal
attention in discussions of socioeconomically successful Asians (Kim 2008: 2, 4, 5;
Purkayastha 2005a: 9). The main focus of these discussions is the middle-class
immigrants’ cultural and community response to host society structures, not the structures
themselves.
Specifically, racialization –or the ways in which the host society categorizes a
group as being fundamentally different and separate from itself (Omi and Winant 1994)
7
—is rarely placed at the center of immigration scholarship on middle-class Asians
(Purkayastha 2005a: 9). The implication is that racialization is not central to the lives of
these immigrants, if they share so many class-based similarities with middle-class whites.
Kim (2008) --one of a handful of immigration scholars to place racialization at the center
of her study of middle-class Asian immigrants
5
-- notes:
“…social class is neither the only key axis of assimilation nor a ticket
out of institutionalized and everyday racial barriers…. [S]ocial class
is but one mark of social inequality. There are myriad factors that
preclude full membership in the mainstream United States culture and
the national identity. For instance, as long as Asian Americans
continue to be associated with Asia, they do not escape racial bias
simply because they have made it into the White American middle
class” (4-5).
Indeed, like the middle-class Korean immigrants of Kim’s study, the professional
Indian immigrants of my study also demonstrate their agency by selectively mobilizing
ethnic and cultural resources to assimilate into the white American middle class. In
Chapters 5 and 6, I discuss how Indian doctors strategically reject and rely upon Indian
cultural frameworks to structure their response to U.S. social hierarchies. However, these
doctors also find that despite their class status and ethnic cultural capital, they
consistently encounter racial bias. Thus, theories of assimilation explain only part of
Indian doctors’ U.S. experience. As I argue in this dissertation, the doctors are defined
not only by their high socioeconomic status, but also by their race.
When Racial Ambiguity Trumps Class-Based Agency: (South) Asian American Studies
Unlike studies of immigration, Asian American Studies focuses on race as the
defining characteristic of Asian Americans’ lives, whether they are first-generation
8
immigrants or the U.S.-born descendants of foreign-born immigrants. Rooted in the
Third World student movements of the 1960s and 1970s (Min 2006: 3), Asian American
Studies sees racial exclusion as the core of the Asian-American experience. Originally a
Marxist enterprise, this field of study initially interpreted racial exclusion as a function of
capitalist exploitation, positing that racial oppression is a symptom of socioeconomic
disadvantage (Hirabayashi and Alquizola n.d.; Chan 2005: 38). Thus, until recently,
Asian American Studies centered primarily on socioeconomically marginalized Asian
Americans, such as laborers (Glenn 1986, 2002; Kwong 2000; Takaki 1998; Zhou and
Nordquist 2000), ethnic community entrepreneurs (Abelmann and Lie 1997; Kim, K.C.
1999; Lee 2000; Light 1988), and refugees (Canniff 2001; Chan 2004; V o 2000). When
mentioned, Asian American professionals usually served to exemplify the persistence of
corporate “glass ceilings” or as proof that Asian Americans are not “model minorities”
experiencing full socioeconomic equality with whites (Cheng and Yang 2000, 473-76;
Chou and Feagin 2008; Fong 2009). But the perspectives of the professionals
themselves, regarding their occupational status, were rarely included.
In recent years, several studies have examined the occupational perspectives of
Asian American professionals in terms of their ethnic identity formation (Bhatia 2007;
Dhingra 2007; Ho 2003; and Kim and Min 2000). These studies have foregrounded the
professionals' selective and strategic expressions of their ethnic identities in white-
American professional spheres. Much like scholarship on Asian immigrants' selective
acculturation, the current research on Asian American professionals highlights their
agency in negotiating the racial and ethnic hierarchies they encounter at work. But the
9
hierarchies themselves, and the specific ways they manifest in the professionals' working
lives, receive marginal attention.
Also currently marginalized in Asian American Studies are the many Asian
American professionals who work in occupational sectors, such as medicine, without
clearly defined corporate hierarchies. Doctors and lawyers, for example, don’t
necessarily work under someone of a recognizably higher occupational status. And
Indian doctors and engineers, particularly information technology professionals, are not
racially or ethnically underrepresented in their occupational field. Indeed, as nearly 7%
of U.S. physicians but less than 1% of the U.S. population, Indians are overrepresented in
medicine (NAIDA 2009; AMA 2009b; LIFS 2009a; U.S. Census Bureau 2009). Several
doctors I interviewed said that they don’t feel like numerical minorities in medical
institutions. My study considers how these Asian American professionals experience
racial discrimination at work, thus challenging the assumption that all Asian American
professionals are the underrepresented employees of white-dominated corporations.
South Asian American Studies has also paid scant attention to the racial formation
of professional South Asians in multiple U.S. contexts. Although concerned primarily
with professionals –over fifty percent of the South Asian American population (Rao
2003; Reeves and Bennett 2004: 14)-- this small but burgeoning subfield has focused on
the identity formation of South Asians within co-ethnic contexts, such as organizations
and events for and by Indian immigrants and their American children (Bhattacharjee
1998, Kurien 2007, Maira 2002, Rudrappa 2004). Studies of these ethnic spaces show
that a professional status grants South Asian Americans, especially first-generation males,
10
the agency to take advantage of contemporary U.S. multicultural politics and assert an
ethnoreligious “Hindu Indian” identity of their own construction (Bhattacharjee 1998,
Kurien 2007, Rudrappa 2004). The hegemonic power of first-generation Indian male
professionals within their co-ethnic community is a phenomenon I also observed among
Southern California's Indian physicians; and I explain its effects on first and second-
generation Indian female doctors in Chapters Four and Six.
Missing from these studies, however, is an analysis of professional Indians’
racialization and racial identity formation in settings where their ethnic, religious, and
racial identities remain ambiguous and unknown. As several scholars of South Asian
American Studies note, in public, South Asians are more likely to be racially lumped with
America’s most marginalized groups --Blacks, Latinos and Middle Eastern Muslims--
than with model-minoritized East Asians whom they don’t physically resemble (George
1997; Joshi 2006; Maira 2002; Purkayastha 2005a). As I show in Chapter Four, outside
of co-ethnic spheres, Indians are seen as “ambiguous non whites” (Kibria 1996) before
they are seen as middle-class professionals.
My study shows that first-generation doctors come to interpret their racial
ambiguity not only in terms of the social strata and hierarchies of the U.S. but also in
terms of the social structures of India –a transnational perspective rarely taken in South
Asian American Studies, or in Asian American Studies as a whole. With the notable
exception of Kim's work on the racialization of Korean Americans in Los Angeles
(2008), the assumption underlying most scholarship in Ethnic, Immigration, and Asian
American Studies is that immigrants’ proficiency in the social frameworks of their
11
homelands will quickly yield to an appreciation of U.S. social structures (Espiritu 1992;
Foner 2000; Kim, C.J. 1999; Omi and Winant 1994; Portes and Rumbaut 2001;
Waldinger 2001). My analysis of how first-generation Indian immigrant doctors interpret
their U.S. racialization challenges this assumption, showing that these professionals
depend on the hierarchical caste framework of India to structure their understanding of
the racial prejudice and discrimination they experience in the U.S.
My dissertation, therefore, expands the racialization framework at the heart of
Asian American Studies to include ambiguously raced South Asian professionals in both
occupational and non-occupational public settings. Analyzing the experiences and
perceptions of the professionals themselves, I demonstrate that their class-based agency
to define their racial formation is limited, especially in those public spaces where their
race and gender are more visible than their occupational status. Furthermore, I show that
when defining their racial status in the U.S., first-generation Indian immigrant doctors
rely on their knowledge of Indian social hierarchies as much as their familiarity with U.S.
social strata. Thus, my research presents a challenge to the Marxist, U.S.-centric
assumptions on which Asian American Studies has traditionally been based.
Of Medical Professionals, Not Just Medicine: The Sociology of Occupations and
Medical Sociology
My research also presents a challenge to the sociology of work and occupations,
including research in the area of medical sociology. In discussing professions such as
medicine, the sociology of work and occupations has focused on the structure,
organization, and power of these professions as institutions (Abbott 1988, Abbott and
12
Meerabeau 1998, Berlant 1975, Freidson 1970, Larson 1977, Saks 1995, Sciulli 2008).
Medicine as a whole is the unit of analysis, not medical professionals themselves. This
top-down examination of U.S. medicine provides a social and historical context for the
profession’s rise in status and influence, and also helps to situate its politically
constructed role in relation to other occupations (Abbott 1988). The sociology of
occupations thus explains the social hierarchies that determine Indian doctors’ high
socioeconomic and professional status in the U.S. It also describes the structural changes
–such as nationwide reforms in health care and medical education (Mechanic 2003;
Tanne 2007; Starr 1982)—that have led to the current growth and distribution of Indian
doctors in U.S. medicine.
But how U.S. doctors themselves, of any ethnicity, experience and perceive these
structural changes in medicine has received little attention in sociological studies of the
professions, including Medical Sociology. As in immigration research and Asian
American Studies, empirical studies analyzing the professional experiences of
physicians, described in their own words, are lacking in the sociology of work and
occupations. Again, the underlying assumption is that physicians, who represent the top
rung of the U.S. occupational ladder (Boulis and Jacobs 2008: 7; Cockerham 2004: 207),
are all primarily and equally defined by their prestigious professional status. Sociologists
often interpret this high professional status to supersede differences in race, class,
religion, gender, national origin, sexuality, and medical specialty among physicians –even
to minimize or erase these differences (Becker 1961; Boulis and Jacobs 2008). The
sociology of occupations and medical sociology suggest that American physicians are a
13
cohesive, united community who all experience gains (and losses) in occupational power
and status in similar ways (Cockerham 2004: 211).
Although medical sociologists have begun to study diversity among U.S.
physicians (see Boulis and Jacobs 2008; Hammond 1980; Hinze 1999; Hoff 1998, 2004;
Lorber 1984, 1993, 1997; Martin, Arnold, and Parker 1988; Riska and Wegar 1993), they
have mostly compared and contrasted the experiences of male doctors to female doctors,
who are now 48.9% of U.S. medical students (Boulis and Jacobs 2008: 2). These
medical sociologists have sought to determine whether (and when) the female doctors
occupy a subordinate status within the medical profession, thus questioning the
assumption that all U.S. physicians enjoy the same occupational prestige and equality.
Occupational segregation by sex has become a recognized and studied aspect of the
medical profession.
The occupational segregation of doctors by race, however, remains a largely
uninvestigated subject in medical sociology, even though 22% of U.S. physicians are not
white (Boulis and Jacobs 2008: 46). The few studies that pay attention to U.S.
physicians’ race are mainly interested in how a doctor’s race affects patient treatment and
satisfaction (Cooper-Patrick et al. 1999; Escarce 2005; Johnson et. al. 2004; LaVeist and
Nuru-Jeter 2002; Saha et. al 2000; Stinson and Thurston 2002; van Ryn and Burke 2000;
and West 1984). Race is studied in the context of doctor-patient interactions. In this
context, the doctor nearly always has situational authority, regardless of race (Atkinson
1995; Cockerham 2004: 148, 190; Parsons 1951). Unlike research on gender differences
among medical professionals, research on the racial diversity of doctors has yet to
14
complicate the premise of occupational equality among physicians. A vertical, top-down
approach still structures studies of racial difference among U.S. physicians. A horizontal
approach concerned with intra occupational race relations seldom appears in sociological
research on doctors.
6
Also lacking is an intersectional approach that considers how multiple social
factors together determine the intraoccupational status of doctors. Feminists of color
have long recognized the importance of intersectionality –or the convergence of more
than one social disadvantage (such as a non-white race, female gender, and lower than
middle-class background)—in defining their subordinate status in the U.S. (Anzaldúa
1987; Collins 2000; Chow, Wilkinson, and Zinn 1996; Crenshaw 1989; Combahee River
Collective 1977; Hurtado 1996, 2003; Moraga 1981; and Sandoval 2000). And scholars
of immigration studies and Asian American Studies often take an intersectional approach
when analyzing the experiences of disenfranchised women of color (Espiritu 2008; Glenn
1986; Hondagneu-Sotelo 2007; Salazar Parreñas 2001). In this dissertation (particularly
Chapter Three), I show that an intersectional approach is also applicable to the
sociological study of non-white professionals, who, although not disadvantaged by class,
still experience both racial and gender subordination, often from colleagues in the same
occupation.
This study of Indian doctors, therefore, brings the sociology of occupations and
medical sociology into dialogue with studies of immigration and Asian American Studies
–three areas of scholarship that rarely meet. It recognizes the socioeconomic assimilation
of these non-white physicians –their defining characteristic in research on immigration—
15
without denying their racialization. It also considers those contexts in which their racial
ambiguity trumps their class-based privilege in determining their ethnic identity
formation, thus expanding the racialization framework at the heart of Asian American
and South Asian American Studies. Finally, it demonstrates that occupational status
alone does not determine these doctors’ professional experiences but intersects with race
and gender to distinguish their experience of U.S. medicine from that of white-American
male doctors. Overall, it calls attention to a diverse but understudied community of the
U.S.: its medical professionals.
The Indian Doctors of Southern California
The Indian medical community of Southern California –a large region comprising
five counties (including Los Angeles and Orange Counties) (Ryan, Wilson, and Fulton
2004: 309)-- represents an ideal case for understanding the racial formation of Indian
physicians in the U.S. There are two main reasons I chose to interview and observe
Indian doctors in this region: 1. its large but dispersed population of established Indian
physicians; and 2. its overall diversity of race, ethnicity, and class. I explain each of
these reasons below.
Large, Dispersed, and Established. Long known as an immigrant destination of
the U.S. (Bohn 2009), California has been recruiting International Medical Graduates
(IMGs) to fill its physician shortages since the 1960s, when baby boomers’ increasing
health care needs coincided with the liberalization of U.S. immigration policy (Hayes-
Bautista 2000). More than forty years later, Southern California hospitals regularly
appear on lists of IMG-friendly medical residency programs in the U.S. (DigitalDoc
16
2007, aajkal 2007). And with 25,408 practicing IMGs, California is the state with the
second largest population of IMG physicians in the nation (AMA 2009a), most of whom
(47,581 or 19.9% of U.S. IMGs) received their medical degrees in India (AMA 2008b).
(New York, with 35,180 practicing IMGs is the state with the largest IMG population in
the U.S.).
Southern California alone is home to 2,082 South Asian physicians (first and
second generation) as well as three Indian Doctors’ Clubs (IDOCs). All three IDOCs are
affiliated with the National Association of Indian Doctors in America (NAIDA) --the
largest ethnic medical organization in the U.S., second in size only to the American
Medical Association (NAIDA, 2009).
7
(In this dissertation, I have given pseudonyms for
all four organizations). IDOCs are associations formed to represent and fulfill the
professional, social, and cultural interests of Indian physicians in the U.S. The largest
and oldest of Southern California’s three IDOCs, the Orange County Indian Doctors’
Club (OC-IDOC), was founded in 1979 --two years before the founding of NAIDA—and
claims over half of Orange County’s 500 Indian physicians as its “life members” (U.S.
Census 2000, OC-IDOC 2005).
8
As a large, established IDOC, therefore, OC-IDOC is
quite involved in NAIDA, in which several of its first-generation male members have
held leadership positions. In fact, the NAIDA President during the 2006-2007 term –the
year in which I conducted my field research—is a member of OC-IDOC.
Although consisting primarily of first-generation Indian immigrant physicians,
OC-IDOC and its two smaller Southern California counterparts –The Los Angeles Indian
Doctors’ Club (LA-IDOC) and The Three Valleys Indian Doctors’ Club (TV-IDOC)
9
—
17
also represent the rapidly growing population of second-generation Indian physicians in
Southern California. I define the second generation as those Indian-American doctors
who grew up primarily in the U.S. and completed most of their education in the U.S. as
well.
10
Many of these young physicians in their twenties and thirties belong to the
Emerging Doctors sections
11
of Southern California’s IDOCs and NAIDA --designed to
bring together medical students, residents, and fellows for networking, socializing, and
mentoring from more established Indian immigrant physicians (NAIDA 2007).
According to NAIDA’s Emerging Doctors Section, approximately 10,000 or ten to twelve
percent of medical students in the U.S. are of South Asian origin –a significant
percentage considering that less than one percent of the U.S. population and seven
percent of practicing U.S. physicians are South Asian (NAIDA 2007).
Moreover, considering that Southern California is home to six medical schools –
more than many states can claim (UnivSource 2009)-- a large number of the 10,000
medical students of South Asian origin are in Southern California. Indeed, medical
students, residents, and fellows were regularly present at the OC- and LA-IDOC
meetings I attended. Some were members of the Emerging Doctors Sections while others
were the children or guests of first-generation IDOC members. All, however, were of the
second generation; and those I interviewed were planning to remain in Southern
California, thus adding to the large population of Indian doctors in the region.
12
In addition to being large, established, and growing, Southern California’s Indian
medical community is also dispersed, as evidenced by the fact that three IDOCs represent
the region. Indeed, OC-IDOC, LA-IDOC, and TV-IDOC overlap greatly in their
18
membership and often jointly sponsor events, including their annual conventions (Nair
2009). When I asked the 2007 President of OC-IDOC, Dr. Mohan Devani, to explain the
need for three IDOCs in Southern California, he said that it was simply a matter of
geography: because Southern California is so large in area and has Indian doctors living
and practicing throughout the region, the LA- and TV- IDOCs formed so that those
members working in Los Angeles County do not have to drive to Orange County during
rush hour (a one-and-a-half to two hour drive in heavy traffic) to attend OC-IDOC’s
monthly weeknight meetings. They can attend the almost monthly weeknight meetings
of the LA- or TV-IDOCs instead. And indeed, during my interviews with OC- and LA-
IDOC members, I learned that many belonged to both organizations but only regularly
attended the meetings of whichever organization was closer in distance. Still, neither
organization experienced a lack of attendance at their weeknight meetings, each of which
usually drew at least 50 people (members as well as their family and guests) during the
time that I conducted fieldwork.
The presence of three IDOCs in Southern California demonstrates that the
region’s Indian physicians are not concentrated in a particular area but spread throughout
the five counties (Kurien 2001; U.S. Census 2000). As the next section explains, the
neighborhoods and communities that constitute Southern California differ greatly from
one another in their racial and socioeconomic class compositions. As a well-dispersed
population of the region, therefore, Southern California’s Indian physicians interact with
people of many different races, ethnicities, and class backgrounds on a daily basis, not
only in clinical environments but also outside of work --when they are without their
19
uniform of the white doctor’s coat. Consequently, these doctors’ racial formation is
complex and dynamic, shaped by a variety of social contexts and encounters not found in
other, less diverse regions of the U.S. “In order to extract the general from the unique, to
move from the ‘micro’ to the ‘macro,’ and to connect the present to the past in
anticipation of the future, all building on preexisting theory” –the basic principles of
Burawoy’s extended case method (Burawoy 1998)—I chose to interview and observe
Southern California’s Indian doctors as a unique, “micro” case for beginning to
understand the racialization of the U.S. Indian medical community as a whole.
Diversity in Southern California. As noted above, Southern California comprises
a racially and socioeconomically diverse set of neighborhoods, ranging from some of the
wealthiest communities in the U.S. (such as “The Platinum Triangle” of Holmby Hills,
Beverly Hills, and Bel Air) to some of the poorest (in the South Los Angeles region)
(Higley 2007; Wolch, Joassart-Marcelli, and Musso 2003). Racially, Southern California
entered the twenty-first century with no racial majority, and with Los Angeles County’s
Latino population exceeding its non-Hispanic white population in size (Sears 2002). The
region’s racial and class diversity has been a favorite topic of Southern California’s
biographers and fiction writers for many years (McWilliams 1946; Davis 2000, 1990;
Yamashita 1997) and captured national attention during the Watts Riots of 1965 and
international attention during the L.A. Riots of 1992.
Relative to other Asian ethnic groups –such as Chinese, Filipinos, and Vietnamese
(City-Data 2009)-- the South Asian population of Southern California is relatively small
and invisible; yet Los Angeles has a South Asian population of 104,482, making it the
20
U.S. city with the fourth largest population of South Asians (after New York, the San
Francisco Bay Area, and Chicago) (Améredia 2008). Moreover, Southern California’s
Indians are a very professionally active South Asian community, as evidenced by the
presence of three IDOCs in the region.
One of the reasons for their relative invisibility is South Asians’ dispersed
settlement throughout Southern California (Marger 2009: 256). Indeed, Southern
California’s South Asian community is one of the most dispersed Asian Indian
communities in the U.S. (Kurien 2001). Indian physicians, as explained previously, are
among the region’s scattered South Asians, living and working throughout its five
counties; and, as I learned through my research, these doctors often serve one or more
medically underserved urban communities far from the predominantly white, wealthy
suburbs in which they live. These suburbs include Palos Verdes, Anaheim Hills,
Torrance, and Southern California's beach communities --places of relatively recent,
secondary affluence as compared to the neighborhoods of Bel Air or Pacific Palisades.
Indian doctors’ dispersion throughout highly diverse Southern California has not
only meant that they regularly interact with a variety of people in a number of different
contexts (as mentioned earlier); it has also meant that they frequently experience ethnic
and racial misidentification. Indeed, as George (1997) observed, Indians in Southern
California are often mistaken for being Latino –the region’s most prevalent non-white
race (Sears 2002) whose physical features resemble those of South Asians. “Latino” or
“Hispanic” was the response I most often received after asking the doctors I interviewed
if they had been mistaken for another ethnicity.
13
Some also named Middle Eastern
21
ethnicities or “Muslim.” Interestingly, all of these races and ethnicities (and the Muslim
religion as a whole) have experienced much greater racial marginalization than have
Indians in the U.S. How do Indian physicians, as some of the most privileged non whites
in the U.S., understand and respond to their conflation with some of America’s most
disadvantaged minorities? Southern California is an ideal context in which to begin to
answer this question; for in this region of unparalleled diversity, the racial ambiguity and
contradictory social status of Indian physicians become compellingly clear.
Socially diverse Southern California, therefore, throws into relief the
intersectionality of race, class, gender, and profession in the lives of Indian doctors. The
variety of people and situations that these doctors encounter in this region highlight both
the benefits and limitations of their high occupational status, or their occupational
citizenship in whiteness. Their social and professional experiences in Southern
California present magnified moments for understanding the racial formation and
occupational citizenship of Indian doctors in the U.S. at large.
On a methodological level, the case of Indian doctors’ racialization in Southern
California can be extended to refine and develop theories of immigrant assimilation, of
Asian American racial formation, and of medical professionalization. Southern
California’s diversity and large but dispersed population of Indian physicians make it an
excellent location for studying Indian doctors’ racial formation in accordance with
Burawoy’s extended case method (1998).
22
Chapter Outline
The remainder of this dissertation is structured to show that Indian doctors’ racial
formation and occupational citizenship are situationally and generationally determined.
Part I, or the next three chapters, discuss the doctors’ accounts of how others respond to
them racially in three distinct contexts. When “with the white coat” --that is, when their
occupational status as “doctor” is clearly marked-- Indian doctors encounter little racism,
but only the male doctors enjoy full occupational citizenship. When they are “without
the white coat,” all of the doctors find themselves much more subject to racist treatment.
Chapter Two analyzes the one context in which Indian doctors are unequivocally
with the white coat: their clinical interactions with patients. This chapter describes the
structural reasons for their positive racialization by patients: the large number of Indian
doctors in Southern California; the doctors’ racial ambiguity in an increasingly non-white
region; patients' limited physician choice in contemporary U.S. health care; and Southern
Californians’ interest in alternative medicine. I then explain that despite recognizing the
importance of these four structural phenomena, Southern Californians --the Indian
doctors included-- believe that the main reason for the doctors' successful patient
interactions is cultural –that they are culturally predisposed to excel in medicine, or are
culturally endowed healers.
Chapter Three discusses the specific forms of prejudice and discrimination that
the doctors experienced at the hands of white, male-dominated medical institutions as
well as the hands of fellow physicians and nurses who struggle to succeed within these
same institutions. This chapter compares the occupational discrimination experienced by
23
the female Indian doctors to that faced by the male Indian doctors to show that the
institutionalized sexism of U.S. medicine exacerbates its institutionalized racism, both in
terms of severity and continuity. No matter how long the interviewees had lived or
worked in Southern California, they felt that colleagues and medical institutions viewed
them as Foreign Medical Graduates (FMGs), not occupational citizens.
Chapter Four explains how Indian doctors in Southern California assert their
occupational status in public, in order to negotiate a defining social tension in their lives:
being racially lumped with some of the most marginalized groups in the U.S. –usually
Latinos, Blacks, and Middle Eastern Muslims—yet having an occupational status higher
than that of much of America’s white majority. Only the male Indian doctors enjoyed full
occupational citizenship in public, however. When the female doctors revealed their
profession in non-clinical spheres, they were often stigmatized as threats to both white
and Indian male hegemony.
Part II, or the last two chapters, analyze how Indian doctors interpret others’
responses to their non-white racial difference. While the first generation depends on the
hierarchical caste framework of India to structure their understanding of the racism they
encounter in the U.S., the second-generation understands their racial image in terms of
the perceived greed and ethnocentrism of the first generation.
Chapter Five shows that first-generation Indian immigrant doctors depend on the
hierarchical social framework of India to structure their understanding of the racial
prejudice and discrimination they experience in the U.S. By invoking the hierarchical
language of caste to rank racist white Americans as inferior to them, first-generation
24
Indian immigrant doctors interpret racism as an individual problem of “low class” or
“low culture,” not a social problem of the U.S. as a whole. For these doctors, the U.S.,
unlike casteist India, is a meritocracy in which their occupational citizenship defines
them more than does the color of their skin.
Chapter Six explains that many second-generation Indian doctors believe that the
prejudice or discrimination they’ve faced is mostly the result of being racially lumped
with first-generation Indian doctors and their “foreignness.” Therefore, they employ the
following three strategies to distinguish and distance them from first-generation Indian
physicians in professional spaces: they choose less surgical but more patient-centered
specialties; they approach medicine as service; and they do not become active members
of Indian Doctors’ Clubs, or IDOCs.
The Conclusion considers the significance of Indian immigrant doctors’ racial
formation for both scholars of race and ethnicity and the American public. It discusses
the relevance of this study to Kim's theory of racial triangulation (1999) as well as
contemporary debates on U.S. health care, with the aim of showing that Indian physicians
can no longer remain invisible in scholarship or in the American imagination.
25
Chapter One Endnotes
1.
Most, but not all, of the interviewees’ professional and life trajectories conformed to these
definitions of first and second generation. A few of the first-generation doctors continued
their medical training in other nations (England, Germany, and Canada, for example) after
completing medical school in India but before moving to the U.S. A few of the second-
generation doctors had grown up in several different nations, including the U.S., or had
attended medical school outside of the U.S.; but all had completed the majority of their
education in the United States.
2.
IDOCs are a pseudonym for the actual organizational designation of these groups. Hereafter,
I will also use pseudonyms when naming the specific IDOCs.
3.
The 1965 Hart-Celler Immigration Act marked a watershed moment in the history of Asian
immigration to the U.S. Restrictions on immigration from Asia were lifted and professional
immigrants, such as doctors, were encouraged to lend their skills to the U.S. (DiFranco and
de Castro Svetich 2004: 138).
4.
The term “occupational citizenship” has appeared in many previous publications (for
example, Crouch 2001: 117; Jacobs 2009: 167; Lieberman 1998: 111; Standing 2009) and
usually refers to one or more aspects of a worker’s membership in the institution of his or her
employment. Here, however, I use the term to refer to an individual’s membership in U.S.
society at large when that membership is based on the individual’s specific type of
employment.
5.
Other scholars of the racialized ethnicity school who have made racialization central to their
study of middle-class Asian immigrants include Espiritu (2003), Kibria (2002), Choy (2003),
Bhatia (2007), Purkayastha (2005a), and Rudrappa (2004). They too situate their studies at
the intersection of Immigration and Asian American Studies, and critique assimilationist
perspectives for giving little attention to race.
6.
Most of the articles I found regarding the occupational segregation of physicians by race
were in medical journals (see Coombs and King 2005; Moore and Rhodenbaugh 2002; and
Memoun 1998). The few sociologists who have studied racial discrimination against
international medical graduates are Purkayastha (2005b) and Shin and Chang (1988).
7.
To preserve the anonymity of all Indian doctors’ organizations mentioned, I provide pseudo-
citations with partially correct information (such as the year of publication). In this way, I
indicate that the source of the cited information is the organization itself, without making the
organization readily identifiable.
8.
As explained later, the membership of all three Southern California IDOCs overlaps so that
many OC-IDOC members also belong to the Los Angeles Indian Doctors’ Club (OC-IDOC),
for example. According to the 2000 U.S. Census, there are 2,082 Indian physicians
practicing in Southern California (U.S. Census 2000).
9.
The Tri-Valley Indian Doctors’ Club (TV-IDOC) is not included in this study because I was
unable to obtain their permission to attend and observe meetings.
10.
Some of the doctors I define as second-generation Indian physicians are also IMGs because
they attended and graduated from medical schools in India.
11.
“Emerging Doctors,” like the names of the IDOCs studied, is a pseudonym.
12.
Not all of the second-generation Indian physicians I interviewed were medical students,
26
residents, or fellows. Several were established Southern California doctors, and many did
not participate in the region’s IDOCs or in NAIDA.
13.
“Hispanic” and “Latino” are disputed terms of ethnic identification among those of Latin-
American descent in the U.S. In general, “Hispanic” refers to all Spanish speakers and to the
European (Spanish) origins of many Central and South Americans. “Latino” is a more
political term that emphasizes a mixed Latin-American heritage (Hamilton 2001). Most of
the doctors I interviewed preferred the term “Hispanic” to refer to Southern California’s
Spanish speakers, even when I consistently used the term “Latino.” This is presumably
because the official, U.S. Census term for those of Latin-American descent is “Hispanic.”
27
Part I:
From Culturally Endowed Healers to Suspicious Brown Aliens: The
Variability of Occupational Citizenship
◊
Chapter Two:
“Patients Tell Me Indian Doctors Are the Best”:
Southern California’s Culturally Endowed Healers
Dr. Gurdeep Dhillon, a neonatologist (a doctor specializing in the health of
newborn children), had been living and working in Orange County for nearly twenty
years when I interviewed him in November 2006. He told me that during this time, he
had experienced “a lot” of racial prejudice and discrimination “every day, every single
day” outside of the hospital where he works. Nevertheless, Gurdeep also said that he was
very happy being a doctor in Orange County, because he had rarely experienced racism
from his patients, nearly half of whom are Latino. “When it comes to the hospital …
most of the time, patients or parents…they don’t want to offend,” he explained. “The
parents or the patients, they do not want to offend their physician, so they don’t show
[racial bias]. I cannot remember…com[ing] across this kind of situation ever.”
In addition to not wanting to offend their physicians, Gurdeep added, his patients
respect Indian doctors, who are many of Southern California’s neonatalogists.
We Indians that way are fortunate that everybody has more respect for
us --even more than for the white population, the general population--
that Indian doctors are good doctors…. There isn’t a choice [to see a
28
non-Indian neonatologist]…because [in] most of the neonatal
practices or the hospital settings…there are a lot of Indian
neonatalogists as opposed to many other specialties. So, that is what
they [the patients] see and that is what they get.
Respect from patients was a common theme in my interviews with Indian doctors
in Southern California, many of whom, like Gurdeep, said that only during clinical
interactions with their patients did they experience more racial admiration than
prejudice.
1
As did Gurdeep, these doctors also noted that their heavily Latino patient
populations had little choice but to see Indian doctors, who are nearly six percent of
Southern California’s physicians and employed by many of the region's major hospitals
and Health Management Organizations (HMOs). Indeed, they are more concentrated in
the region's medical institutions than they are in the region as a whole, where South
Asians make up less than one percent of the total population (U.S. Census 2000).
Why are clinical interactions with patients the only context in which Southern
California’s Indian doctors experience not only racial acceptance but also racial esteem?
This chapter offers an answer to this question, first by describing the structural reasons
for Indian doctors’ positive racialization by patients in clinical contexts: 1. the large
number of Indian doctors in Southern California; 2. the doctors’ racial ambiguity in an
increasingly non-white region; 3. restricted physician choice in contemporary U.S. health
care; and 4. Southern Californians’ interest in alternative medicine. After describing each
reason, this chapter explains that despite recognizing the importance of these four
structural phenomena, Southern Californians –the Indian doctors included-- believe that
the main reason for the doctors' successful patient interactions is cultural. They maintain
29
that Indians are culturally predisposed to excel in medicine –that they are, in other words,
culturally endowed healers.
Contemporary racial theorists argue that cultural rationalizations have replaced
biological rationalizations for explaining the racial and ethnic divisions that continue to
exist in a purportedly “color blind” U.S. (Omi and Winant 1994; Bonilla-Silva 2006).
Thus, as I explain below, Southern California relies on cultural explanations to rationalize
the noticeable presence of an ethnic minority in a profession idolized by the American
public and media (Helm 2009; Cockerham 2004: 207). In clinical interactions with
patients, Indian doctors’ professional authority --clearly marked by their uniform of the
white doctor’s coat—grants them full occupational citizenship, or complete social
acceptance as members of U.S. society. This occupational citizenship, in turn, validates
and even dignifies the doctors’ racial difference from white America. In Southern
California, patients look to Indian doctors’ ethnicity and culture in order to explain their
overrepresentation in the majority white institution of U.S. medicine.
2

Too Big to Ignore: Indian Doctors’ Visibility in U.S. Medicine
According to the 2000 U.S. Census, almost 6%, or 2,082, of all physicians in
Southern California are Asian Indian (U.S. Census 2000).
3
Yet Asian Indians are less
than 1% of the total population in the region (KAC-CIC and CKKS 2003). Thus,
Southern Californians are more likely to encounter Indians in a hospital or clinic than
they are anywhere else. Indeed, the reason interviewees most often gave for their racial
acceptance and respect from patients was the large number of Indian doctors in the
region.
30
Dr. Vanita Ramanathan, a second-generation physician specializing in
rheumatology (or diseases of the joints and connective tissues), explained that by the time
patients came to see her, they had usually seen at least one other Indian physician in the
Los Angeles area:
I think in Los Angeles there’s so many Indian physicians that a lot of
[my patients have] had an Indian physician before, if I look at the
names of their primary care physician or if I look at the nephrologist’s
[kidney specialist’s] name. There’s so many Indians who are
physicians in Los Angeles that I don’t think…[seeing me] fazes them
[my patients], at least in my opinion.
Vanita was not alone in her opinion. Most of the interviewees felt that America in
general does not view Indian doctors as minorities, because of their large numerical
presence in medicine. Several of the doctors I interviewed said that they themselves have
never felt like numeric minorities in U.S. medicine. “I don’t really consider Indian
doctors a minority anymore,” declared Dr. Almas Mizra, an Indian-American doctor of
family medicine, who had pursued her education and medical training in several different
regions of the U.S. and the world.
Dr. Mohan Devani’s patients would most likely agree with Almas. According to
Mohan –a first-generation orthopedist (doctor of bone health)—his patients are so used to
seeing Indian physicians in Southern California, that they believe most Indians are
doctors. “Most…patients respect Indian doctors because they see so many of them in
Southern California at least,” he observed. “And many patients have told me that their
primary care physician is also an Indian [and they say], ‘Oh, you guys in India--
everybody is bright. Everybody is a doctor!’ [chuckles a bit ].”
31
In reality, not even 0.1% of India’s population of over one billion pursues
medicine (academics-india.com n.d.; India Reports 2004). And, as evidenced by the
large number of first-generation Indian immigrant doctors in the U.S., many of India’s
medical graduates leave India to pursue professional opportunities in other countries. It
is these medical immigrants who come to represent all Indians to Southern California’s
patients, who rarely interact with any Indians outside of clinical contexts.
Moreover, many of the Indians that Southern Californians see in the U.S. media
either represent physicians or are physicians themselves. Dr. Sanjay Gupta (Cable News
Network’s Chief Medical Correspondent and a recent candidate for U.S. Surgeon
General), Dr. Deepak Chopra (hailed as the pioneer of alternative medicine in the U.S.),
and Dr. Atul Gawande (a surgeon and journalist who has authored three best-selling
books on his experiences in medicine) are perhaps the three most widely recognized
Indians in the United States. Their popularity, according to Dr. Sachin Malwani –an
Indian American specializing in urology (urinary tract disorders)—has brought visibility
and respect to the Indian medical community as a whole. For Sachin, the celebrity of
Drs. Deepak Chopra and Sanjay Gupta has been key to “mainstream” (white) America’s
racial acceptance of Indian physicians.
Dr. Chopra has actually done a lot to bring attention to the Indian
medical community. I think Sanjay Gupta is obviously very well
established and respected... I’ve seen him on TV, and I think he does
a great job. I think for the most part, a lot of that media attention is a
good thing, because, again, it breaks down boundaries. It breaks down
barriers. It makes people aware of people. It makes them less afraid of
cultures. And that can only be good for a community that faces a
prejudice or faces discrimination. The more mainstream you become,
the more mainstream you are…[then] the less discrimination, or an
32
outsider approach, people take to you because they’re more
comfortable with it.
In addition to their numeric and media presence, the established reputation of “the
pioneer” Indian immigrant doctors has helped Southern California’s patients feel
comfortable with both later-arriving and second-generation Indian physicians. Boulis
and Jacobs (2008: 6) use the term “pioneers” to refer to women who pursued medical
careers in the late 1960s and the 1970s –the first time that women entered U.S. medicine
in large numbers. Boulis and Jacobs describe these pioneer female doctors as
“trailblazers” who paved the way for later female physicians (the “settlers”) to succeed.
Similarly, Indian medical graduates first started entering U.S. medicine in large
numbers in the late 1960s and the 1970s. And, as several interviewees explained, the
professional success of these pioneers allowed later arrivals as well as the second-
generation to experience ready acceptance from U.S. patients. Dr. Sarita Joshi was one
such interviewee. A first-generation immigrant who arrived in Southern California in
1984, Sarita attributed the positive patient interactions she has had as a pediatrician and
genetic counselor to the strong reputation of the Indian IMGs who preceded her.
I think the Indians who came before me have set pretty good
examples, and … [for the] most part have been reputable physicians.
… And that has helped the next generation who has come in after
that, because …here [in the U.S.], Indian physicians have been
extremely successful…. I think in general the Indian physicians have
a very good reputation. Many of the patients…say, ‘I’ve had an
Indian physician,’ or somebody they know ha[s] had an Indian
physician, either their internist or their OB. And they’ve always had
good rapport and [a] good relationship with the physicians, and they
look at Indians as being very knowledgeable. [S]o I have never really
had a negative…interaction with a patient based on my Indian
ethnicity.
33
Thus, together with their large numerical presence and their visibility in the U.S.
media, Indian doctors’ established reputation has also made them acceptable to Southern
California’s patients. These patients –not only accustomed to seeing Indian physicians
but also rarely seeing South Asians in any other role—have come to associate all Indians
with medicine. Rather than detracting from their situational authority in clinical
interactions with patients (Atkinson 1995; Cockerham 2004: 148, 190; Parsons 1951),
therefore, Indian doctors’ ethnicity underscores this authority.
Proportionally more visible in U.S. medicine than any other ethnicity (Wu 2003:
53), Indian physicians seem to conform to U.S. stereotypes of Asian Americans: hard-
working model minorities who excel in clinical, scientific, and technical professions but
otherwise call little attention to themselves (Wu 2003: 68). As seemingly ideal examples
of these stereotypes, Southern California’s Indian doctors appear to be good immigrants
and honorary whites –their high occupational status clearly marked by their uniform of
the white doctor’s coat. The white coat readily distinguishes them from negatively
racialized, disenfranchised non whites (including their patients) whom they otherwise
physically resemble. Thus, Southern California’s patients quickly grant Indian
physicians occupational citizenship when they are in the white coat in clinical contexts,
where the doctors I interviewed said that they experience very little, if any, racism.
A Doctor for All Minorities: The Benefits of Non-White Racial Ambiguity. In a
1996 article, sociologist Nazli Kibria labeled South Asian Americans “ambiguous non
whites” and explained that despite their being politically and geographically grouped
with other Asian Americans, they are not visibly identifiable as Asian, a term used in the
34
U.S. primarily to describe Chinese, Japanese and Koreans (Kibria 1996). Phenotypically
resembling some of the most marginalized groups in the U.S. –usually Latinos, Blacks,
and Middle Eastern Muslims –more than their model minoritized Asian counterparts,
South Asian Americans often find themselves the victims of white racism. Studies that
mention their racial misidentification emphasize the costs of non-white ambiguity in the
U.S., in order to show that South Asian Americans are not fully accepted members of
white America (Chou and Feagin 2008; George 1997; Joshi 2006; Maira 2002;
Purkayastha 2005a).
The doctors I interviewed certainly experience the costs of racial ambiguity
outside of clinical settings, as shown in Chapter Four; however, as this section
demonstrates, within the context of doctor-patient interactions in racially diverse
Southern California, Indian doctors find their racial ambiguity to be more of an asset than
a liability. Indeed, Dr. Mohan Devani believed that he enjoyed excellent rapport with all
of his non-white patients who feel that they can relate to him better than a white
physician.
I would say most …[patients] actually feel more comfortable talking
to me when they are minorities themselves. They have more trust [in
me]. That’s what I’ve felt. …So… me being…an ethnic
physician…--of ethnic origin-- is helpful… [The patients] may not be
the same ethnicity but they just feel more close to me…. [I]t doesn’t
matter [whether] it’s a male or female [patient]. But just [because of]
the ethnicity, they feel like that.
Establishing an immediate connection to ethnic minority patients is important to
Mohan, because, like most interviewees, he treats a majority non-white patient
population in Southern California. As the 2000 U.S. Census revealed, Southern
35
California is a majority non-white region (WRAL.com 2000), with Latinos outnumbering
all other groups in Los Angeles County (Sears 2002). Most of the patients the
interviewed doctors see, therefore, are also racial minorities to whom they bear a close
physical resemblance. Indeed, Indian-American doctor Dr. Deepak Chandramohan –a
podiatrist who, like many recent U.S. medical graduates, speaks fluent Spanish
4
—said
that the “Hispanic” community in the neighborhood where he works often mistakes him
for being Hispanic; and this mistake helps his patient population grow.
I got to know the [local patient] community by going to the senior
centers and talking to people. Once they found I could speak
Spanish…they were more apt to come in and talk to me because they
felt they could communicate with me. A lot of the times [before], they
were speaking to people who didn’t speak Spanish and they had to
use a translator, but they still didn’t feel comfortable. Even though
they were getting the point across, they didn’t feel fully comfortable. I
feel that when they come here, they feel like, ‘Okay, I can talk to this
guy and let him know.’ And they’re happy for the fact that I did grow
up in the neighborhood and the area. A lot of people know that here.
They mistake me for being Hispanic all the time, which is a great
thing. They feel more comfortable.
As Deepak’s observation suggests, doctors who not only speak Spanish but also
are familiar with the cultures and communities of the Latino patients they treat are rare in
Southern California. Unlike Indians, Latinos are severely underrepresented in U.S.
medicine. Despite being almost fifty percent of Los Angeles County’s population,
Latinos are less than six percent of the County’s physicians (Hayes-Bautista et. al. 2000:
729, 732). African Americans, although not as poorly represented, are eight percent of
Southern California’s population but only five percent of its physicians (U.S. Census
2000). Thus, as Dr. Sunil Subramanya –an Indian-American resident of internal
medicine—explained, his Black and Latino patients have little opportunity to see a
36
physician of their own race; so they take comfort in at least being able to see a doctor
who is also a racial minority.
[T]hat’s all I deal with here is…minorities… And I think that…the
patient population…if they ask you [your ethnicity] they don’t like
you to say, ‘I’m American,’ you know? They want to know:
‘Where’s your family from?’… And…if I’ve said, ‘Yeah, I was born
here,’…nobody just says, ‘Oh, okay.’ Everybody says, ‘Where are
you really from?’ So I think that…[it’s]… not…just…people
want[ing] [to] know, but more…Because when you’re Brown, they
don’t think of [you] as American… They think of…White Americans
[as American]…. [T]hey say, ‘Oh, you’re Indian,’ you know, and for
a lot of them I think it’s like a source of some kind of, like, ‘We’re all
foreigners here’… it’s like that kind of bond…. I think that a lot of
them can bond to you over the fact that they feel like you’re a
foreigner too…. But I think that that’s what’s kind of sad is that [the]
Black and Latino population…don’t have many of their own
practicing medicine, so they have to get used to people…not from
their community taking care of them.
In addition to Southern California’s large non-white patient population, therefore,
its paucity of Black and Latino physicians also allows Indian doctors to benefit from their
non-white racial ambiguity. Blacks and Latinos, both significantly disenfranchised
populations in Southern California, have little choice but to see physicians who do not
share their race. Under these circumstances, some Latino and Black patients, like
Sunil’s, seem eager to relate to physicians who at least share their status as non-white
minorities or immigrants.
Relating to racially diverse patient communities is rarely a problem for the Indian
doctors I interviewed, especially those of the second generation who often grew up in
communities where there were few other Indians. Indeed, according to Portes and
Rumbaut (2006), Indians are one of the most dispersed ethnic groups in the U.S., rarely
forming residential enclaves or concentrated ethnic communities (14, 41, 165). The
37
professional status and class resources of many Indians afford them a high degree of
geographic mobility (47, 51). As a result, many Indian Americans, including several
interviewees, spent much of their youth interacting with non Indians of various racial and
ethnic backgrounds –experience that later helped them establish strong rapport with
patients of any race.
Dr. Aparna Nathan, for example –an Indian-American child psychiatrist—said
that having grown up in several very different places allowed her to have positive
interactions with nearly every patient she had seen.
I grew up in inner-city Pittsburgh, and then we moved to the suburbs
which was an all-white area, and then I lived in India [for medical
school], so I can essentially strike up a conversation with just about
anyone. So I connect very well with African American patients. I
connect very well with rich, white patients, so…even in [North
Carolina], when I worked for the V A [Veteran’s Administration]
hospital – I was really afraid of that because I was afraid they were
going to think I was Middle Eastern, and, you know, swear at me and
stuff like that…Oh my god, I mean, the VA patients were the people
that seemed to feel most connected to me for some reason. And here
too [in L.A.], I mean, I get along with kids. I’m in child psychiatry
now, so it’s not very hard to win people over…. They seem to really
like [having an Indian-American doctor], for some reason. I think
they feel safe with the differences. Like, the difference offers some
protectiveness. I don’t know how…
Even in those instances when Aparna feared that her non-white “differences”
would cause patients to disparage her, she was able to win her patients’ confidence. Her
prior experience interacting with people of several different ethnicities (including
Indians), in addition to her racial ambiguity, helped Aparna form strong connections with
diverse patient populations. For Aparna and several other second-generation
interviewees, growing up in a variety of places enhances the benefits of racial ambiguity:
38
these doctors not only physically “pass” for several different races and ethnicities; they
can also identify with the experiences of diverse racial and ethnic groups.
Racial ambiguity and a familiarity with various ethnic communities, therefore,
benefit Indian doctors in the “majority minority” region of Southern California (Pollard
and Mather 2008), but only in the context of doctor-patient interactions. In this context,
the doctors’ occupational status and medical authority are anything but ambiguous –
clearly demarcated by both the white coat and the highly structured exchange between
doctor and patient (Cockerham 2004: 147; Parsons 1951). Visibly defined by their
occupational identity, Indian doctors’ racial ambiguity appears neither threatening nor
alienating to Southern California’s patients. On the contrary, this non-white ambiguity is
welcomed by patients of color who seldom see doctors from their own communities.
During patient interactions, Indian doctors’ racial ambiguity –like their Indian ethnicity—
reinforces their occupational citizenship in Southern California.
Limited Physician Choice: The Contemporary Constraints of Health Care
Southern California, more than seventy percent white in 1970 (Reyes 2001: 34), rapidly
shifted from a majority white region to a majority non-white region. And this
demographic shift led to significant changes in the region’s patient population. In the
twenty-first century, Southern California’s physicians are much more likely to see non-
English speaking patients with either state-sponsored health insurance or no insurance
than they were in the 1970s, when Indian IMGs first started arriving in the region
(Andersen et. al. 1981; Boulis and Jacobs 2008: 145; LCHC 2005; Tanne 2007). This
contemporary patient demographic reflects not only the increased population of non-
39
English speaking immigrants in Southern California (and the U.S. as a whole), but also
two major trends in the structure of U.S. health care: 1. the rising cost of health
insurance; and 2. the growth of managed care facilities, safety-net providers, and group
practices --all of which are quickly replacing the solo physician clinic as the primary
institutions of outpatient care
5
(Boulis and Jacobs 2008: 27; Mechanic 2003; Tanne
2007; Starr 1982: 445, 446). Indeed, of the 52 Indian doctors I interviewed only 23% ran
solo physician practices, and a few also worked in hospitals or group practice settings in
addition to their individual clinics. The majority of the doctors (77%) worked primarily
for Health Management Organizations (HMOs), safety-net clinics (such as urgent care
facilities), or group practices, including hospitals (which usually operate as HMOs, group
practices, or safety-net facilities).
For Southern California’s doctors and patients, these dramatic shifts in medicine
have meant that they exercise little choice in whom they see in clinical settings. Patients
must consult doctors who accept their specific type of health insurance (or their lack of
health insurance); and doctors must treat the patients served by the facilities that employ
them (Mechanic 2003; Starr 1982). There is little latitude for either party to choose or
refuse whom they consult based on racial preferences.
Indeed, Dr. Susheela “Sue” Vellu –a first-generation immigrant and cardiac
anesthesiologist— was obligated to see the many Vietnamese patients who had recently
started coming to the Orange County hospital where she worked, even though she felt
frustrated with their limited knowledge of English and medicine.
Most [of my] patients are middle class, and they used to be majority
Caucasian and Hispanic, but in the last ten years, there has been a
40
tremendous change, a massive influx of the Vietnamese population. I
don’t see that many Caucasians any more and very few Hispanics….
There are a lot of Vietnamese. The problem that I face is a lack of
professional satisfaction because the majority cannot communicate in
English. I use translators. And their knowledge is limited. Choices
are made by family members.
Sue’s patients would probably prefer to see a physician who speaks Vietnamese,
but, like many patients, do not have the authority or means to select their own doctors.
Under these circumstances, patients have little opportunity or power to discriminate. As
Dr. Ajay Raman –a second-generation interviewee and doctor of family medicine—
implied, patients at the urgent care facility where he worked either had to accept care
from a non-white doctor or refuse medical treatment altogether.
I can imagine that…[it’s] different in different parts of the country or
maybe at a different time, but in Los Angeles I haven’t experienced
[racial discrimination from patients]. And that includes places like
[the predominantly white beach community] where…I work with a
doctor all day on Sunday, and he’s a black doctor. You know, he went
to school in Nigeria…and went to medical school here, and then
residency; and he’s black, so…when…the patient walks in the room
and sees the two of us standing there, they don’t have much of a
choice…. I don’t know if…[they] want…a choice. They don’t
express that to me.
Patients seldom expressed a preference for doctors of a particular race, gender, or
age, according to the interviewees. Although several female interviewees said that some
patients had initially questioned their medical authority because of their gender and
youthful appearance, these patients rarely refused their care. Dr. Sunita Gangal, a first-
generation doctor of family practice, told me that a few patients had assumed she was a
nurse, when she first met them. But once she convinced them that she was their
physician, they quickly accepted her without further questions.
41
Every once in a while…I would feel that patients don't immediately
think of [me]…as a doctor when they see a woman...like they
would…think that you're a nurse. That's the most common…
[response]: 'Oh, you're a doctor! Okay.' Then the perspective changes.
That happened, especially when I was so much-- I look much younger
than many of the other doctors, when I started out, especially. So they
have a little second look: 'Are you a doctor? You sure?' [laughs]…
that sort of thing.
“Second looks” and questioning, although they still occurred, were becoming
increasingly uncommon for many female interviewees. Indeed, several mentioned that
their patients had come to appreciate and even prefer female doctors to male doctors--
especially female patients, who have been shown to access health services more
frequently than men (Merzel 2000; Xu and Borders 2003: 1077; Iniguez and Palinkas,
2003: 53). As Southern California’s non-white patient population grew, so did its number
of female physicians, who are now approximately 44.8% of doctors in Southern
California (Boulis and Jacobs 2008: 2; U.S. Census 2000). The female physician is no
longer an anomaly in U.S. medicine, particularly in the feminized specialties of
obstetrics-gynecology, pediatrics, and family medicine. But even outside of these
specialties, in traditionally male-dominated medical fields, Southern California’s patients
had come to appreciate the growing presence of women doctors, according to several
female interviewees. Dr. Smitha Bhalala, an Indian-American child neurologist, told me
that when her patients had made any remark regarding her gender, it had usually been
positive.
The majority of…times…I don’t see any remarks about gender.
Actually, some people are very happy to have a female physician,
especially a neurologist, because there are not very many, so they’re
quite often happy to have a female. Some of them comment, because
we [female doctors in general] do listen better, or that we’re more
42
caring to explain things….or that we’re capable of understanding
some of the things that they go through…[like] some of the
experiences some of the female patients have given: ‘It’s all in your
head. You’re making it more than it needs to be’ type of comment. So
I think actually being a female neurologist is beneficial.
Mostly, however, just being a doctor, no matter the specialty, was beneficial for
the interviewees, whose patients expressed gratitude for any medical attention they
received at a time when basic health care is less a right than a privilege. Poor, uninsured
patients are especially grateful for their doctors’ care, explained Dr. Shantali Bharat –an
Indian-American medical resident in pediatrics. These patients, unaccustomed to
receiving much help with their problems, are highly appreciative of Shantali, despite her
very different social background.
Oak Villa Medical Center…[is] a county facility, and this is my
favorite place to go…. [I]t’s…like 95% Latino…probably 85%
Spanish speaking only, and they’re uninsured…and they have
really…a variety of presentations--…a lot of …pretty healthy kids…
all the way ranging up to like really late presentations of pretty
serious diseases that they just didn’t get helped anywhere because
they didn’t have insurance…. I love those patients…. [T]hey’re just
going through a lot of things that I can’t understand probably, like
poverty and being uninsured and …a lot of…social issues and…
family violence…. [W]e have a lot of…child abuse cases…there….
But I love seeing those patients because I feel like whatever little you
do there for them goes a long way…. And they really appreciate,
like, whatever you do; they really, really appreciate it. And if you
take the time to talk to them, they immediately… bond. And…if you
just explain things they will listen and…they’ll really appreciate you
being there and helping. So it’s really nice. [I]t’s a very rewarding
experience.
Socioeconomically disadvantaged and medically marginalized, patients who are
poor and uninsured can barely access a doctor, much less a doctor of a certain race or
ethnicity. Thus, even though Shantali --a middle-class Indian American-- shares little in
43
common with the Spanish-speaking patients at Oak Villa Medical Center, these patients
greatly appreciated her care. Here, her professional dedication received much greater
attention than her race.
The doctors report that when interacting with underprivileged patients, their
medical authority received much greater attention than did their race, gender, or age.
Many interviewees said that their low-income, poorly educated patients readily submitted
to their professional authority, thus upholding the traditional doctor-patient hierarchy that
sociologist Talcott Parsons (1951) described as being necessary for Western medicine to
function. Although more recent studies in medical sociology have declared hierarchical
doctor-patient relationships nearly obsolete (Frank 1991; Lowenstein 1997; Warren,
Weitz, and Kulis 1998), they are still the norm for a significant number of the doctors I
interviewed. These doctors often wanted patients to be their own health care advocates
--taking an active role in their health care and treating physicians as equal partners, not
omniscient authorities, in helping them maintain good health. However, as several
medical sociologists have noted, disenfranchised patients have neither the resources nor
the skills necessary to engage in a “mutual participation” model of health care, or to
adopt a consumerist perspective when consulting physicians (Boulton et al. 1986;
Cockerham et. al. 1986; Haug and Lavin 1981, 1983; Weitz 1999). According to the
interviewees, only wealthy, educated patients approach doctors as their equals or even
their stewards. But patients with low incomes and limited education --the majority of
patients for most interviewees-- still passively submit to doctors’ medical authority.
44
Dr. Peter Johns’s poor Latino patients, for example, responded to him very
differently than did his middle- to upper middle-class white patients. Whereas the former
asked very little of him during clinical interactions, he observed, the latter made many
requests. Peter –a first-generation doctor of urology— admitted that he, in turn, varied
his interactions with each group.
I see lots of CEOs and very high society people, and they demand
more…. They’re very knowledgeable. They come with their laptop.
And they’ll ask questions and questions and questions. And,
naturally…I can’t brush them off, whereas a poor Mexican may come
and…well…I tell him, ‘You have this”--however [it goes]. [And he
says,] ‘Okay, good.’ He walks out. And, so, it is not intentional. But
it is on demand, I may spend more time with the more knowledgeable
and high society type of person, you know.
As a minority of the patients most interviewees see, however, “knowledgeable,”
“high society” people have yet to render hierarchical doctor-patient relationships obsolete
in Southern California. Parsons’s concept of the sick role, which describes patients as
passively accepting of their doctors’ authority and care (Parsons 1951), is still relevant
for explaining the behavior of many patients whom the interviewees treat. In a health
care system that is not easily accessible, these patients lack the agency necessary to
question their doctors’ medical knowledge or challenge their authority.
Thus, more than differences in race, gender, or age, the class differences between
Indian doctors and the majority of their patients in Southern California structure the
clinical interactions between both parties. As health insurance rises in cost and
increasingly determines patients’ physician choice, acquiring even basic health care is
above the means of many Americans, especially those with little income or education.
The U.S. health care system itself has established a hierarchical relationship with these
45
disenfranchised patients by providing only minimal access to its professionals,
particularly its physicians. Under these systemic constraints, Southern California’s
increasingly non-English speaking, state-insured patients are often grateful for the
medical attention of any physician, regardless of the doctor’s race, gender, age, or even
language abilities. As the interviewees’ observations (quoted above) suggest, these
patients do not want to risk losing a doctor’s care by questioning her authority or
credentials. Moreover, underprivileged patients often lack the knowledge and resources
that empower the middle class to approach their doctors as equal partners in their care.
For Southern California’s Indian physicians, these class differences mean that the
majority of their patients passively and respectfully accept their clinical presence and
authority, without expressing any racial preference or prejudice. When interacting with
these patients, the physicians’ occupational citizenship is almost guaranteed.
Seeking Alternatives: The Popularity of Asian Medicine. Complementary and
alternative medicine (CAM) –or health treatments and practices not traditionally included
in Western medicine (Cockerham 2004; MedicineNet.com 2004; NCCAM 2009)—
enjoys great favor among Southern Californians of all races (Goldstein et. al. 2005: 560,
561) A recent study of Californians’ use of CAM (Goldstein et. al., 2005) revealed that
nearly half of the diverse sample surveyed had visited a CAM provider at some time in
their lives, and that those with high incomes and high levels of education were most
likely to utilize the services of CAM providers (560, 561-2).
Indeed, several interviewees noted that their wealthy, educated patients –“the
knowledgeable, high society” patients whom Dr. Peter Johns described above—were
46
most likely to seek provider-based CAM, such as herbal medicines and homeopathic
treatments (Goldstein et. al., 2005: 561). As the following observation by Dr. Sushil
Ramachandran –an Indian-American medical resident in pediatrics—suggests, some
wealthy Southern Californians trust the medical advice of their herbalists so completely
that they too adopt the traditionally submissive sick role thought still to apply only to
low-income patients (Cockerham et. al. 1986).
[I] try to find out what…[alternative medicines my patients are]…
taking. And unfortunately, people don’t really know. That’s the tough
thing…. I just had a well-off person from [Los Angeles’s wealthy
Westside] say that they’re taking an herbal medicine for their kid’s
allergy or…kidney problem or something like that. [I asked,] ‘What
herb is it?’ [The patient said,] ‘I don’t know. I just take whatever they
tell me to take.’… I try not to be judgmental about it, but I think
probably I come across a little bit judgmental… I can’t help but
feeling that they’re just wasting their money or they’re taking
something that has no benefit.
The majority of Indian doctors shared Sushil’s perspectives on CAM, explaining
that although they seldom openly objected to their patients’ use of alternative medical
treatments, they themselves had little faith in such treatments. None of the doctors I
interviewed had any formal training in CAM, although many expressed a curiosity for
learning more about alternative practices, particularly those with origins in India (such as
ayurveda).
Nevertheless, despite the interviewees’ unfamiliarity with any form of CAM,
several mentioned that some patients came to see them assuming that because they are
Indian, they possess knowledge of alternative medicine from Asia. Dr. Deepak
Chandramohan said that many patients from Los Angeles’s wealthy Westside initially
47
chose to see him because his name resembles that of the famous Indian immigrant and
CAM pioneer Dr. Deepak Chopra.
6
In West LA, [yoga and meditation]…[were] kind of in vogue when I
was there. Because I was ‘Deepak,’ that’s why they actually came to
my office in the first place, a lot of them, just because it was
‘Deepak,’ my [first] name, and they wanted to come in…. I think that
people approach us [Indian doctors] differently. I think they’re more
apt to visit us rather than someone else because they feel like, ‘Oh,
this guy is... “Deepak,” he’s gonna be open-minded about holistic
medicine, and I’ve been reading these books about it and I can ask
him what he feels about that.’ Or any Indian…name. I’ve talked to
other doctors, and any Indian doctor, that’s been the case for them,
too…. They [the patients] came to see you because you’re Indian and
they think you already know about it… They came into the door
because of that.
Thus, these patients came through Deepak’s door because of his Indian ethnicity,
not in spite of his ethnic background. In a region where CAM treatments from Asia –
particularly acupuncture and herbal medicines—are both popular and readily available
(Goldstein et. al. 2005: 561), Indian doctors benefit from their Asian racial identity even
when they make no claim to know or support Asian forms of CAM. In the eyes of many
privileged Southern Californians, Asian doctors’ race alone qualifies them to speak
authoritatively about CAM. This racialized assumption of Asian doctors’ credentials,
even when proven false by the doctors themselves, helps Indian physicians acquire new
patients in Southern California. As Deepak implied, once a patient decides to enter a
doctor’s office, he or she usually continues to see that doctor, even after the physician
does not meet the patient’s racialized expectations: “They’ll probably end up staying
with you anyway…[even] if you don’t know anything about [alternative medicine].”
7

48
Similarly, Dr. Vanita Ramachandran’s observations suggest that despite her
neutrality regarding CAM, many of her chronically ill patients –those shown most likely
to use CAM (Goldstein et. al. 2005: 564)—pursue alternative treatments while still
continuing to seek her medical counsel. Vanita never mentioned having a patient
completely reject her in favor of CAM, even those patients who initially came to see her
with the perception that Indian doctors advocate alternative medicine.
Lata: Do a lot of your patients pursue alternative treatments?
Vanita: Yeah, they do, and it’s because we don’t have cures for our
diseases. So yes, they do…. Some have had some success
in that. Some haven’t. I do have one very frustrating patient
who has rheumatoid arthritis and will not take any
medications, but I don’t see her that often. She’s just not
ready, and when she’s ready, then she’ll come to me. I’ve
given her all the literature, I’ve given her everything, and
I’m waiting for her to make that decision on her own. But I
don’t want to push her, because I just give her the data….
I guess some patients perceive me being Indian…—that
I’m more okay with alternative medicine because of my
background. But I guess I’m not [laughs]. I guess I
shouldn’t say that I’m not…. I reserve any kind of feeling
about it one way or the other.
Regardless of the interviewees’ medical and personal opinions regarding CAM,
their racialized image as CAM healers –deriving from Orientalist discourse depicting
Asians as mystically and spiritually inclined (King 1999)—mostly benefits them in terms
of racial acceptance from patients. Dr. Sachin Malwani observed that no matter how
Indian doctors feel about CAM, they should recognize that Deepak Chopra’s positive
media portrayal as a CAM expert aids the image of all Indian doctors in the U.S.: “I
don’t necessarily believe in alternative medicine, but whether you believe in it or not, Dr.
49
Chopra has actually done a lot to bring…positive…attention to the Indian medical
community.”
Thus, like the model minority stereotype, the stereotype that all Asians possess
some knowledge of alternative medicine helps Indian doctors gain acceptance from
Southern California’s patients. Again, the doctors’ racial difference is more of an asset
than a liability in the context of doctor-patient interactions. And in a region where Asian
forms of CAM enjoy great popularity, their ethnicity alone seems to grant them
occupational citizenship among their patients. Nevertheless, without both their physician
status and their ethnicity clearly conveyed, Indian doctors’ race remains ambiguous and
unassociated with Asian forms of healing. Only in the context of clinical interactions,
when both their ethnicity and title are known, do Indian doctors experience occupational
citizenship based on their patients’ fascination with alternative treatments.
Cultural Explanations of Indian Doctors’ Positive Patient Interactions
While the interviewees recognized the structural reasons described above as
explaining their strong patient rapport, many also emphasized cultural reasons for their
clinical success. Namely, these doctors believed that they gained the acceptance and
respect of their patients by virtue of their Indian cultural values. And many of their
patients’ remarks supported this belief. In general, cultural explanations for Indian
doctors’ conspicuous presence and success in U.S. medicine enjoy greater cachet in
Southern California than do the complex structural explanations for their occupational
citizenship.
50
In contemporary “color blind” America, culturally justifying a non-white group’s
socioeconomic success or failure appears not racist, but, rather, culturally sensitive and
enlightened (Omi and Winant 1994; Bonilla-Silva 2006). This is especially the case
when praising the group for having outperformed whites (the invisible norm) in a specific
activity or domain. As O’Brien (2008) shows, many non whites themselves subscribe to
cultural rhetoric not only to distinguish themselves from white America, but also to
explain how these distinctions make them “model minorities,” equal or superior to white
Americans in some way. Thus, the Indian doctors I interviewed claim that all South
Asian Indians are culturally predisposed to compassionate healing, even though this
claim constitutes a stereotype not far removed from racist descriptions of Asians as
spiritually exotic in Orientalist discourse. Viewing themselves as culturally endowed
healers helped the interviewees justify, and even excuse, their proportional
outperformance of whites in U.S. medicine in a way that is socially legitimate and “color
blind.”
Dr. Kishore Rajput, for example, described Indians’ success in U.S. medicine as
the inevitable result of what he saw as their cultural propensity for healing. Kishore's
description of this propensity as an unchanging essence that all people of Indian origin
“naturally” possess made it seem more genetic than cultural. But by eschewing
biological or racial language, Kishore (a first-generation cardiologist) avoided appearing
racist and implied that non Indians could approximate Indians’ medical success if they
improved their cultural values.
The biggest difference between [an] Indian and non-Indian is by
virtue of [Indians’] cultural background. [Indians] are more patient
51
and listen to the patients. That distinguishes us from anybody.
Everything else is comparable, I mean... they are intelligent, we are
intelligent. They work hard, we work hard. But... the root cause of
success of Indian doctors in this country is their cultural heritage of
discipline, respect to elders, respect to people, respect to life...giving
their time due to the patient. …So, that distinguishes, not only me…
[but] all Indians....
Kishore’s comparisons of Indian doctors to non-Indian doctors sets up a cultural
hierarchy of U.S. physicians with Indian doctors at the top. And, according to other
interviewees it’s a hierarchy that many of their patients support. These patients, after all,
live in a region that has historically looked to India for spiritual advice and healing
(McWilliams 1946: 271; Prashad 2000: 49) –an Orientalist gaze reinforced by the
contemporary New Age movement and the popularity of alternative medicine (Prashad
2000). Thus, some of the Southern Californians who see Dr. Teja Shah –an Indian-
American doctor of obstetrics and gynecology—have stated a preference for Indian
doctors because they believe that Indians in general possess desirable qualities: “I’ve
actually had some comments…from the non-Indian patients…that ‘I only want Indian
doctors’…that ‘They’re such good people. They’re such good doctors,’ things like that.”
Similarly, Dr. Sita Rao –a first-generation pediatrician—said that her
predominantly Latino patient population liked seeing Indian doctors, even when these
doctors, like Sita, spoke limited Spanish. According to the patients’ comments, their
affinity for Indian physicians had nothing to do with the relative lack of Latino doctors
(and comparative multitude of Indian doctors), but, rather, the kind nature of Indian
physicians.
[Q]uite a few parents say that …we…Indians…explain [things] very
well with them. We explain [things] very well to them, spend a lot of
52
time with them, so they’re very happy with us as doctors I think…
because [we’re] very compassionate. I think we as a community…
[are] quite compassionate. [O]nce they come to me, again, the
compassion, the time we spend, the care that we give, these are
factors that are very important to…[my Spanish speaking patients].
Plus I have excellent Spanish [sic] nurses in the office who are
Spanish speaking so they have no reason to really leave me and go to
[a] Spanish doctor.
Thus, non-Indian patients themselves perceive Indian physicians to be culturally
superior healers, thereby maintaining a medical hierarchy in which Indians occupy the
top rung. Southern Californians approve and perpetuate this hierarchy because it aligns
with other prevalent cultural stereotypes of Asians, namely the Orientalist stereotype of
spiritual exoticism (described earlier) as well as the model minority stereotype.
According to the latter, Asians are culturally predisposed to excel in technical, scientific
occupations, such as medicine, but not in more creative, humanistic fields (Wu 2003: 68).
Patients like those of Dr. Rajendra “Roger” Pandey, therefore, are pleased to see him –an
Indian-American spine specialist—in a role they believe he is culturally and ethnically
qualified to fulfill.
Lata: How do most of your patients react to having an Indian
American doctor? Any usual reactions or responses you’ve
heard?
Roger: [Laughs] … I think they love it. I think they think I’m smarter
than a non-Indian doctor. … It’s a positive stereotype, I’ll tell
you that.
Lata: And how do they usually express this to you?
Roger: Well in not such a direct way, but, you know, like ‘You must
be smart. You must know what you’re doing’ type of thing.
‘Oh, you’re Indian.’ … you know …
53
As with Southern Californians’ interest in alternative medicine, however, the
stereotype of Asians as culturally gifted healers only benefited the interviewees in the
context of doctor-patient interactions, when their ethnicity and occupational status were
known. When they were not known, as in non-clinical public contexts, Southern
Californians did not stereotype the interviewees so positively (as shown in Chapter Four).
This contrast in response not only demonstrates the importance of context in determining
Indian doctors’ occupational citizenship; it also shows the importance of the hierarchical
doctor-patient relationship in allowing non-Indian patients to temporarily concede
cultural superiority to Indians.
As explained earlier, most patients in Southern California already view doctors of
any race as being superior to them in clinical settings, due to the doctors’ medical
knowledge and authority. Having already granted medical superiority to their physicians,
patients seldom hesitate to grant their Indian physicians cultural superiority as well, as
long as the cultural superiority reinforces the medical. Patients, as several interviewees
observed, often approach their doctors with not only respect, but also apprehension,
afraid of physical discomfort or alarming news regarding their health. In this state of
mind, patients latch on to any physician attribute that assures them of a positive clinical
experience, even when doing so results in racially stereotyping their doctors as culturally
superior to themselves. Admiring Indian doctors as culturally endowed healers,
therefore, likely has less to do with positively reinforcing these doctors’ occupational
citizenship than it does with the patients' reassuring themselves that they are under good
care. After all, as shown in subsequent chapters, Southern Californians are not so
54
admiring of Indian doctors’ occupational citizenship when they are not seeking these
doctors’ care.
Conclusion
Only when interacting with patients in clinical contexts do Southern California’s
Indian doctors experience unequivocal occupational citizenship in the form of praise,
respect, and loyalty from patients. This occupational citizenship, as explained above, is
structurally determined by four factors: 1) the large number of Indian physicians in
Southern California; 2) the non-white ambiguity of these physicians in a region where
most patients are racial minorities; 3) patients’ lack of physician choice in the current
health care system; and 4) the regional popularity of Asian forms of alternative medicine.
The Indian doctors interviewed and their patients, however, preferred to culturally
rationalize the doctors’ occupational citizenship. Interpreting Indian doctors’ success as
the result of their cultural values falls in step with prevailing stereotypes of Asians as
model minorities and exotic spiritualists, both of which benefited the doctors during their
patient interactions. Patients, often anxious about their health, gladly placed their Indian
doctors on a cultural pedestal to assure themselves of the doctors’ excellence. And the
doctors gladly accepted their elevated status among patients, despite its basis in racial
stereotypes and cultural generalizations; for outside of clinical interactions with patients,
the doctors rarely experienced racial acceptance, much less racial praise.
Thus, context matters for Indian doctors’ occupational citizenship. Only when
their occupational status is clearly marked by the white coat and they are engaged in
hierarchically structured patient interactions do they enjoy complete occupational
55
citizenship. Furthermore, only when their Indian ethnicity is known do they benefit from
the model minority stereotype and the generalization that Indians are culturally endowed
healers.
Many recent studies of Asian Americans show the model minority stereotype to
be a false, harmful generalization (Chou and Feagin 2008; Fong 2008; Joshi 2006; Lee
1996; Prashad 2000; Wu 2003), while recent studies in medical sociology question the
contemporary relevance of a doctor-patient hierarchy (Cockerham 2004: 189; Cockerham
et. al. 1986; Frank 1991; Haug and Lavin 1981, 1983; Lowenstein 1997; Warren, Weitz,
and Kulis 1998). But my research shows that both the model minority stereotype and the
doctor-patient hierarchy are of benefit and currency to Indian doctors in racially diverse
Southern California. Among patients in clinical settings, both help to grant them
occupational citizenship.
56
Chapter Two Endnotes
1.
I did not interview the patients of Indian physicians in Southern California, due to the
concern that non-Indian patients would not feel comfortable telling me –an Indian
American-- how they racially perceive their Indian doctors. Thus, this chapter is based on
Indian physicians' perceptions of how their patients respond to them racially.
2.
Indians constitute approximately 7% of the physicians in the U.S. but less than 1% of the
U.S. population (NAIDA 2009; AMA 2009b; LIFS 2009a; U.S. Census Bureau 2009).
Whites, however, constitute approximately 37% of the physicians in the U.S. but 68% of the
U.S. population (AAMC 2006).
3.
The term “Asian Indian” refers to all U.S. residents with origins in the Indian subcontinent
(South Asia). The Census does not differentiate between Asian Indians from India and those
from other South Asian countries. Similarly, the National Association of Indian Doctors in
America (NAIDA) and Southern California's Indian Doctors' Clubs (IDOCs) represent all
South Asian physicians in the U.S.; and the doctors I interviewed emphasized the similarities
that all South Asians share.
4.
Deepak credits his mother, his friends, his nanny, and his high school Spanish classes for his
knowledge of Spanish. Deepak's mother is a Filipina immigrant, and, according to Deepak,
speaks a dialect with “a lot of Spanish words in it.” (Deepak's father, however, is a first-
generation Indian immigrant; and Deepak said that his primary ethnic identification is
Indian). When he was a child, Deepak had a Peruvian nanny, who, he said, was like an
adopted grandmother to him; and she spoke to him only in Spanish. Also, while growing up
in Southern California, most of Deepak's friends were “Hispanic,” and he took Spanish
classes all through high school.
Most of the other second-generation interviewees also mentioned formal classes and
interactions with Latinos –primarily patients in Southern California and in Latin America--
as the major sources of their Spanish language education. Unlike Deepak, however, they did
not credit parents or nannies for their knowledge of Spanish. (All but Deepak had parents
who were both first generation South Asian immigrants).

5.
Managed care facilities, such as health maintenance organizations and preferred provider
organizations, “ 'manage' or control the cost of health care by monitoring how doctors treat
specific illnesses, limit referrals to specialists, and require authorization prior to
hospitalization, among other measures. As providers in managed care plans, doctors would
have to work in accordance with the regulations and fee structure set by the plan that
employs them” (Cockerham 2004: 237).
Safety net providers are those that “organize and deliver a significant level of health care and
other related services to uninsured, Medicaid, and other vulnerable patients” (IOM 2000).
6.
“Deepak Chandramohan” is a pseudonym for the doctor whose patients often associated him
with Dr. Deepak Chopra, based on his name. The doctor's actual name does resemble
“Deepak Chopra” but not in the same way that the pseudonym does.
7.
MacStravic (1994) found that a number of factors influence patient loyalty to physicians (54,
55).
57
Chapter Three:
“They Didn’t Want Me to Get Ahead”: Occupational Discrimination
Dr. Pushpa Narayanan appears to be the classic immigrant success story. A first-
generation immigrant, Pushpa arrived in New York City in 1976 with a medical degree
from India but “no relatives, no job, no money --only $8” in her pocket. When I
interviewed Pushpa in May 2007, she was an oncologist (cancer specialist) and traveling
doctor of internal medicine who served prestigious hospitals and private clinics
throughout Southern California. Her house had a bathroom bigger than her first U.S.
apartment. And her son was following in her footsteps and studying medicine.
Yet Pushpa said that her life in the U.S. had been “rough and tough and
deprived...in many ways.”
Professionally...I’m right now frustrated because there’s a glass ceiling
[in medicine]. Even at this stage [of my career], there is discrimination.
I’m sure if I was an American physician, I wouldn’t have had this
much.... I think that the American male physician is the top of the
echelon.... My only wish is that the future generation, like my son, who
is American-born East Indian, doesn’t face the same discrimination.
Many of the other first and second-generation Indian doctors I interviewed
shared similar frustrations and hopes. Despite having achieved a high occupational
and class status, these Southern Californian doctors said that discrimination from
medical institutions, colleagues, and nurses had prevented them from enjoying the
same professional success as white-American male physicians. No matter how long
the interviewees had lived or worked in Southern California, they felt that
colleagues, staff, and medical institutions viewed them as Foreign Medical
Graduates (FMGs), not occupational citizens –non whites perceived to be both
58
professionally successful and economically beneficial to the U.S., and thus
deserving of most of the same rights and privileges as white Americans.
The Indian doctors I interviewed were perceived by other health
professionals to be professionally inferior and economically threatening –taking
away coveted medical positions from native-born white Americans. For the female
interviewees, this racial prejudice was compounded by gender discrimination from
not only non-Indian health care professionals, but also from fellow Indians.
In this chapter, I discuss the professional discrimination that Southern California's
Indian doctors experience from U.S. medical institutions as well as from other doctors
and nurses. In doing so, I demonstrate that Indian doctors' prestigious profession and
high class status do not protect them from occupational discrimination, as previous
scholarship in U.S. Immigration Studies, Asian American Studies, and the Sociology of
Occupations suggest. These non-white physicians, like their low-income counterparts,
are just as subject to racial discrimination; and this discrimination is not only inter-
occupational –coming from those above or below them in professional rank-- but also
intra-occupational, or coming from those who share their professional rank.
Moreover, Southern California's Indian female doctors also experience the
“multiple marginalities” and “intersectional discrimination” usually ascribed to
disenfranchised women of color in feminist scholarship (Anzaldúa 1987; Collins
2000; Crenshaw 1989; Espiritu 2008; Glenn 1986; Hondagneu-Sotelo 2007;
Hurtado 1996, 2003; Moraga 1981; Sandoval 2000). In this chapter, I show that an
intersectional approach is also applicable to the sociological study of non-white
59
female professionals, who, although not disadvantaged by class, still experience
both racial and gender subordination, often from colleagues in their same
occupation.
Institutional Discrimination
The most common form of occupational discrimination the interviewees
experienced was institutional, or attributable to the structural inequalities of an
institution (in this case, U.S. medicine) rather than the prejudices of a specific
individual or group (Feagin and Feagin 2003: 15; Hamilton and Carmichael 1967:
4). Four kinds of institutional discrimination were mentioned repeatedly in my
interviews with Indian doctors: 1. the requirement that all Foreign Medical
Graduates (FMGs) repeat their medical residencies in the U.S.; 2. the multiple,
cumulative marginalization of female FMGs; 3. glass ceilings that prevent the
selection of FMGs for administrative positions; and 4. Indian-American doctors
having to prove that their knowledge and credentials are equal or better than those of
white doctors. I explain each type of institutional discrimination below.
Repeating the Residency. The United States requires that FMGs complete a
medical residency at a U.S. hospital before allowing them to practice medicine
within its borders (AMA 2010a). For all of the first-generation immigrants I
interviewed, this meant that they had to repeat the post-graduate medical training
they had already completed in India –training that most believed was adequate for
practicing their chosen specialty in the U.S. Many of the interviewees resented
having to repeat these three or more years of residency training in the U.S.,
60
especially the first year of such training –the intern year-- for medical interns, as
newbies, are often assigned the grunt labor that more senior residents and physicians
do not want to do themselves. Dr. Parminder Batra, an anesthesiologist, said that her
medical internship year in the U.S. (1979 to 1980) was her roughest year in the U.S.
because of the number of hours she had to work.
My internship was very hard, and as an intern you sometimes have
12 hours on and 12 hours off. Now people have this [limited
hour] work week. We didn’t have that at that time. So there was
no limit upon how many hours an intern had to work. So an intern
was like a work horse of the whole medical structure. So, that
was a very, very rough year for me.
For some interviewees, the difficulty of having to work long shifts –common to
all medical interns-- was exacerbated by their foreign status. Dr. Pushpa Narayanan, an
oncologist (cancer specialist) and doctor of internal medicine, recalled that the hospital at
which she repeated her residency during the late 1970s took advantage of her desperation
for a job and her previous training in India to give her extra work not expected of other
interns.
I repeated my internship, which is the worst thing that can happen to
anybody. And I repeated my residency. Not only did I repeat it, but I
was taken advantage of, because...I was overqualified..... They [the
hospital] knew [that] back home [in India]... I had finished my
internship, finished my residency. So they knew I was capable. So
although it’s illegal, they made me as an intern man the emergency
room and then they put me on call every other night. That’s illegal... So
I was given extra duties because I had already been trained back
home.... Seriously, I could have taught...the rest of the interns. I was
well-trained. And I really feel that the internship and the residency did
not add to my knowledge. In fact, it added to my frustration and ill
health, because every other night you cannot function. And now it’s
illegal...to do that. Even then it was, but they asked me to write a note
saying that I will never complain to...[the] National Residents and
Interns [organization]. I would have done anything to get a job.
61
Thus, Pushpa felt continually punished for her foreign qualifications, even though
she believed that this previous training made her a better intern than her peers. Similarly,
Dr. Hari Subramanya –an oncologist and hematologist (blood specialist)-- felt continually
punished for his foreign attributes throughout his U.S. residency. His observations
suggest that his Jewish colleague's religious differences received more respect than his
Indian ones.
I was surprised that I was supposed to work weekends. I took all the
weekend calls, and there was a Jewish gentleman who was working
with me, and he said for religious purposes...[he] never took any calls.
He said that...Saturdays...are the day[s] of not using any...instruments.
He cannot drive a car. He cannot use the telephone. So, I was told to
cover for him a lot.... Even though I was off...I was supposed to cover
[for him]. And...whenever I gave a lecture, I was criticized much—I
felt that I was criticized much more than what my peers or my other
fellows were.
From the moment that they began working in the U.S., therefore, the first-
generation interviewees faced discrimination due to their foreign status. Repeating their
residency training, particularly their internship year, served as a daily three-year reminder
that both they and their medical training in India were considered inferior to U.S. medical
graduates and training. The interviewees' U.S.-trained peers, after all, did not have to
suffer the indignities of extra work and criticism in addition to the long hours already
demanded of all interns. First-generation Indian immigrant doctors clearly lacked full
occupational citizenship during their U.S. residencies, despite their professional
knowledge and qualifications.
Female and Foreign: Cumulative Disadvantage. Several of the female first-
generation immigrants I interviewed said that their experience of institutional
62
discrimination began well before their U.S. residencies. These interviewees were trained
in obstetrics-gynecology (ob-gyn) in India, where, as they noted, this specialty is
feminized or considered to be women's work. However, in the U.S. during the 1970s and
1980s –when most first-generation interviewees immigrated-- ob-gyn was one of the
most desired specialties among U.S. Medical Graduates (USMGs). Dr. Susheela “Sue”
Vellu explained that medical residency programs always prefer to admit USMGs before
FMGs, and only accept the latter when there is a shortage of the former to fill available
residencies. Thus, after being trained in ob-gyn in India, Sue, and many other first-
generation female interviewees found that there were no ob-gyn residencies available to
them in the U.S.; they had already been filled by USMGs. Consequently, these female
FMGs had to interview for residencies in the lowest-paying specialties least desired by
USMGs: psychiatry, family practice, and pediatrics (AMA 2008; Boulis and Jacobs
2008: 80, 81). Steered into ob-gyn in India because of their gender, these doctors were
quickly steered out of this specialty in the U.S. because of their foreign status.
Moreover, while pursuing U.S. medical residencies and hospital jobs, the first-
generation women again found themselves doubly disadvantaged by their gender and
foreign status. Afraid that young, foreign, female doctors were inexperienced and likely
to leave their positions once married or pregnant (Boulis and Jacobs 2008: 98-99), male
hospital administrators sought to intimidate the female FMGs during interviews and
subsequent communications. As Sue recounted, it was while she was pursuing her
current job as an anesthesiologist, in 1988, that a hospital administrator discouraged her
from taking the job, telling her that California does not welcome foreign, female FMGs.
63
I was approached by hospital owners here…while looking [for a job
in Southern California]. There was a white Italian man here, whom I
asked for an application, in anesthesia. I still remember he gave me a
firm, hearty handshake. I thought it implied acceptance.... Then I got
a phone call from the owner of the hospital, who was Jewish. He
wanted me to come back, because there was an opportunity for a job.
He loved gulab jaman [an Indian sweet], and he told me he doesn’t
care how good a surgeon I am as long as I make good gulab jaman.
At first, I was offended, but then I realized it was a joke. Then he
told me that the department doesn’t want outsiders.... but [that] I
should ignore any resistance to my coming.... [That's when] I saw a
different side of the head of the anesthesia department –[the] Italian
[man]. He was hostile and rude. I was shielded by the owner at my
side.... So, I went back to New York and...I received a letter from the
billing company that bills for anesthesia here, and it basically said
that I don’t belong here. [An old man from the company] told me on
the phone that I have three strikes against me: I’m a foreigner, I’m an
FMG, and I’m female; I won’t survive here in California. That
business has folded now, and the old man would probably turn in his
grave if he knew I became chairman of the department.
Many of the other first-generation female interviewees also recalled offensive
interviews and hostile male administrators who made them aware of the “strikes” against
them –their gender and their foreign status. They encountered these strikes not just in
California, but in hospitals throughout the U.S., indicating that discrimination against
foreign females was a widespread institutional phenomenon during the 1970s and 1980s.
“The Fs,” as several interviewees referred to them, reflected hospitals' concerns that their
patients and clientele would not readily accept foreign, female physicians, and that the
physicians themselves would quit. The hospital administrators themselves did not always
hold personal prejudices against these doctors (as was the case with the former owner of
the hospital where Sue works). As later sections of this chapter suggest, the second-
generation female interviewees also encountered institutional discrimination based on the
Fs, although it was usually expressed much more subtly.
64
Although Sue eventually overcame the double stigma of being a female FMG and
rose to a prominent position in her department, most of the first-generation female
doctors I interviewed were not so fortunate. Continually having to seek new job
opportunities in medicine had prevented them from establishing a career in one clinic or
hospital where they could build seniority and advance to administrative positions. Dr.
Sarita Joshi –trained in ophthamalogy in India but now working as a genetic counselor--
observed that her peers who had stayed in India were much more established in their
careers than she was in the U.S. If she had stayed in India, she mused aloud, she would
most likely be working independently or preparing to retire.
[O]nce you come here [to the U.S.], you realize that, ...you have...to
put in [a] lot more...effort into reestablishing yourself professionally.
Whatever we had done in India…I had to put in … five more years of
training to get to even a place where I could start working. Actually it
took me six, because the first year you spend trying to get through all
the exams and then you start applying, so it takes six or seven years of
training before you start. So it’s seven years of literally wasted time.
Whereas...all my friends who graduated from India and stayed back
home had established themselves professionally by the time I was even
able to finish my education and start working. So there was a-- there
is a big gap in where my friends are at this stage in life whereas where
I am at this stage in my life....And I think in India, it would have been
pretty easy for me to establish myself.... I don’t think it would have
been a problem. And so coming to the U.S., although [it] has not been
bad...I just feel that it’s taken me lot longer to establish...myself as a
clinician. [As far as] having my own private practice, I think I would
have been better off in India....Not that I haven’t done well. But I
think if I was in India, I probably would have retired by now. And I
probably would have had my own nursing home and done my own
things and been more independent than having to work for somebody,
like I’ve done here.
Several other first-generation female interviewees made similar observations; and
some were either still trying to establish themselves professionally (like Pushpa), or
65
considered themselves retired because health problems prevented them from continuing
to pursue a full-time career.
1
None of the first-generation male interviewees described
similar situations, as none had to pursue specialties completely different from what they
had studied in India. These men entered the U.S. under the sponsorship of a hospital
residency in their chosen specialty, and thus arrived with the status of occupational
immigrants. The women, however, usually immigrated as the dependents of their
husbands, with no official occupational sponsorship or status in the U.S. As Purkayastha
(2005b) explains, this dependent immigrant status haunts professional Indian immigrant
women throughout their U.S. lives., as they struggle to have their Indian credentials
respected. These women accrue what Purkayastha calls “cumulative disadvantage”
--barriers that accumulate in all major domains of their U.S. lives because of blocked
mobility in one domain (183). For example, the female FMGs' subordinate gender status
leads to their dependent immigration status. And this immigration status, in turn, results
in their financial dependence in the U.S., where, without the sponsorship of a U.S.
hospital, they have difficulty establishing independence from their husbands.
Moreover, as their husbands work hard to establish themselves in their
professional careers, the immigrant women are left to manage all domestic and child-care
responsibilities, including socializing the family into middle-class, white-American
suburbia (Purkayastha 2005b: 184). Without a network of family and friends to help
them with these responsibilities, the women find themselves with little time to pursue
professional careers of their own. Indeed, Dr. Parminder Batra said that she quit her job
66
as a clinical instructor for a teaching hospital in Southern California because she wanted
to have more time for her children.
I worked with [the teaching hospital] for a year but I did not want to
have a...steady [position with them]. I didn’t want to work for
[teaching] institutions...[because] for me, I feel guilty if
[while]...teaching residents...I didn’t study myself. And for that, I need
time and I didn’t have the time because I had two little kids at home.
Once I came back from work --I used to leave for work at 5:30 in the
morning...and...when I used to go back, which was around four, I
would be [in] bumper to bumper [traffic] and I would be kind of
dozing off because I have two little kid[s] at home. I didn’t get my
sleep because my son was [a] baby at that time. He would get up at
night and obviously I would be the one to go and try to calm him
down, and so that whole year when I worked for [the teaching
institution]...I was tired and sleep deprived.
Never did Parminder remark that her husband –also a physician-- made similar
professional sacrifices for the family. She was “obviously” the one to do so. Similarly,
although nearly all of the female interviewees with families spoke at length about the
difficulties of caring for their children while also pursuing medical careers, none of the
male interviewees even mentioned such difficulties. “The Fs,” therefore, not only
affected the female doctors in the professional sphere, but also in the private one. As
female FMGs, they were the victims of cumulative disadvantage.
Glass Ceilings. Scholars arguing against the thesis that Asian Americans are
model minorities have noted the “glass ceilings” that many Asian-American professionals
encounter while working for corporations (Cheng and Yang 2000: 475; Chou and Feagin
2008; Prashad 2000: 90; Woo 2000). Although these professionals are often able to
secure well-paying technical positions, institutionalized racism usually prevents them
67
from advancing to administrative or management positions. They hit a promotional glass
ceiling.
The Indian doctors I interviewed also hit promotional glass ceilings, despite the
lack of a clearly defined and publicly recognized hierarchy among physicians. As Dr.
Vitthal Tukaram –a head and neck surgeon-- explained, the barriers to advancement that
Indian doctors experience are not overt or readily identifiable; but they do tend to keep
these doctors out of leadership positions in hospitals, academic institutions, and
professional societies.
[A]t your level or higher I think...certainly you always feel as if there
may be a glass ceiling. Since, fortunately, most of our work is
autonomous, it doesn’t affect patients' care, or billing, or like your
actually getting money. But I think to an extent it might affect getting
opportunities for, like, say research or advancing in an academic career
and in professional societies --that there, there is a lot [of] buddy-
buddy type[s] of thing[s] going on. And again, I don’t know, maybe I
shouldn’t even say that, because I know several Indian immigrant
doctors --not those who are raised here-- [who] were fairly active in all
these places... So it might be in part sometimes just a misperception
that it is because of that. And there may be [other] factors also. Who
knows? But I think to an extent it definitely exists. Supposing, for
example, there is a project that needs to be done; and it is somewhat
prestigious or [there is] an award attached to it, or travel grant, or
something like that, I would imagine that if there is a director or
medical director who is...Jewish, probably [he would choose someone
else Jewish for a position]. Then again, you wouldn’t know if it was
really because of the Jewish guy's ability, and you are [not as]
experienced or qualified, or whether it was purely just racial. So you
always wonder. But it was never overt, that [someone] say[s], ‘Oh,
Indian. Okay, come tomorrow or don’t call up.’ It’s not like that, but
sometimes you would sense that may be there is something.
Like Vitthal, most of the interviewees described U.S. medicine's promotional glass
ceilings as subtle and difficult to prove, but still illustrative of institutionalized ethnic and
gender preferences. Nevertheless, the first-generation interviewees expected that the
68
second-generation Indian doctors, as USMGs, would not face such institutionalized
ceilings to promotion.
The majority of second-generation Indian doctors I interviewed were still too
early in their medical careers to qualify for leadership roles. As second-generation
interviewee Dr. Kimish Surat (a radiologist) remarked, however, there were few first-
generation Indian immigrants already in such positions to serve as role models for them.
[T]here’s so many Indians in the medical field, but as far as
being...discriminated against or …I don’t know if I necessarily have
like felt that but I definitely see it when I go to the different schools,
and I see that there isn’t an Indian chairman. There isn’t an Indian
who’s at the top of the chain.... [Y]ou don’t see that. And you see the
white guy, and you see the white, old man that is that role. When I
went to interview in Boston, I remember particularly being in a big, big
office and…I wonder[ed] if an Indian could ever get to this point, you
know, would it be possible? I think now in our generation it’s going to
become more and more possible...
The “buddy-buddy” system that Vitthal described precludes this possibility,
however. If established physician leaders tend to choose people of their same race and
gender for promotions, then second-generation Indian doctors will be subject to the same
institutionalized racism, sexism, and resultant glass ceilings as the first generation.
The Second-Generation Burden of Proof. Indeed, several second-generation
interviewees told me that during their medical training and interviews, they were
considered to be less qualified than their white peers, despite their U.S. education.
Confused and conflated with Indian FMGs, these doctors said that they consistently had
to prove their American credentials and medical competence. Because of their race, U.S.
institutions of medicine still treated them as inferior outsiders. Dr. Raja Murali –a retina
69
eye specialist-- felt that he had to work much harder than his white-American peers to
receive positive attention from his mentors while on a medical fellowship.
...[T]he physicians who were my mentors…were racist… They had to
overcome their own cultural biases.... I had to be better than any of my
white compatriots to get their attention. Much better. Another two
grades better, and you have to fight that on a day-to-day basis. Your
judgment’s always [in] question…and they treat you badly and they
put you down…Your opinions don’t matter because they come from
you and not the content of your knowledge base …You find all those
things. ... You always have to keep your guard up because if you say
something it can be used against you, and you’re always fearful, and
it’s a terrible thing. It’s the unspoken. You’re always an outsider, even
though you’ve been trained here at better places than your colleagues.
…They feel threatened by somebody who’s intelligent and probably
has worked harder to get there, and…therefore has more knowledge
and so on. So it creates…a very untenable situation because the new
kids who come to town are better qualified than the people who lived
there because they have to get through all of this. They’re better than
the local guy and then how can the local guy treat them fairly because
he’s not worthy? It’s just a very kind of ironic situation.
Raja's observations suggest that established white-American doctors seek to make
Indian-American physicians feel medically inferior because the younger doctors are
actually medically superior. Believing that the young, non-white physicians threaten
both their professional power and their racial privilege, the older white doctors
subordinate the Indian Americans as outsiders to U.S. medicine, thereby perpetuating its
institutionalized racial hierarchies. Had Raja's mentors been first-generation Indian
immigrants, he would have likely had a much better fellowship experience.
Pediatric neurologist Smitha Bhalala's non-Indian mentors felt similarly
threatened. But rather than treating Indian-American doctors as inferior, these mentors
treated them as model minorities, expecting them to “naturally” perform better and work
harder than their white peers. Smitha's instructors seemed to be testing the Indian-
70
American students, as if asking them to prove that they were deserving of their
prevalence in U.S. medicine.
I wouldn’t say it’s overt, but I think throughout our practice and
experience and training, there is some amount of prejudice, like, “'Oh,
there are too many Indian doctors.' So more of a contradiction than one
would expect of, 'Oh, she’s a woman, she’s not gonna be as good.' It’s
more of an offensive thing...especially [from] those [doctors that are]
in the training process. I think from experience they feel that we are
high achievers, and they feel somewhat threatened by that. So it seems
like to them a little bit of an unfair advantage. We were also expected
to work harder in that anticipation. But it’s nothing that’s ever taken
— ...It’s never anything that’s said overtly. But you do feel the pressure
and you just do the best you can. And that goes on even until today, in
your referrals and your doctors --the physician community at large.
Thus, despite the first-generation interviewees' hopes that the second generation
would experience professional equality, the second generation continued to experience
institutional discrimination in U.S. medicine. Although USMGs by training, the second-
generation interviewees were still seen to be FMGs because of their race. Reduced to the
stereotypes of either “perpetual foreigners” or “model minorities,” these Indian-
American physicians had to prove not only that they had American credentials but also
that they were deserving of these credentials. This discriminatory treatment, while often
occurring in medical institutions, reflects the individual prejudices and fears of
established white physicians as much as the institutionalized racism of U.S. medicine. It
therefore resembles the discrimination that interviewees said they had experienced from
their physician colleagues, which I discuss in the following section.
Discrimination from Colleagues
In addition to experiencing institutional discrimination, many of the Indian
doctors I interviewed said that they also experienced individual discrimination from
71
colleagues who were equal to them in status --including other Indian physicians. The
interviewees described two major types of intra-occupational discrimination from
colleagues: 1. white physicians referring patients only to other white doctors and 2.
established physicians treating the first-generation females poorly in an attempt to
maintain the white male dominance of U.S. medicine. I explain each type below.
Referring to White Colleagues Only. Those interviewees who did not become
hospitalists but started or joined a private clinical practice experienced little institutional
discrimination after their residency years. Nevertheless, private practitioners who saw
patients only by referral noted that initially white doctors would not refer patients to them
but to other white physicians in their same specialty. Drs. Peter and Linda Johns
--married but specializing in different fields (urology and physical rehabilitation
respectively)-- experienced such discrimination early in their careers.
Peter: I was...the second or third non Caucasian or colored [sic] person
to practice here. So it was a shock for...not patients. It was the
referring doctors who were afraid to send their patients to me, thinking
that if they send...[them] to me the[ir] [patients will] think that [they
are] sending...[them] to an inferior doctor or whatever it is. So it took
me ten years.... She [Linda] got accepted much faster than I...got
accepted, I think.
Linda: Hey, it’s not that! I think the patients don’t have a problem.
Peter: It’s the referring doctors.
Linda: It is really...the referring physicians...that takes a little time to
accept you.
P: They’re worried [about] what will happen, you know.
L: In the private community, you surely do have to prove yourself....
And, once they see your work, then they do not have a problem.
72
P: And me being a surgeon.... It took a much longer time....because
suppose you have to have an operation, the first thing you say is, ‘Well,
[to] whom should I go?’ And, you know, you run to...somebody who is
already known or, you know, white people...They always like to go to
somebody like [them].... So it took me almost eight to ten years before
I was accepted by the referring physicians as well as the colleagues.
Several other first-generation immigrant interviewees shared similar experiences,
recalling that white colleagues preferred to stick to “somebody who is already known”
and referred their patients and their work to other white doctors, even if their patients had
no objection to seeing an Indian specialist. This was especially the case for the female
first-generation interviewees who were not only among the first “non Caucasian” doctors
to practice their specialty in Southern California, but were also among the first female
doctors in their specialty. These women found themselves temporarily defined by “the
Fs,” but like Peter and Linda, said that once they had proven to be good physicians, they
began to receive referrals from white colleagues.
A few second-generation interviewees, however, said that their white colleagues
still referred patients to white specialists in their field, even though Indians were no
longer new to medicine in Southern California. Dr. Smitha Bhalala --a pediatric
neurologist who sees patients by referral but as a member of a Health Management
Organization (HMO)-- told me that such race-based referrals were not uncommon among
private practitioners.
In your referrals and your doctors, the physician community at
large--... I wouldn’t want to call it cliquish, but it tends to migrate in
that direction. So for example, Caucasian physicians referring only to
other specialists who are Caucasian, keeping it in the group. It
becomes a little bit competitive. I’m not in private practice in that
regard, but I do see it.
73
Thus, although discrimination in the form of colleagues' race-based referrals was
hardly as professionally crippling as institutional forms of discrimination, they did delay
the establishment of several interviewees' private practices (such as Peter's). They also
demonstrated to the interviewees that they can experience occupational discrimination
from those equal to them in status.
Maintaining the Good Ol' Boys. U.S. medicine has traditionally been a white,
male-dominated institution (Allen 2005; Boulis and Jacobs 2008: 7). But the increasing
presence of non-white, female physicians appears to threaten the privileged status of
white, male doctors. Afraid of experiencing a loss of status, some white male physicians
are racist and sexist towards their female Indian counterparts. Indeed, Dr. Susheela
“Sue” Vellu recounted all the ways that both the former chairman of her department and
his “cronies” explicitly expressed their dislike of her gender and foreign status.
There are many people in the operating room who think I came here [to
the U.S.] because it is great and the place I came from [India] is
nothing, so I should be very grateful to them for me to be able to work
with them. These are mainly the friends of the old man, the chairman
of the department.... There was an Indian lady before me, in pediatric
anesthesia. She had a thirst for cases and would solicit for them. The
[department’s] dislike of her spilled to me.... For the first two years
here, no one talked to me, none of the anesthesiologists, or even gave
me a potty break. The day I arrived, they recruited an American
cardiac anesthesiologist from Harvard, just to put someone in
competition with me. Fortunately, we both worked out very well. But
then he [the other cardiac anesthesiologist] left.... [F]or eleven years I
was the only cardiac anesthesiologist here, working nonstop. But the
chairman and his entourage of nurses never changed their treatment
towards me. The chairman used to scream at me at meetings. He had a
low opinion of females.... He couldn’t accept a female as having as
much or more ability than him.... When I joined the Medical Executive
Committee, which was in need of a female perspective, he had a hard
time accepting it. He was the chairman of this quality assurance
74
committee for four years.... As a woman, you need more validation of
your credentials than a man for the same position.
In the eyes of the former chairman, Sue's gender and race defined her. She was
judged not by her medical abilities but by the actions of the Indian woman who had
preceded her. Moreover, the racism and sexism Sue endured came not only from the
chairman himself –a white man-- but also from other members of the department,
including women. These other members depended on the favor of the white, male
chairman for their professional success and survival. They therefore contributed to his
racist and sexist treatment of Sue, and upheld his white, male privilege.
Indian immigrant male doctors also contributed to the sexist treatment of their
female counterparts, as several interviewees observed. Indeed, Dr. Pushpa Narayanan
noted that those colleagues who had discriminated against her the most were Indian men
who regarded her as competition for their positions. Although Pushpa interpreted this
discrimination as sexist and not racist (after all, the Indian male physicians shared her
race), race certainly played a role in their hostility. In addition to representing
competition for the favor of white colleagues –who would likely disapprove of too many
Indian FMGs in one department as constituting a “yellow peril” (Wu 2003: 13-14)--
Pushpa represented an opportunity for the Indian male doctors to reproduce the gender
hierarchies that privileged them in India (George 2005). Thus, she was not only the
victim of her Indian male colleagues' sexism, but also their racism.
Prejudice and Discrimination from Staff
The Indian doctors I interviewed also experienced hostile treatment from health
care professionals clearly below them in rank, particularly nursing staff. Although nurses
75
did not possess the same medical authority as doctors –and were the doctors' subordinates
(Lorber 1997: 39)-- they too, like many physicians, assumed that the interviewees were
FMGs with inferior training from abroad. As a result, several interviewees said that
nurses respected them less than white physicians. In conjunction with nurses' well-
documented gender bias against female doctors –whom they often regard as being too
authoritarian for women, and too great a competition for male doctors' favor (Floge and
Merrill 1986: 938, 941; Boulis and Jacobs 2008: 200)-- nurses' racial bias caused the
female interviewees to feel especially marginalized among medical staff.
Assumed to Be Inferior. Dr. Raja Murali, a second-generation physician, recalled
that during his residency, he and another Asian doctor experienced racial discrimination
from nurses. These nurses, Raja implied, associated the doctors' Asian race with a
foreign medical education, while assuming that white doctors received superior medical
training in the U.S.
At hospitals...ethnicity sometimes matters with nurses. They treat you
differently sometimes.... There’s more difficulty sometimes. This was
true in residency when I was here with the Caucasian nurses and an
Asian physician because they feel, 'You’re not the same as a white
physician.' Because they’re not as educated...some of that racism
filters through. And it’s not that they’re nurses. It’s just that they’re
not as educated.
Raja believed that if nurses were more educated they would know that not all
Asian doctors are FMGs and that Asian physicians are equal to white physicians in
medical competence. However, considering that many of the interviewees' physician
colleagues (including Raja's) are highly educated yet still treat Indian doctors as inferior
physicians, nurses' educational level likely has little to do with their racism. Rather,
76
prevailing U.S. stereotypes that all Asian Americans are foreigners and that a foreign
education is inferior seem more responsible for the nurses' bias.
Moreover, as first-generation immigrant Dr. Sue Vellu suggested, many native-
born American nurses resent FMGs for outranking them in professional status after
having been educated abroad. The predominantly African-American staff at the hospital
where she completed her residency seemed to begrudge Sue --a recent non-white
immigrant-- her high occupational status; for they were her subordinates despite their
American upbringing and U.S. training: “...[D]octor or nurse --the majority of people in
the hospital were African Americans. They tend to look down on you, to some extent.
They do not respect you. You’re just there [at that hospital] from some other country
because you couldn’t make it there [in that other country].”
Sue's explicit mention of the hospital staff's race implies that African-American
nurses resented Indian FMGs' high occupational status not only because of the doctors'
foreign training, but also because of their shared minority status. The nurses appeared to
have trouble respecting the authority of a doctor who, like themselves, was not white, and
yet was professionally superior to them after only a short time in the U.S. Thus, they
treated Sue as if she were inferior to U.S.-trained physicians, most likely out of envy and
a sense of injustice. As the next section shows, the shared gender of most nurses and
female FMGs often exacerbates these feelings. Female nurses of color rankle under the
authority of foreign-trained physicians who share their minority status and gender but
supersede them in professional status.
77
Gendered Racial Resentment. Dr. Almas Mirza –an Indian-American doctor of
family medicine-- is not an FMG. But she is of the same ethnicity and gender as the
nurses with whom she has the most trouble communicating. After first noting that “it's
pretty well known and...documented that female nurses...treat female physicians with less
respect...and are much friendlier with male doctors,” Almas observed that the nurses with
whom she'd had the most trouble establishing her authority were first-generation Indian
immigrant women. Almas explained that she had difficulty giving orders to Indian
women of the same age as her parents and her parents' friends. “I have trouble telling
them what to do and being an authority figure with them,” she said. A young Indian-
American woman giving orders to older, first-generation Indian immigrant females
completely overturns the age hierarchies of the Indian ethnic community. Although such
hierarchies –and the expectation that youth respect their elders-- exist in most ethnic
communities, the Indian-American community often touts this “family value” as being
especially important to Indians, and one of the reasons for their model minority success
(Kurien 2007: 81, 84). Thus, both Almas and the older Indian nurses resist upsetting the
age-based authority of the nurses, even though the professional hierarchies of U.S.
medicine require that they do so. Here, not only are the shared gender status and shared
minority status of a doctor and her nurses potential sources of resentment, but also the
difference in age, with the younger doctor exercising power over older co-ethnic nurses.
As Dr. Sue Vellu remarked, however, age and ethnicity matter less than gender
and foreign status in evoking the resentment of female nurses. For Sue, “the Fs” once
again marked her in her professional interactions, this time with subordinates who felt
78
that they were more deserving of Sue's medical authority than was Sue –a foreign-trained
female.
Wherever you go, nurses have bias, especially against females and
female physicians, and god only help you if you’re a foreigner. You
have to phrase things carefully and be polite. Otherwise, the 'b-word'
comes right out. And you have to do three times more proving. But a
male doctor can do anything. Every sin committed is forgiven with a
hug or compliment.
Thus, the first-generation female doctors are the most disadvantaged of all the
interviewees, not only institutionally and among colleagues, but also with those below
them in medicine's occupational hierarchy. Although not directly able to determine the
first-generation females' advancement in medicine, nurses' non-compliance often means
that the interviewees themselves have to perform tasks that the nurses willingly complete
for male doctors (especially white male doctors). Indeed, several first-generation female
interviewees mentioned having to do “nursing duties” (such as finding and arranging
medical supplies and setting up equipment), particularly during their residencies and
early years as U.S. physicians. This extra work occupied time that they could have spent
on professional activities that would improve their chances of medical advancement –
activities like adding to the patients under their care, or socializing with colleagues in
leadership positions. Health care professionals below them in occupational status, as
much as professionals equal to them in status, therefore, contribute to the cumulative
disadvantage of the first-generation females.
79
Conclusion
Seemingly immigrant success stories, the Indian doctors I interviewed were not
immune to professional discrimination based on their race and gender. Although
members of one of the most prestigious occupations in the U.S., Indian doctors lacked
full occupational citizenship, or social acceptance based on their economic achievements
and professional status. Medical institutions, colleagues, and staff consistently treated
them as foreign outsiders but often in subtle ways that were not readily identifiable due to
the lack of established occupational hierarchies in U.S. medicine. Indian doctors often
experienced discrimination from physician colleagues equal to them in status --not
clearly above them in rank-- and thus were victims of intra-occupational discrimination
as much as inter-occupational discrimination (or unequal treatment from health
professionals above or below them in status).
First-generation Indian female doctors were particularly subject to both intra- and
inter-occupational discrimination based on their gender, race, and foreign status. “The
Fs” --being Female and Foreign-- defined these doctors more than their medical
credentials and skills, not only in the professional domain but also in the private sphere.
These doctors suffered from what Purkayastha calls cumulative disadvantage (2005b), or
marginalization in one area of life that leads to marginalization in other areas as well.
Even health care professionals below them in status, nurses, contributed to this
disadvantage by refusing to comply with their orders out of resentment for their high
professional status. Thus, first-generation Indian female physicians are the perpetual
foreigners of U.S. medicine. They rarely experienced occupational citizenship.
80
The professional discrimination experienced by the second-generation Indian
physicians as they become more established in their medical careers remains to be
studied. So too does the professional discrimination experienced by Indians in other
prestigious professions without publicly recognized hierarchies, such as law.
81
Chapter Three Endnotes
1.
Other than Pushpa, the first-generation female interviewees who were partially or fully retired
due to health problems rarely spoke in detail about these problems. And I did not ask them to
do so. Considering the many professional difficulties that these women faced, however, I
would not be surprised if their health problems resulted at least in part from work-related
stress.
82
Chapter Four:
Without the White Coat: The Gendered Occupational Citizenship of
Southern California’s Indian Doctors
Dr. Smitha Bhalala, an Indian-American, has spent most of her life in Southern
California. In my June 2007 interview with Smitha, she told me that while she was
growing up in the region, her peers often thought she was “African or Samoan or any
other ethnicity that they were familiar with” because of her “darker complexion” and
“curly hair.” If she told them she was Indian, they would ask, “ ‘What Indian are you
talking about?’ ” “They didn’t know Indian from American Indian,” she explained. But
after becoming a physician, Smitha said, she rarely encountered such racial
misidentification, especially when wearing her white doctor’s coat in clinical settings.
According to Smitha, Southern Californians are very accustomed to seeing Indians in the
role of doctor.
Smitha’s experience was common to many of the other Indian doctors I
interviewed, who also described being racially misidentified in public contexts of
Southern California but hardly being questioned about their ethnicity once they literally
or figuratively donned their white doctor’s coats. In this chapter, I show that such
contextually-dependent experiences of racialization point to a defining social tension in
the lives of Southern California’s Indian physicians: their non-white racial ambiguity
often results in their being racially lumped with some of the most socially marginalized
groups in the U.S. –usually Latinos, Blacks, and Middle Eastern Muslims—yet their
occupational status is higher than that of much of America’s white majority.
1
Indeed,
83
Indians –who constitute 7% of U.S. physicians but less than 1% of the U.S. population
(AAPI 2009; AMA 2009b; LIFS 2009a; U.S. Census Bureau 2009)-- are so
overrepresented in contemporary U.S. medicine, recent studies (Akins 2007; Purkayastha
2005b) suggest that medical care is as much of a publicly recognized ethnic niche
occupation
3
as is domestic work for Latinas (Hondagneu-Sotelo and Avila 2003),
gardening for Latinos (Catanzarite 2000), and nursing for Filipinas (Choy 2003).
However, whereas domestic work and gardening carry little prestige (Parreñas 2001;
Catanzarite 2000, 48), and nursing is not known to pay well (Gordon 2005), medicine –
due to its very selective training and concern with saving lives-- is often considered to be
one of the most prestigious, highest-paid occupations in the U.S. (Cockerham 2004, 207-
208). Even engineering and information technology --two other high-paying occupations
in which Indians cluster
2
—do not carry the same prestige (National Science Board
2002); for, although both are economically respected, they do not garner the high social
respect accorded to medicine (Hirning 2009).
To resolve this lived contradiction between the stigma of their racial ambiguity
and the prestige of their ethnicized profession, the Indian doctors I interviewed
continually highlighted their occupational status and, consequently, their racial and class
difference from socially marginalized non whites. Physically resembling these
disadvantaged non whites more than their model minoritized Asian-American
counterparts, the doctors’ honorary membership in whiteness lies in their occupational
status. They are occupational citizens
4
–minorities with access to most of the same rights
and privileges as white Americans only when perceived as being both professionally
84
successful and economically beneficial to the U.S. In public settings of Southern
California --where, without their uniform of the white coat, the doctors’ occupational
citizenship is not readily apparent—Indian doctors must always be prepared to make their
occupation known.
As with domestic work, gardening, and nursing, however, medicine is not only
ethnicized but also gendered. Despite the growing number of female doctors in the U.S.
(Boulis and Jacobs 2008), the stereotypical image of a physician is still that of a
heterosexual man (Bowen, Wang, and Brown et. al. 2008, 16; Morrall 2009, 176). The
Indian doctor is especially subject to this stereotype, as suggested by the much greater
celebrity of Indian male physicians (such as Dr. Sanjay Gupta of Cable News Network,
best-selling author Dr. Atul Gawande, and Dr. Deepak Chopra of alternative medicine
fame) than Indian female doctors in the U.S. Not surprisingly, therefore, only the male
doctors I interviewed enjoyed full occupational citizenship. The female doctors, in
contrast, said that revealing their profession in non-clinical spheres often stigmatized
them as threats to both White and Indian male hegemony.
In this chapter, I discuss the public contexts of Southern California in which the
doctors’ gendered occupational citizenship determined their interactions with others:
driving on suburban streets and traveling by plane, for the men; but gaining acceptance
into social and professional groups, especially from fellow Indians, for the women.
Previous sociological literature on Asian-American professionals pays little attention to
the role that occupational status plays in their racialization and gendering, particularly in
non-professional realms. I end the chapter with an analysis of the one social context in
85
which both the male and female Indian physicians enjoyed occupational citizenship
equally in a consumer-driven nation (Ewen and Ewen 1992, 51): shopping.
“I Didn’t Get a Ticket Because I Had a White Coat”: Second-Generation Males and an
Occupational License to Drive While Brown
The occupational citizenship of Indian male doctors is most evident in the
encounters that my second-generation male interviewees have had with the police, not
only in Southern California, but also in other urban regions of the U.S. Several said that
they had been stopped by police officers for “Driving While Brown” (DWB) (Mucchetti
2005).
5
But once the officers came to know the doctors’ occupation, they let them go.
These encounters show that young Indian men risk being racially misidentified as those
labeled “the superpredators” of U.S. society --young, urban Black and Latino men (Rios
103-104, 2008)—whenever they do not make their ethnic or professional status readily
apparent.
Indeed, Dr. Sunil Subramanya told me that he is frequently stopped by White
policemen, who racially profile him as “suspicious” when he is driving in predominantly
White neighborhoods of Southern California. He recalled one such incident of being
pulled over by a White cop for DWB in a wealthy White beach community.
I was going out at…eleven o’clock [at night]… I was driving [my
older sister’s] car, and it was…kind of a run-down car, and I was
looking for parking…[in] pretty much a strip of White…bars and
stuff – …it’s a pretty wealthy neighborhood… And this White cop…
followed me for like five blocks, and then he pulled me over. So he
was like… ‘You look suspicious,’ and I was like, ‘What do you mean
I look suspicious?’ And he…asked for my driver’s license,
registration… [My] driver’s license was expired (laughs)…And my
registration – I think I couldn’t find it – it was [my sister’s] car. And
86
then I had insurance or something, but he had it all, and he said, ‘I’m
going to run this.’
But the cop didn’t “run” anything, because when he shined his flashlight into the
back seat of the car, he saw something that cleared Sunil of all suspicion and legitimated
the young Brown man’s presence in a wealthy white neighborhood.
…[M]y white coat, which is the doctor’s coat, was in the back of my
car seat, so…he shined…[his] [flash]light in my backseat and I had
my stethoscope and my white coat, and he’s like, ‘What’s up with all
the doctor paraphernalia?’ And I was like, ‘I am a doctor.’ And I
had…my ID hanging on my white coat, so I handed it to him, and I’m
like, ‘I’m a resident at [names local hospital].’ And he…handed back
all my stuff, and he just started apologizing. He was just like, ‘Look,
I’m so sorry.’
Sunil’s experience clearly demonstrates the power of occupational citizenship in
the U.S. Physicians, as high-earning Samaritans, are so revered that the police officer not
only apologized to Sunil for his unwarranted racial profiling but also overlooked Sunil’s
lack of current license and registration. At the same time, the police officer’s response
indicates how strongly Americans associate non white men with illegal or unprofessional
activities. The officer initially assumed that “the doctor paraphernalia” did not belong to
Sunil. Not until Sunil showed him his hospital identification card did he even stop to
consider that Sunil might be a legitimate working professional. Outside of clinical
settings, therefore, young Indian male doctors have very limited social citizenship. Only
when racially whitened by their occupational citizenship –the white coat—do they have
ready access to White-American spaces.
Social citizenship is even more restricted when young Indian men dress in urban,
hip-hop style clothing, as Dr. Kimish Surat’s experience suggests.
87
When I dress socially, I don’t dress like a professional, as far as a
doctor…so you know I dress very hip hop… I’ll wear baggy pants,
baggy jeans or a hat and things of that sort. I may not come off as
this doctor, or what an impression of what a doctor should look like…
So I think a couple times I was driving…in New York, and I [was]
pulled over…. When…[the police] saw a white coat hanging on the
side of the door, they would ask, ‘Oh, are you a doctor?’ And when
you said you were a medical student, they changed their entire
demeanor towards you…. And I actually didn’t get a ticket because I
had a white coat in the seat next to me.
Thus, hip-hop apparel becomes incriminating on the bodies of young Brown men,
because Americans are socialized to understand this clothing as the chosen “uniform” of
Black and Latino gang members (Lacy 2007; Lehn 2009; Maira 2002; Perry 2009). At
the same time, they are socialized to believe that the white doctor’s coat is the chosen
uniform of those perceived least likely to engage in criminal activity – White Americans
(Bowen et. al. 2008, Harris Poll, 2006). Young Brown men who choose to include both
of these racialized uniforms in their daily wardrobes partially defy the social assumptions
of most Americans, particularly Whites (who themselves can usually sport a “gangsta’”
style without fearing criminalization) (Lacy 2007, 74, 76; Wald 1996, 162).
Nevertheless, these young men’s adoption of both uniforms also helps to reinforce
Whites’ assumption that the social worth of Americans of color lies only in their
occupational contributions. According to this assumption, non-white Americans are only
occupationally acceptable, as participants in the formal U.S. economy, but they are
otherwise undesirable and suspected of illegal and anti-(White) American activities
(Espiritu 2008; Glenn 2002; Park 2005). After being repeatedly seen as suspect, Indian-
American male doctors learn that in order to be allowed social access to white-America –
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to show that despite their youth, gender, skin color, and style, they are good Americans—
they must always be ready to prove their occupational citizenship.
Indeed, Dr. Deepak Chandramohan noted that after experiencing the “same old
rigmarole” of being stopped for DWB as a high school student –when, lacking any
occupational citizenship, he would have the police call his Dad (a local businessman) to
vouch for him—he now “instantly” drapes his white doctor’s coat on the driver’s seat of
his car.
I think after…[getting pulled over] used to happen to me…a lot in
high school…and once as a [college] student, I tried to be more—I
don’t know, I think maybe subconsciously I put my clinic jacket on
the back of my seat, so I don’t encounter that…. Maybe it’s just my
subconscious, so I don’t have to deal with it. I always just instantly
put my clinic jacket on the back of my seat, or I’m wearing scrubs
anyway.
In “subconsciously” using signs of his occupational status to “try to be more” of a
“model minority” and less of an angry Brown man in the eyes of White Americans,
Deepak is distancing himself from those Blacks and Latinos who may not have a uniform
that serves as ready proof of their occupational citizenship in the U.S. Deepak's scrubs
and white coat, always placed in a conspicuous location while he's driving, serve to
distinguish him from other, “criminal” Black and Brown men. It is the same message
conveyed by Kimish’s recent trading in of hip hop style for a “toned down,” “more
typically casual” dress as a medical resident. To gain social acceptance from White
America, these men feel they must suppress any sign of identification or solidarity with
marginalized Blacks and Latinos, but must instead visibly demonstrate their occupational
worth and loyalty to the U.S. –their conformity to the “model minority” stereotype.
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In her study of Indian-American college students in New York, Maira (2002, 70)
also found that young second-generation men’s identification with hip hop culture tends
not to last beyond their college years. According to Maira, pressure from the Indian
immigrant community to assimilate into the professional, white collar culture of America
is mostly to blame. However, my interviews with young Indian-American male doctors
suggest that this pressure also comes from White society, which requires that these
doctors disassociate themselves with Blacks and Latinos and associate almost entirely
with their occupational identities in order not to be treated like criminals in non-
professional realms.
“After You Say, ‘I’m a Doctor,’ They Realize You’re Not Some Hijacker”: First and
Second-Generation Males and an Occupational Passport to Fly While Brown
After the terrorist attacks of September 11, 2001, urban streets are no longer the
only non-professional realm where the second-generation male interviewees have had to
prove their occupational citizenship. Airports are another realm where these interviewees
are profiled as criminals, until they reveal their occupational status. Here, however, they
are suspected to be Muslim –an entire religion that has been demonized as terrorist and
racialized as Brown since 9/11 (Joshi 2006, 97). As Dr. Chander Baroda observed,
brown skin and male gender alone place travelers under suspicion in airports: “One time,
a few of my friends…[and I] went on a trip to Jamaica, and it was…two Indian guys, a
Persian guy, and a…guy who was – he’s like half-Indian, half-Iraqi. Four of us went, and
we got searched because…well, obviously, they… [thought] we’re Muslim.”
But this is “obvious” only in the context of post-nine eleven U.S. air travel, in
which all passengers who racially resemble South Asian or Middle Eastern men and have
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“exotic” names are suspected terrorists (Chou and Feagin 2008; Joshi 2006). In this
context, America does not fear the young, Brown man in hip-hop clothing –indeed, such
clothing could be seen as demonstrating an allegiance to American culture (Maira 2002,
73). America fears the Brown man who seems “too foreign” because he displays some
cultural or religious loyalty to a non-Christian faith (Chou and Feagin 2008; Joshi 2006).
Thus, the first-generation male interviewees, only one of whom identifies as Christian,
are especially subject to racial profiling while traveling. Dr. Anand “Andy” Patnaik, a
first-generation male doctor, recalled helping fellow passengers find pillows during a
flight he took about a year after nine eleven, only to find out later that his assistance had
scared them.
I was flying and…I didn’t go and sit down…[right away]… People
were looking…[for]…the pillows… I knew where the pillows were
so I went and gave [them out]:…‘Here…[are] the pillows… Anyone
else want…a pillow?’ And I was standing and moving….It was about
within a year or so of 9/11… So after a while the hostess came and
she sat down, started talking. She was very nice. She said, ‘You
know, some people complain[ed] about you…because they were
afraid.’… And my [white-American] wife was there too.
So strong is the post-nine eleven fear of Brown immigrant men on airplanes that
both Andy’s friendliness and the presence of his white-American spouse did little to
convince fellow passengers of his innocence and loyalty to the U.S. To Andy, even just
mentioning that he is a doctor didn’t seem enough to assure the forthright air hostess of
his harmlessness; he felt that he had to specify the particularly patriotic character of his
occupational citizenship by sharing his military title and perhaps even showing his
military identification card as proof of his twenty-one years of medical service for the
U.S. Army Reserves.
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I said [to the hostess], ‘Okay, well, don’t worry…. If you get a
chance, tell them [the passengers] they are in safe hand[s]. I am a
colonel in the U.S. Armed Forces. I can be protective to them.’ So
she laughed and she said, ‘Do you want to have a drink or
something?’ … [So] it resolved [itself] right on the spot… I am sure
people are fearful by seeing [me] but …when I show…my U.S. Army
thing as ID, people have said, ‘Thank you for serving the country.’…
[That makes me] very happy because [everyone] feel[s] safe…in the
aircraft.
Andy thus relied on literal proof of his occupational citizenship in the U.S. to
trump his frightening foreignness and affirm his status as a patriotic model minority –to
cover his dark skin with a White mask (Fanon 1967). Most of the male doctors I
interviewed did not possess such proof of occupational citizenship, however, nor did they
travel by plane with their white coats in full view. Once on an airplane few were given
the opportunity to disclose their occupation, so, like Dr. Peter Johns (first generation and
Christian), they watched fellow passengers move to seats farther away from them; or, like
Dr. Kimish Surat (second generation), they silently suffered suspicious stares throughout
their flights. But when allowed to reveal their occupations during airport searches,
several second-generation interviewees said that simply mentioning their professional
status was enough to win the trust of airport security. Indeed, Dr. Sachin Malwani was
emphatic in claiming that occupational status alone clears Brown doctors of any and all
suspicion, whether from police on the street or airport security.
I get screened at airports all the time, because I’m young and brown
and I could pass for Middle Eastern. I get brought aside and patted
down…all the time….not every single time, but often enough to
where-- …if you go to these airports, or if you deal with the police
and you say, “Look, I’m a doctor, here’s my license,” of course
they’re gonna treat you differently after they realize that you’re not
some hijacker or gangster or whatever driving through a ‘hood….
[You’re] let go because obviously you’re an upstanding person.
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According to Sachin, doctors are assumed to be “upstanding” people in the U.S.
In telling airport security or the police that he’s a doctor, Sachin believes he is also
expressing his commitment to the general health and welfare of America; and how could
someone who has taken the Hippocratic Oath want to hurt others? The security and
police who had questioned him and other second-generation male doctors shared this
belief, although whether they still do, after seven doctors were among the terrorists
responsible for the July 2007 attempted car bombings in the United Kingdom (Landler
and Lyall 2007), remains to be seen. What does seem certain is that Sachin and other
second-generation male doctors have a smaller burden of proof to convince airport
security of their patriotism than do the first-generation male doctors, who must
compensate for considerably more “un American,” foreign attributes: “strange”
mannerisms and expressions; accented English; and perhaps a long, non-biblical name
that is difficult to pronounce. These first-generation male doctors are required, like
Andy, to provide greater evidence of their occupational citizenship in the U.S. than just
their word. And this evidence has to demonstrate that they share more in common with
White Christians than they do with Muslims, or with America’s racialized perception of
Muslims. According to this perception, all Brown Muslims are potential terrorists; and
terrorists, like Black and Latino gang members but unlike doctors, are assumed to be
immoral and unprofessional (Joshi 2006, 98; Lacy 2007). Indian male doctors reinforce
this perception every time they use their occupational citizenship to distinguish
themselves from Muslim terrorists.
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America requires that its Indian male physicians identify with their profession
more than with the Muslim community, not unlike its requirement that young Indian male
physicians refuse any identification with urban Blacks and Latinos.
6
Indian male doctors
must either contribute to America’s othering of Muslims –many of whom also hail from
South Asia and thus share ethnic similarities with the doctors—or else risk being detained
in airports. The Indian doctors’ occupationally-based gain in social citizenship
underscores Muslim men’s loss in social citizenship after 9/11.
“Oh, You Don’t Look Like a Doctor!”: Female Indian Doctors and the Burden of
Proving Occupational Citizenship
While the occupational citizenship of the male doctors was readily respected and
appreciated once they clearly made their profession known, the female doctors told me
that their occupational citizenship was often questioned in public, even when they were
wearing their white coats and hospital identification badges. The stereotype that all
doctors are men is so prevalent in non-clinical spheres that Southern Californians of all
races have trouble conceptualizing women in the role of doctor. Add to this the American
stereotype that South Asian women are submissive, financially dependent, and limited to
traditionally female roles (Das Dasgupta 1998, Rudrappa 2004, 128), and the idea of an
Indian woman in a white coat has no place in the American imagination. Even the sight
of a Brown woman in a white coat is met with suspicion, as Dr. Archana “Archi”
Somani’s experience illustrates so poignantly.
My first year out as a doctor, [in] two physicians’ parking lots…[at]
two separate hospitals, I had to fight to get into the doctors’ parking
lot to park. I had to prove—I remember the first time…the…
security…guy’s looking at me… I have my white coat on. I have to
go and do surgery at this hospital, and he’s going, ‘Excuse me, where
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are you going?’ I said, ‘I’m going to the OR [Operating Room].’ And
he was just confused, and he kept questioning me. He’s seeing it says,
‘Dr.’ [on my name tag]. I introduced myself as ‘Dr.’ and finally he
goes, ‘Wait, you’re the doctor?’ And I said, ‘Yeah.’ ‘Oh, I thought you
were wearing your boss’s jacket.’ You know, the first name’s ‘Archi,’
and I guess they think it’s a man’s name. I went, ‘No. You’re making
me late. I’ve got to be in the OR.’... The second…[time], I had to
prove—I had to take out my business card and my driver’s license so
he could match the names before he let me into the doctors’ parking
lot.
For Archi, in contrast to the male doctors, even literal proof of her occupation, in
the form of a white doctor’s coat or a hospital name tag, initially confused hospital
security before it convinced them of her right to access physician parking. Many other
women recounted hearing exclamations of disbelief --such as “Oh, you don’t look like a
doctor!”—after revealing their occupation in public settings. As Dr. Maya Patil recalled:
[P]eople never ever ever ever would look at me and assume I’m a
physician. They[‘ve] tagged me a certain way… [O]nce at the
airport this child was having a problem, and I was talking to the mom
for a while, and I kind of gave her advice on what to do, and she was
like, ‘How do you know?’ And I was like, ‘I’m a pediatrician.’ And
she was like, ‘What? I never would have guessed that.’ And I get
that a lot…. I don’t know why people have that certain perspective of
a doctor being this white coat, stiff, stethoscope person…and they just
kind of visualize the doctor as being that person and that may be…
normal ‘cause they still are kind of stiff like that, but I don’t know
why that happens. I don’t know if people just naturally look to me
and think, ‘She could never be a doctor.’ I just don’t fit that mold [of]
being a doctor.
Maya described the “normal” doctor as exhibiting the stereotypically masculine
traits associated with scientists, such as stiffness and an attachment to objective, technical
instruments (Carpenter 1995, Flores 2002, Lorber 1984, Losh 2006, National Science
Board 2002). A doctor, she implied, is assumed to exhibit the masculine stereotypes of
science even if she is a woman. As a young, outgoing female, Maya hardly fits these
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stereotypes. But even if she did, it’s unlikely that the people she meets in public would
readily assume she is a physician, or unquestioningly accept her medical expertise.
According to Dr. Pushpa Narayanan, women are never seen to be doctors. Even when
they tell others that they work in health care, the assumption is that they are nurses.
“They never think you're a physician,” Pushpa began, “even if I tell them, for example,
'I'm in the health industry.' 'Oh, you're a nurse?' ... I think in all communities, they don't
assume that you're a doctor because you're a female. They say, 'Oh, you're a nurse?'”
Dr. Urvasi Davé made a similar observation, noting that whenever she had
introduced herself as a doctor, people never remembered her title and “downgraded” her
to less prestigious professions: “No one ever thinks I’m a doctor. I was just complaining
about that the other day. Another Indian woman introduced me as a nurse the other day,
and…a whole bunch of moms at [my son’s pre school]…still don’t have it in their head
that I’m a physician and they’ll downgrade me. It’s like I’ve been downgraded to a nurse
or some other – somebody thought I was a physical therapist the other day.”
As Brown women, Urvasi, Pushpa, and the other female interviewees are
acceptable only in the feminized, supporting roles of medicine –as nurses and physical
therapists. In these roles, perceived to involve more care work than scientific knowledge
(Carpenter 1995; Gordon 2005; MacLean and Rozier 2004), Indian women do not upset
America’s racialized gender hierarchies, which privilege white men as having the greatest
access to scientific occupations (Eugster 2009; Heroy 2009; National Science Board
2002). The American public hardly hesitates to grant social citizenship to Brown female
nurses or physical therapists. Indeed, many nurses in the U.S. are immigrant women of
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color (Choy 2003, George 2005).
7
But the Brown female doctor appears too powerful to
comprehend, and thus, threatens the privileged, hegemonic status of White-American
men. She must be “downgraded” to an inferior position just to be granted social entry
into non professional, public contexts, much less social citizenship. As representatives of
pariah femininity, the Indian female doctor does not have an understood social status in
the U.S.
Pariah femininity is Schippers’s (2007) term for characteristics that, when
practiced by women, are stigmatized and sanctioned because they threaten the hegemonic
relationship between masculinity and femininity. When a Brown, Asian woman has an
occupational status higher than that of many White men –as in the case of the female
Indian doctors I interviewed—she defies Americans’ gendered racial expectations. She
thus becomes socially threatening because she is seen to have achieved professional
equality with White men without appearing to have relinquished all of her racialized
feminine traits. The female Indian doctor represents a type of pariah femininity in the
U.S., namely the aggressive, authoritative bitch (Schippers 2007, 95). Stigmatized in this
way, the female doctors rarely experience full occupational citizenship in public contexts
of the U.S. Unlike the male doctors, they risk losing social acceptance and desirability
whenever they make their occupation known.
By ignoring their occupational status and focusing exclusively on the female
doctors’ hegemonic femininity, Southern Californians worked to contain the
contamination that these doctors present. For example, the married women I interviewed
told me that in addition to “downgrading” and forgetting their occupation, their peers –
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Indian and non Indian alike-- would transfer their occupational title to their husbands in
order to conceptually maintain gendered family hierarchies. In other words, if their
husbands didn’t share the title of doctor but shared their same last name, then Southern
Californians, after seeing their names written together, would assume that their husbands
were the doctors but that they were not. Urvasi explained: “[My husband]’s the doctor,
and I’m his wife. Always. It happens all the time…. And he is a doctor; he’s a PhD.
But he’s not a medical doctor. And he gets mad at me because I don’t assert myself,
because I don’t ever introduce myself as [a] doctor.” But of course, when Urvasi had
introduced herself as a doctor, she found that people never remembered her title or
associated her with less prestigious professions.
For Indian female doctors, therefore, citizenship in Southern California depends
not so much on their occupation but on their familial ties to men who are seen to possess
occupational citizenship. While the non-white men’s productive contributions to the
region legitimate their presence in public, the non-white women’s dependence on these
men is what legitimates their public presence. Whereas the male Indian doctors are
perceived to be less threatening when their occupation is known, the female Indian
doctors are perceived to be more threatening upon revealing their profession.
“Oh, You’re a Doctor?”: Female Indian Doctors as Too Socially Threatening
Although some Southern Californians coped with the female doctors’ pariah
femininity by focusing on their traditional feminine roles as wives and mothers to the
exclusion of their occupational role, the Southern Californians described in this section
focused on the doctors’ occupational identity to the exclusion of their femininity. A
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number of the female interviewees told me that new people they met and even co-ethnic
friends and family often assumed that because of their occupational status, they shared
little in common with other women who are not doctors. Their high occupational status
in a stereotypically masculine field seemed to place their commitment to traditional
femininity in question, which once again rendered them threatening to established gender
norms, and examples of pariah femininity. It is as if Indian female doctors cannot
simultaneously be occupational citizens and heterosexual women; they can only be one
or the other.
Dr. Smitha Bhalala’s family and friends, for example, were surprised to learn that
she could successfully perform feminine domestic activities given her masculine
occupation of doctor.
[Others] do get surprised. Even my mother-in-law and her
expectations: ‘She’s a doctor and she cleans the house and she
cooks? Oh, my God, she’s a real person!’ They are very surprised
that we do all the normal things that everybody else does, which
sometimes gets overshadowed by the ‘You’re a doctor.’ I think it
would be a drawback for those people that carry it that way, that can’t
look past that. ‘Oh, you can cook a meal! Oh, you can make a cup of
coffee and serve it to your friends!’ Because at that time, you’re not a
doctor. You’re just a friend, just who you are. And I think that role is
important. You want to leave your coat and leave it where it is and
move away.
As Smitha’s experience suggests, one of the only ways for an Indian woman to
“leave the white coat where it is and move away” is to immerse herself in the domestic
world, cooking, cleaning, and catering to her friends and family. To remove the stigma of
pariah femininity attached to their occupational status, Indian female doctors must
regularly prove their aptitude for feminine tasks and roles –for hegemonic femininity.
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Only then are they considered “real,” “normal” people who can socialize with
“everybody else” as “just a friend” –as socially desirable Brown women.
Dr. Teja Shah observed that when she told Southern Californians her occupation,
they often assigned to her the same stereotypes assigned to white male doctors, such as
materialism and intelligence (Flores 2002). But whereas these stereotypes render white
males socially desirable (Bale, Morrison, Caryl 2005; Santos 2008), they render Brown
females, like Teja, socially intimidating (Bose 1999, 126; Mediratta 1999, 84)–so much
so that she and many other female interviewees told me that they avoid disclosing their
occupation when meeting new people in social contexts.
…[O]nce you tell someone [you’re a doctor] they do judge you on it:
… ‘Oh, you must have lots of money, or you must have this.’ And I
just want to tell them, ‘No, I’m actually in debt from med school, and
I’m paying off my loans and you probably are worth more than me’…
but I think the stereotypes [remain]: ‘They’re rich. They play golf.
They have lots of money… Or they’re smart.’ We’re not smarter
than anybody else; we’re the same. But I think that’s what my
husband thought from what he’s told me… Before we got married, he
goes, ‘I thought you were out of my league.’ I mean, he himself said,
‘Oh, you’re a doctor. I’m not, so there’s no way we would get along.’
So even my own husband had this prejudice on what doctors are
supposed to be like and what physicians are supposed to be like…
so…I don’t tell people what I am. I don’t tell them I’m a physician…
[because] it’s good to avoid all of that.
Teja’s husband, although not a doctor, is also Indian American. Thus, even co-
ethnic males feel threatened by the occupational status of Indian female doctors. As
Kurien (2007, 187-188) notes, the Indian immigrant community attributes the
professional success of its men to the persistence of traditional gender hierarchies in the
private and ethnic spheres –a persistence that also grants its men the privileged majority
status they lack in public in the U.S. When its female members pursue traditionally
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masculine professions, however, they threaten these gender hierarchies, which, in turn,
endanger the community’s status as well as the power held by its men. Their
occupational citizenship is once again assumed to be incompatible with their feminine
citizenship; and, therefore, several female interviewees, like Dr. Maya Patil, felt it
necessary to emphasize their domestic identities to co-ethnics, including me.
I’ve never really identified myself as Maya the doctor. I’m just
Maya, I’m Indian, I’m married, I love my family, and then career, yes,
I’m a doctor…. But I never outwardly tell people that I’m a
physician, outside....I don’t think it’s important. I don’t think it
defines me outside of [work]. I mean, here I’m Dr. Patil. At home
I’m Mrs. Gora, my husband’s name. I just kept Patil for being a
physician here, and my license and everything has been that way…
But I’m never one to be like [a doctor] on my credit cards, and I never
announce I’m a doctor. I’m not like that.
Maya stressed that outside of formal public contexts, her identity revolved around
her husband and her family. She sought to convince others that her professional
membership in the traditionally White, masculine institution of medicine had not
precluded her adherence to the gendered expectations of the Indian immigrant
community. For Maya, rejecting these ethnic norms would be the same as rejecting her
family, or, more accurately, grounds for her family to reject her as an overly powerful
pariah female. Moreover, as the previous section shows, even if Maya did regularly
announce her occupational title in public, others would probably ignore it in favor of
reducing her to more feminine professional and domestic roles.
The female Indian doctors I interviewed, therefore, clearly do not enjoy full
occupational citizenship in the U.S. Their occupational status, rather than removing their
gendered racial stigma as Brown women, underscores this stigma. It forces them to
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accept being characterized as lesser professionals and domestically-oriented wives, or
else risk being cast out of their families, communities, and social circles as pariah
females. Literally or figuratively donning the white coat, by making their occupation
known, hardly benefits the female interviewees in terms of social citizenship.
Consequently, many refrain from disclosing their occupation in public, where they
experience greater acceptance and understanding as stereotypical Asian women than as
the professional equals of White men.
“If You Want to Buy Anything Expensive, They Say You Cannot Afford It”: Consuming
on Occupational Credit
The one context in which Indian female doctors and Indian male doctors
benefited equally from occupational citizenship was shopping. As Feagin and Sikes
(1994), Lacy (2005), and Park (2005) all suggest, in the consumer-driven economy of the
U.S., a customer’s class status –or economic citizenship— can potentially trump the
customer’s race or gender in determining the treatment he or she receives in public.
Nevertheless, all three studies show that the middle-class consumer of color must work
harder than the White consumer to convey class status; for the stereotype that non Whites
do not possess the same financial and cultural capital as White Americans remains
prevalent. When I asked my interviewees to describe the prejudice and discrimination
they had faced “out and about” in Southern California, the most common response I
received was that salespeople had often treated them poorly --racially stereotyping and
profiling them as too criminal, indigent, or ignorant to deserve access to the same high-
quality consumer goods as Whites. But once the salespeople learned that the
interviewees were doctors, they changed their demeanor entirely. I received this response
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from interviewees of both generations and genders, many of whom experienced this
about-face on weekends, while dressed shabbily and shopping for expensive
commodities, even homes, as was the case with Dr. Smitha Bhalala.
[When] buying this house…I wasn’t really particularly interested in
moving to a new location, because we had moved three times prior. It
was a weekend, and my husband had just finished running and he was
unshaven. My mom particularly wanted to look at this house, so we
all came together in the oldest car that we had and in our worst
Sunday clothes that you can imagine --flip-flops, unshaven, half-
heartedly coming to look at this house. And the real estate agent was
not even interested in showing us the home, because she just took one
look and I guess it spoke a million words. She was geared to speaking
with my mom, because she was wearing a sari and looked decent,
appropriate, I would say....So as the agent proceeded to show her the
home, because she was older and probably looked like she could
afford this home, she actually told the agent, ‘It’s they who are going
to be buying it, and they’re doctors.’ It seemed like once she said that
word…[the agent’s] treatment of us completely changed.
The agent initially assumed that Smitha’s mother was the one interested in
purchasing the home because she was the only one dressed well enough to appear as if
she could afford it. Wearing a sari, traditionally and originally Indian, she left no doubt
as to her ethnicity, which, in the U.S., has been racialized as an economically successful
model minority group (George 1997, 37-38).
Smitha and her South Asian husband, in contrast, wore clothes that suggested
nothing about their ethnicity, although it was probably clear that Smitha’s sari-clad Indian
mother was their relative. What these sloppy clothes did suggest is that they weren’t as
economically successful as Smitha’s mom, for whom they were probably just providing a
ride, in the agent’s eyes. Brown, unkempt, and driving an old car, Smitha and her
husband fit the stereotype of the poor, lazy immigrant couple, unable to afford the
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expensive trappings of upper middle-class white America (Fiske 1998, 379). It wasn’t
until Smitha’s mom mentioned their profession that the agent deemed them worthy of her
attention, suddenly realizing that they possessed occupational citizenship in upper
middle-class White America even though they did not share the same race or culture as
wealthy Whites. It’s likely the agent would not have initially dismissed Smitha and her
husband so completely, even in their “Sunday worst,” if they were White. A shabby
appearance, like hip hop clothing, stigmatizes Brown bodies more than White (Lacy
2007, 74).
Indeed, Dr. Deepak Chandramohan recognized that the White car salesman who
treated him and his Indian-British wife disparagingly --as if their ragged clothing meant
they were too poor to purchase the car they liked, and too ignorant to know it was beyond
their means—was responding to their Brown skin as much as their disheveled
appearance. And Deepak didn’t hesitate to accuse the salesman of such racism.
I was looking for a car for my wife… I…[had been] working in the
yard and doing stuff. We went to Costco. You know, you get dirt on
you just from picking up the boxes in the office and stuff. So…we…
went in…to…[the local] Toyota [dealership]…and this gentleman
comes up to me and starts…treating me like, ‘What are you doing
here? This is Toyota. It’s expensive.’… He was going on about how
Toyota is like Tommy Hilfiger, it never goes on sale..... He was like,
‘…This is top of the line. This is Tommy Hilfiger. These pants are
Tommy Hilfiger.’ I…was trying to keep a straight face. My wife was
like, ‘Let’s get out of here. This guy’s a total redneck.’… I was
having fun. I was like, ‘Why don’t you tell me?...Spend time with me
[as] [i]f I had the money for this...’ And he did. And I was turning
more red and more red and more red…. When he was done with that,
I said, ‘Okay, stop. I’m an educated person. And you know what? It’s
kind of sad. You probably do this to every person who’s brown who
comes in here in jeans and a T-shirt.’... Yeah, I said that to him. I said,
‘This is my business card. I will definitely consider buying a Rav, but
not here.’
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Deepak’s evidence of occupational citizenship humbled the salesman into later
contacting him to apologize.
He actually called my office…[to] apologize…I said, ‘Oh, that’s
okay. Apology accepted. But I’m buying the Saturn Vue anyway.’ …
[I wanted] to prove a point to him: ‘Don’t be ignorant, Man…. You
can go to a Porsche dealership in a T-shirt, shorts, and flip-flops, and
they’ll give you the time of day and treat you with respect….’
Business is business and people are people. No matter who comes up,
you treat them all the same, basically, was what I was getting at to
him…. And I told him, ‘You know, you can get your Tommy Hilfiger
on sale at Costco. The pants, by the way, you can get ‘em for less than
20 bucks. And your dress shirt, too, less than 20 bucks at Costco,
okay? So don’t waste your money any more.’ [laughs]… I felt good
doing it. I felt better doing that. So maybe he’s a better salesman after
that.
Here, the car salesman perceived Deepak and his wife to be lacking in not only
the financial capital necessary to purchase a Sports Utility Vehicle, but also the cultural
capital necessary to appreciate the class prestige attached to certain brand names. Like
Smitha’s real estate agent, he wrongly equated their poor grooming and non-white racial
status with an inferior class and cultural status. But, unlike the agent, the salesman
boldly tried to take advantage of his mistake to assert his perceived racial, cultural, and
class superiority in the U.S. --his white privilege. Of course, Deepak quickly set the
salesman straight by demonstrating that he actually possessed more cultural and class
capital, despite not sharing the same racial privilege. It was probably unnecessary for
Deepak to say as much as he did “to prove his point,” however. Simply giving the
salesman his business card would have made his point for him, as it reveals his
occupational citizenship with those Americans who can purchase expensive cars and
clothes.
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In these contexts of consumerism, therefore, Indian doctors must make their class
status –their economic citizenship in wealthy white America—visible to compensate for
their marginalized racial status as non whites. As dark-skinned consumers, the doctors
are racialized similarly to middle-class Blacks and Latinos, who are conceptually lumped
with the low-income criminals and undocumented immigrants who share their race (Lacy
2007; O’Brien 2008). Revealing their occupational status is the most unequivocally
direct way to distance and distinguish themselves from their poorer racial counterparts.
Thus, shopping is the one context in which some female interviewees, like Dr. Nikhila
Sangam, seldom hesitate to reveal their occupational status, which is deemed more
important than their gender during a financial exchange.
I think there is definitely a lot more respect when people find out that
I’m a doctor....It could be as simple as making a hotel reservation
somewhere, and, you know, if ‘Nikhila Sangam’ made the reservation
that would be one thing, but if ‘Dr. Nikhila Sangam’ made the
reservation, they probably would give me a better room. You know, it
could be as simple as that, where they don’t even know where I am,
but just as simple as the fact that I put “doctor” on there. I think you
get better service sometimes. People just cater to you more – it’s like
a hierarchy almost that people seem to think that if you’re a doctor
you’ve accomplished something and they tend to kind of respect
that.... I tend to keep it fairly low key, in the sense that some people
put it on their credit cards, they put it on all of their information that
they can, and, in many ways, I don’t want people to know that I’m a
doctor. Um, I think in an impersonal way, if it can get me a better
seat at, or, you know, an upgrade to first class I would use it, but
not…in a way that it might put me at an advantage over somebody
else that is unfair. (Emphasis added).
As consumers, Indian female doctors are able to use their occupational status to
trump their race and gender and receive treatment equal to that of White men. In the act
of consumption, Indian female doctors enjoy occupational citizenship and elude pariah
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femininity, while America’s White male hegemony remains intact. Feagin and Sikes
(1994) and Lacy (2007) suggest that White males, however, are not required to always
specify their occupational title to be offered a better hotel room or a first-class seat.
Thus, as with the male interviewees, the female doctors’ occupational citizenship does
not completely erase their gendered racial stigma but compensates for it. For a brief
moment, while shopping, the women’s title of “doctor” overshadows their subordinated
gender and racial status.
Conclusion
In conclusion, this chapter shows that occupation and gender greatly determine
the public racialization of Southern California's Indians, a group with an already
ambiguous racial status in the U.S. Always at risk of being racially lumped with
America’s most stigmatized groups (Blacks, Latinos, and Middle Eastern Muslims),
many Indian doctors in Southern California have found that disclosing their highly
prestigious occupation in public serves to distance themselves from these marginalized
groups and accords them a model minority status. Granted social acceptance based on
their occupational identity alone, these otherwise racially unidentifiable nonwhites are
what I call occupational citizens of the U.S. Their social citizenship depends on their
occupation.
However, whereas occupational citizenship nearly always results in greater social
acceptance for the male doctors, female doctors who reveal their occupation risk
experiencing greater social stigma from non Indians and co ethnics. Their membership in
a traditionally male-dominated profession, one in which they out represent White men,
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contaminates their femininity so that they are socially acceptable only when occupying
traditionally female roles. In public, the female Indian doctor is deemed too powerful by
both non Indians and co-ethnics alike. Except in the context of shopping, where class
status matters more than race or gender, Indian female doctors derive their social
citizenship from supporting the racialized gender hierarchies of the U.S., which often
relegate Asian women to the most subordinate roles.
Indian doctors’ experiences of public racism thus resemble the public racism
experienced by middle-class Blacks, Latinos, and South and Central Asian Muslims as
much as, if not more than, the public racism experienced by other Asians. Race alone
often identifies East Asian Americans as middle-class model minorities. Indeed, Chou
and Feagin (2008) found that the Asian Americans they interviewed, unlike the Indian
doctors of my study, seldom asserted their socioeconomic status to resist racial
discrimination in public. But the middle-class Blacks interviewed by Feagin and Sikes
(1994) and Lacy (2007) would sometimes explicitly state their profession, as did the
Indian doctors, to resist racism in public contexts.
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Chapter Four Endnotes
1.
Indians constitute approximately 7% of the total number of physicians in the U.S. but less
than 1% of the U.S. population (American Association of Physicians of Indian Origin 2009;
American Medical Association 2008; LIFS 2009a; U.S. Census Bureau 2009). Whites,
however, constitute approximately 56% of the total number of physicians in the U.S. but
70% of the U.S. population (American Medical Association 2008; Association of American
Medical Colleges 2005).
2.
I adopt Schrover, van der Leun, and Quispel’s broad definition of ethnic niche occupations as
any labor market sector that has been important to the employment of immigrants (2007,
531)
3.
According to the 2000 U.S. Census, 25.8% of the Indian-American population is employed in
computer, scientific, or engineering occupations (LIFS 2009b).
4.
The term “occupational citizenship” has appeared in many previous publications (Crouch
2001: 117; Jacobs 2009: 167; Lieberman 1998: 111; Standing 2009) and usually refers to one
or more aspects of a worker’s membership in the institution of his or her employment. Here,
however, I use the term to refer to an individual’s membership in U.S. society at large when
that membership is based on the individual’s specific type of employment.
5.
Mucchetti (2005: 2-3) describes “driving while black” or “driving while brown” as racial
profiling against non-white drivers, who are stopped and searched because their race alone
makes them suspect of criminal activity in the eyes of U.S. police.
6.
None of the male participants in this study were Muslim. (One second-generation female
participant was Muslim but never described experiencing any prejudice or discrimination
related to her religious identity).
7.
Choy (2003: 1), citing Ong and Azores (1994: 164), writes: “Between 1965 and 1988, more
than seventy thousand foreign nurses entered the United States, the majority coming from
Asia. Although Korea, India, and Taiwan are among the top Asian sending countries, the
Philippines is by far the leading supplier of nurses to the United States.”
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Part II:
Of Caste-Based Denial and Career-Based Consciousness: Generational
Differences in Racial Perspectives
◊
Chapter Five:
Re-Caste-ing Race: How Southern California’s First-Generation
Indian Immigrant Doctors Interpret Racism
When I asked Dr. Anand “Andy” Patnaik to share any experiences he’s had with
patients or community members expressing prejudice against him or discriminating
against him, he hesitated, in order to count the number of experiences. “There were two
or three incidents in my entire stay of forty-two years in the United States,” he calculated,
after spending several seconds counting out loud. Then, without pause, he went on to
describe the details of these incidents, the first of which had occurred more than twenty
years before I interviewed him in December 2006.
One time in [a Veterans Administration Hospital, before I moved to
California], a patient, you see I cannot make that reflection because
[laughs] he was a loser guy. He lived from place to place and the
hospital was a great thing for him because he could stay. He made a
statement… ‘I don’t know why they keep you niggers,’ or something
like that. And I felt bad that I got angry at him because I thought,
‘How can you get angry at some idiot talking to you like that? I
mean, he is not an equal.’ So I felt bad. I don’t remember what
remark I made, really; I don’t remember exactly. But that was one
[incident]. Obviously it must have hurt me so I remember it…
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The second incident Andy remembered occurred in a Southern California hair
salon which he used to frequent because “it was close by” and “cheap.” Two of the salon
employees refused to cut his hair because, he recalled, they said he didn’t use the correct
“terminology” in describing how he wanted his hair cut. Moreover, one of the employees
told him that they prefer to serve white customers; so Andy walked out, but not before
telling them that they should be ashamed of themselves, and that he is a member of the
U.S. Army.
As with the V A Hospital patient, Andy characterized the salon employee as a
“loser” and expressed regret for allowing the words of such “low-class people” to affect
him. There was no need for him to feel so upset, he explained, because he has been so
well accepted in the U.S., as evidenced by his service as a colonel in the U.S. Army.
Indeed, according to Andy, “people of varying ethnicities” have treated him with respect.
“I never felt a real significant racial prejudice,” he said, in ending his response to my
question. “[I]n fact if there is any, I’ve felt the other way around. People treated me
better [laughs] for whatever reason.”
I was initially puzzled by Andy’s response. Why did he express more regret than
anger about the racism he has experienced?, I wondered. After all, as Andy himself
noted, these incidents must have hurt him if he still remembers them many years later.
So, instead of critiquing U.S. society and developing a racial consciousness, why does
Andy feel that America has more than accepted him because of his ethnoracial identity?
Turning to canonical works in the fields of Immigration, Ethnic and Asian
American Studies provided incomplete answers. The assumption underlying scholarship
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in both these fields is that professional immigrants come to understand their social status
in the U.S. in terms of American social strata and hierarchies, not the social strata and
hierarchies of their nations of origin (Espiritu 1992; Omi and Winant 1994; Foner 2000;
Portes and Rumbaut 2001; Waldinger 2001). Most scholars of Ethnic, Immigration, and
Asian American Studies expect that immigrants’ proficiency in the social frameworks of
their homelands will quickly yield to an appreciation of U.S. social structures. As Nadia
Y. Kim (2008:2) notes in the introduction to her transnational study of Korean
immigrants’ racialization, “the classic social scientific literature…started and stopped its
analyses within U.S. boundaries.”
Nevertheless, as I continued to interview more first-generation Indian immigrant
doctors in Southern California, I began to realize that these doctors depend on the
hierarchical caste framework of India to structure their understanding of the racial
prejudice and discrimination they experience in the U.S. By invoking the hierarchical
language of caste to rank racist white Americans as inferior to them, first-generation
Indian immigrant doctors interpret racism as an individual problem of “low class” or
“low culture,” not a systemic social problem of the U.S. as a whole. For these doctors,
the U.S., unlike casteist India, is a meritocracy in which “the white coat” or their
occupational status as doctors defines them more than does the color of their skin. They
see themselves as full occupational citizens.
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“That Came from Such Low Class People”: Critically Class -ifying Whites’ Racist
Behavior
The first-generation Indian immigrant doctors I interviewed often interpreted
racism as the ignorant reaction of lower-class white Americans to their high class status
and occupational success. Here I argue that this interpretation is rooted in the
immigrants’ internalization of India’s social system of caste. Proscribed in 1950 by the
Indian Constitution and continually condemned by international human rights groups,
caste-based discrimination is a practice that few Indians explicitly endorse (Oommen
2005: 35, 38-9; Sharma 1997: 18; Kurien 2007: 174, 187). But, although most Indians
today claim not to engage in any formal discrimination based on caste, Indians as a whole
informally accept and apply caste hierarchies as appropriate indicators of their “natural”
abilities and character (Fuller 1996: 12-14, 16, 21, 23; Sharma 1997: 19, 21, 31; Smaje
2000: 234-5; Kurien 2007: 177). Indeed, several of the first-generation Indian immigrant
doctors I interviewed suggested that their caste identity is the primary determinant of
their individual behavior and identity. For example, in explaining why he disliked being
“second to a white man” in early 1970s England, Dr. Kishore Rajput declared, “I am
independent. I am a Rajput,” referring to his high-caste status in India, where Rajputs are
believed to be the descendants of royal warriors (Kurien 2007: 33, 176; Smaje 2000:
180). For Kishore, caste status explains individual propensities.
Similarly, for Dr. Pushpa Narayanan, a high-caste Brahmin status explains her
occupational inclinations and attitudes. Among the first generation of Indian Brahmins to
pursue medicine, Pushpa almost quit medical school because it involved the dissection of
dead bodies, considered to be polluting and, thus, formerly forbidden to Brahmins.
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Every day, when returning home after classes, her parents required that she enter through
the back door and shower before setting foot in the rest of the house. As a practicing
physician in Southern California at the time of her interview, however, Pushpa could not
consider doing any other work. “[Y]ou know, if I was good in selling, I would have been
in practice or in business, right?” she observed. “Brahmins are known for their skills in
eating and brain power, that’s all. I don’t know how to sell anything. I’m not a good
business person.”
In addition to determining their own individual and occupational identities, caste
status and hierarchies also determine how Indians identify and understand the behavior of
others in relation to themselves. Pushpa recounted that a non-Brahmin Indian immigrant
colleague would pejoratively mispronounce her first name to rhyme it with “Brahmin,”
and would also call her a “bummin’ Brahmin.” She, in turn, attributed the colleague’s
“very obstinate and mule-headed” behavior to his own caste status, which is much lower
than hers. Alternatively, Pushpa’s shared Brahmin status with a former Inspector General
of Police in New Delhi, most likely explains why he took “a liking to” her and helped her
fulfill her desire to emigrate to the U.S., Pushpa said.
As Pushpa’s and Kishore’s statements suggest, caste forms the axis of many of an
Indian’s identities (Fuller 1996: 26-7; Oommen 2005: 97; Kurien 2007: 176, 177). And
caste hierarchies structure the informal social relationships among Indians (Sharma 1997:
24; Kurien 2007: 40-1). In informal interactions with non Indians, therefore, Indians
appear to seek another hierarchical framework by which to rank casteless non Indians in
relation to themselves and guide their behavior accordingly. For professional first-
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generation Indian immigrants in America, I argue, this hierarchical framework is usually
the socioeconomic class system of the U.S. The U.S. class system, like India’s caste
system, is a social ordering of people based, in part, on hereditary factors considered to
be objective and outside of individual control, such as the income and occupation of
one’s parents (Warner et. al. 1960: 10; Weiner 2007: 243). However, both caste and class
labels also connote value judgments of a person’s level of education, appearance, and
manners (Warner, 21; Weiner, 243, 245), which, especially in the U.S., are perceived to
result from individual behavior and choice (Weiner, 244). Thus, a sloppily dressed adult
can be criticized as being “low class” even if he or she is wealthy. As with caste in India,
class in the U.S. is constructed as a legitimate basis for explicitly denouncing a person’s
conduct in informal interactions (Kincheloe and Steinberg 2007: 5). The socioeconomic
class hierarchy of the U.S., therefore, approximates the caste hierarchy of India in
framing the social perspectives of professional first-generation Indian immigrants. These
mostly affluent immigrants attribute Americans’ behavior –particularly behavior they find
offensive—to the non Indians’ class status, which, in terms of educational and
occupational achievement, is usually lower than their own.
Indeed, when the first-generation Indian immigrant doctors I interviewed
discussed experiencing racism outside of clinical contexts in the U.S., they often ascribed
the racism to the “low class” status of its perpetrators, as did Andy, quoted in the
introduction to this essay. Reflecting on both his homeless patient’s racist comment and
the racial discrimination he experienced at his neighborhood hair salon, Andy said: “That
came from such low-class people … I mean it, low class in the sense … not just
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socioeconomic low class [but] loser type of low class –the…VA hospital patient; and here
is a woman, God knows what is in her mind.” These reflections demonstrate that for
Andy, the inferior class status of those who have expressed racism against him had left a
greater impression than the racism itself. (Indeed, Andy had trouble remembering the
exact words uttered by the patient and by the salon employees). Of course, the bigotry he
experienced is quite minor compared to the life altering racism suffered by many other
Americans of color. But, more than displaying a consciousness of others’ economic and
racial hardship, Andy’s dismissal of the bigotry in favor of focusing on the bigots’ class
status demonstrates his continued adherence to the caste-based ideologies he learned in
India. Just as Pushpa (quoted above) attributed her Indian immigrant colleague’s
prejudice to his low caste status, Andy suggested that the racist behavior of the homeless
patient and the salon employees is a function of their individual low class status. Class is
Andy’s proxy for caste. He could not label these perpetrators “low caste,” most
obviously because white America does not recognize or share the caste hierarchies of
India. In addition, Americans in general are appalled with India’s system of caste, which,
due to its more overt social applications, they regard as much more oppressive than the
class or racial structure of the U.S. (Kurien 2007: 174; Helweg and Helweg 1990: 87).
Indeed, as Kurien explains, a key objective of Indian immigrant organizations in the U.S.
is to improve white America’s image of the caste system and, thus, India, often by re-
presenting the system’s oppressive features as not inherently Indian, but products of
Western colonialism and exaggeration (Kurien 2007: 174, 177).
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Caste labels, therefore, have no currency in the U.S. Nevertheless, by referring to
the racist white Americans as “low class,” Andy achieved effects similar to those he
would have achieved had he used the label “low caste.” First, through repeatedly
belittling these Americans as lacking in socioeconomic power, Andy also belittled their
racist conduct as lacking any appreciable social power. In India, a person’s conduct is
often seen as being only as virtuous as the person’s caste status, regardless of that
person’s economic achievement (Fuller 1996: 15, 16, 17), as demonstrated in Pushpa’s
criticism of her Indian immigrant colleague’s prejudicial statements. Pushpa attributed
the statements to the doctor’s low caste status in India, because, to her, he is still a “not
too brainy” farmer, no matter his occupational achievement in the U.S. Similarly, for
Andy, a veteran himself, it was the homeless V A patient’s current social impotence that
rendered his racial slur impotent, a former military career notwithstanding. And it was
the salon employees’ unremarkable, even dirty, work of ridding people of hair –a bodily
waste product— that seemed to inspire Andy to want to rid himself of any hurt feelings
over their discrimination. To Andy, their efforts to devalue his presence in the U.S. was
as much a waste as the hair they cut, because he, as a doctor and former serviceman, is
more valuable to the U.S. than are they, whatever their income may be. In calling these
three white Americans “low class,” therefore, Andy was referring not only to their
socioeconomic status, but also to their lack of societal worth, as evidenced by his
explanation of the term: “low class in the sense … not just socioeconomic low class
[but] loser type of low class.” Andy wanted his use of the term to convey the same
meaning that the label “low caste” would convey in India.
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Through his assessment of his encounters with racism, Andy strives to reinforce
not only the class difference, but also the class distance between the racist white
Americans and himself. It is a distance that Andy struggles to maintain, as insinuated in
his last statements regarding the encounters: “…[Y]ou know, I really feel bad that I
reacted internally so much. In other words, there’s no reason to. I could’ve just washed
it off and, uh, you know, gotten away. I suppose that’s our built up-- you know, I can’t
say.” What Andy most likely “can’t say” (because it is not part of his conscious
awareness) is that he and other professional Indian immigrants have “built up” the
expectation that, as “high-class” members of U.S. society, they will be literally distanced
from “low-class” Americans and their racism. This expectation arises from the fact that
in India, different caste groups tend to maintain both a social and a physical distance
from one another so that low castes will not “pollute” high castes (Kurien 2007: 33, 34,
175). It is rare that a member of a low caste would directly insult a member of a higher
caste, especially if the low-caste member’s livelihood depends in some way on the high-
caste member (Helweg and Helweg 1990: 87; Beteille 1996: 177). In this relationship of
respectful distance, however, both Indians consider themselves members of the same
race. When Indian immigrants such as Andy are no longer the racial majority, they are
disappointed to find that lower-class Americans will not necessarily keep a social
distance and treat them with deference. Consequently, they, like Andy, continually
endeavor to “get away” from these Americans --physically and psychically-- and thereby
reestablish their class superiority.
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Indeed, Drs. Peter and Linda Johns claimed that after several years of
endeavoring to rise above “uneducated,” “middle-class” Americans, they have
successfully “gotten away” from them, and thereby reproduced the “caste distance” that
high-caste Indians experience in India. Peter and Linda said that the racial discrimination
they have experienced in the U.S. is limited to their early years in Southern California
(during the late 1970s), when they were medical residents who could only afford to shop
at “ordinary” stores with “middle-class” “clerical workers.” But now that they are
established doctors wealthy enough to have their clothes delivered to them and to
associate only with other educated professionals, they told me that they no longer have to
worry about racial prejudice and discrimination.
Peter: It’s mostly, you know, middle class, uh, white Americans [who have
been rude to us].
Linda: The difference is, uh, really, you know, the more educated the people
are … the more tolerant they are….The only time we have had [a]
problem is really the clerical positions, you know, in the stores and so
on, where they… just… absolutely, you know, I mean, they’re
not…service oriented at all to…somebody with [our] skin color.
P: [A] non-white person.
L: …And that’s where we have had problems, not, uh, not in the
hospital.
P: …Nowadays, we don’t go to an ordinary store….I go to only two
stores…to buy any clothes. And I hardly ever even go
there….Because they will even deliver it here [to our home] for
me, my clothes, you know….Because that’s, we can afford to
do it, and they know us in the society, how we are….And, I mean …
[I] go to one of the stores, [a] boutique store…and, she’ll [a store
employee] come and fit me …[for] pants, and say, ‘Well, I’ll
bring it home, Dr. Johns.” That’s different.…
L: You know, I think we still would see that discrimination—
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…
P: [But] we, we don’t go to such [ordinary] places now at all.
L: Yeah.
P: We don’t have to go to such places, fortunately, you know.
Like Andy, Linda and Peter see racism as a function of class status, or as a
character flaw of “ordinary,” “middle-class” white Americans (with “middle class”
connoting mediocrity). But, unlike Andy, they did not dwell on the lower class status of
the store clerks in an effort to “lower” the impact of these white Americans’
discrimination. Nor did they recall or regret reacting emotionally and possibly
jeopardizing their image of high-class refinement and rationality. They instead focused
on the literal distance that their high-class status had placed between “ordinary” store
clerks and themselves. Linda and Peter spoke as if such a distance was inevitable, given
their “education.” Direct contact with less educated white Americans was simply a
temporary inconvenience during their early days of navigating life in Southern
California, as new immigrants. Indeed, Peter and Linda suggested that such contact was
a test of character allowing them to prove their educational merit –their tolerance,
patience, poise, and rationality. It seems that for them, “education” is the equivalent of
“breeding,” and, as with caste, it is an inherited, not acquired trait. Thus, they implied
that a person cannot essentially change his or her class status over time. Linda and Peter
have always been “educated,” high-class individuals; the high-class, educated white-
American “society” just had “to know” them, “how [they] are.” Once that knowledge
was established, Linda and Peter no longer had to face racism. Racism, according to
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these doctors, is relegated to the less educated (and, therefore, less tolerant) lower
classes, who constitute both its perpetrators and its victims. In noting that racial
discrimination still exists in “ordinary places,” the doctors indicated that low-class status
is an innate characteristic (just like their own high-class status); and “clerical” white
Americans will never completely rise above it.
In Peter and Linda’s reflections on the racism they’ve experienced, class labels
yet again operate as do caste labels in India –as not only an index of socioeconomic or
occupational status, but also as an index of societal worth. In contrast to Andy, however,
Peter and Linda did not struggle with translating their societal worth into social distance
between lower-class white Americans and themselves. Their remarks suggest that any
genuinely high-class Indian immigrant can successfully reproduce the physical and social
distance separating high-caste groups from low-caste groups in India. Peter and Linda
would most likely interpret Andy’s inability to do so as a sign that he lacks some of their
inborn class, not that their greater wealth and history –as a physician couple who have
lived in Southern California since their arrival in the U.S.—has facilitated a protective
isolation that Andy can’t completely afford.
Thus, in the caste-based interpretations of the doctors I interviewed, individual
qualities, rather than structural constraints, repeatedly emerged as the determinants of a
person’s class status, which, in turn, determine that person’s vulnerability to racism.
Having internalized the social hierarchies of India --where an individual’s caste status is
often seen to result not only from societal ascriptions, but also from his or her deeds
(karma) (Oommen 2005: 102)—Indian immigrant doctors view America’s class structure
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as a natural sorting of people based on their virtues. And one of these virtues is a
colorblind tolerance of racial difference, assumed to occur spontaneously among the high
class. In blaming racial prejudice and discrimination on low-class individuals, Indian
immigrant doctors avoid recognizing the racism embedded in America’s class
hierarchies. As I show later in this chapter, these doctors believe that if they have
achieved wealth and occupational success as non-white immigrants, then racism is an
individual problem not a social problem of the U.S. The solution to this problem,
therefore, lies in their “getting away,” as far as possible, from low-class white Americans,
not in developing a social consciousness that helps them mobilize the Indian medical
community against racial disparities in the U.S.
“The Biggest Difference between Indians and Non-Indians is by Virtue of their Cultural
Background”: Explaining the Racism of White Male Peers
Invoking India’s caste ideologies to blame whites’ racist behavior on their “low
class” serves as a logical response to racism for Indian immigrant doctors, as they do
enjoy a higher class status than most white Americans. Nevertheless, as I show in
Chapter Three of this dissertation, Southern California’s Indian immigrant doctors,
particularly the female doctors, also experience racism from white-American colleagues.
And these colleagues share the Indian doctors’ upper middle-class status in the U.S. In
responding to racism perpetrated by these peers, Indian immigrant doctors cannot
immediately translate caste hierarchies into class hierarchies, and, accordingly, dismiss
their colleagues as “low class” individuals from whom they could easily “get away.”
Consequently, several doctors I interviewed extrapolated the hierarchical caste system of
India to rank the different cultures of India and the U.S., and to conclude that both their
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success and white doctors’ resentment of this success result from India’s superior culture.
In other words, culture replaces caste and class when Southern California’s Indian
immigrant doctors assess the racial resentment they experience from white colleagues.
Indeed, in interpreting the jealousy of his white, male colleagues (who have
disliked his greater popularity with patients and staff), Kishore implied that the white
doctors’ problematic culture is responsible for their racial envy.
There is a perception among white male-- my general observation in
the Western world: there is a perception among the White, European
race that they are the first people. Generally, it’s kind of a given thing
in their mind --they are the people; they are superior to every other
race-- in their subconscious mind. If anybody else is as good or
better, they question it: ‘How come this guy is good as us? He is an
Asian…’ I felt that time to time, that… ‘Oh my God! You’re as good
as everybody else.’ So, generally, what I have felt…: white male has
a problem.
Although the “problem,” as Kishore described it, is whites’ racial ideology, I
would argue that for Kishore, it is more a cultural than an ideological problem. Kishore
spent much of his interview trying to convince me that “the Indian race” is superior to all
other races, as evidenced by Indians’ “intelligence and hard work”; their financial
“fortune” in the U.S.; and their “toleran[ce]…[of] all religions.” This superiority,
according to Kishore, is due to “the fact” that India is the original source of all races,
civilizations, and cultures.
…[T]he biggest difference between Indian[s] and non-Indian[s] is by
virtue of their cultural background…. [T]hat distinguishes us from
anybody…. [C]ivilization started in India... [A]ll three races exist in
India… no other country… They didn’t come from somewhere else,
they started there. …. [T]he first humans come from India….
India…is timeless, territory-less. I want you to write that. My quote:
‘The Indian culture is timeless and territory-less.’… So many races
invaded India, but they couldn’t touch the soul of India….
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[A]…South American…he just migrated from Europe. There’s no
culture, there is no history there. Same thing [with] America. Two
hundred years ago this was a jungle, right?...[T]he democracy, the
family values we talk about [in the West] come from…[India], not
from [the] Middle East, not from Europe. Long before, we had it.…
Greece [and] Rome learned from India through Egypt... [A]nd …
[ours]… [is] the only culture still existing after thousands of years….
Roman civilization, dead. Greek, dead. Egyptian, dead.... [O]ur
culture is based on facts and science, and it won’t change… [P]eople
come and go, countries come and go, civilizations come and go, but
Indian culture lives on.

Kishore measures the merit of a culture by its age. Accordingly, he believes that
Indian culture is better than all other cultures because, as he claims, it is older than all
other cultures. Moreover, as his quoted statements imply, white men’s racial superiority
complex is a product of their “lesser culture.” The complex doesn’t exist among Indians,
in his view, because they have “more culture.” For Kishore, and many of the other first-
generation doctors I interviewed, culture, like class, is a hereditary possession, its amount
dependent on the number of years it has existed among a race or nation of people. Thus,
cultures too can be rated in a hierarchical manner, with older cultures having greater
worth and, therefore, ranking above younger cultures.
Hierarchically ranking cultures is not unique to professional Indian immigrants.
In her study of transnational Chinese entrepreneurs of the 1980s and 1990s, Ong (1999)
found that China attributed the economic success of its overseas entrepreneurs to the
superiority of its national culture, especially in relation to the cultures of other Asian
nations (48). But what is distinctive about Indian immigrant professionals’ ranking of
cultures is that it seems to function as an almost seamless extension of India’s caste
system, when these professionals encounter racism or ethnocentrism from non Indians of
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their same class status. Unable to denounce these non Indians’ caste or class status as
being deficient and therefore responsible for their discriminatory behavior, the Indians
focus on their different culture instead. Non Indian colleagues’ racism is interpreted as a
symptom of their “low culture.”
Indeed, many of the first-generation female doctors I interviewed implicitly
blamed America’s inferior culture for its lack of female physicians, much less “foreign”
female physicians, during the 1970s and 1980s. The majority of these interviewees cited
this lack for their white male colleagues’ initial difficulty in seeing them as equals, and
for the double marginalization they experienced as a result. (I discuss specific instances
of this double marginalization in Chapter Three). This lack of female doctors never
existed in India, several said, because Indian culture, unlike American culture, recognizes
women’s natural talent for providing medical care. Indeed, India has more female
professionals, particularly in the sciences, than the U.S. (Paul 2006). And in 2006, its
percentage of female medical graduates, 35% to 40%, was higher than the percentage of
practicing female physicians in the U.S.: 27.8% (Biswas et. al. 2007; AMA 2010a).
According to Dr. Sunita Gangal, India encourages women to pursue medicine:
“[M]edicine was much more a chosen profession for the women there [in India]…
because women in general are more nurturing, and it fits their persona much better… I
mean, you’d be surprised that in India there are a lot of female doctors, and the
proportion is, I don’t know how high, but it may be as high as thirty percent, which is
pretty good.”
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“Pretty good” when compared to the U.S. seemed to be Sunita’s unspoken
observation. She assumed that I, as someone who has grown up in the U.S., would be
surprised at the number of female doctors in India. This assumption most likely arose
from an awareness that Americans tend to view Indian women as being oppressed, but
their own women as having achieved unparalleled professional equality with men
(Kurien 2007: 177; Dasgupta 1998: 1). As far as the medical field is concerned, this view
is mistaken, Sunita implied, not only because there are many female doctors in India, but
also because Indian culture, not American, understands that medicine “fits” the female
persona.
If medicine did not fit women, particularly Indian women, so strongly and
naturally, then white male doctors would not fear losing their jobs to Indian immigrant
female doctors, a number of female interviewees implied. Dr. Mala Sahni told me that
although she was the only foreign female doctor at the first medical practice she joined in
Southern California (during the early 1970s) her white male colleagues felt threatened by
her qualifications.
[W]hen I first join[ed], there was some [prejudice and discrimination]
because I was the first female to join…as a foreigner. But after a
while…they were all okay…. [Y]ou know, it was competition and I
took it…you take it as it comes. I felt I was well qualified to face
them. I felt it was their own little weakness because I was the board
certified pediatrician. I taught and I have done research. They felt
[that] maybe I’ll take their practice…
In comparing herself to her white male colleagues, Mala suggested that they were
weaker doctors than she, and this weakness led to their sense of competition. She, in
contrast, was the strongest of the doctors at the practice, not only because she had more
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qualifications, but also because she was able to “take” the competition and eventually
earn her colleagues’ acceptance. Mala did not explicitly attribute her strength and her
colleagues’ weakness to cultural differences between India and the U.S. Nevertheless,
the assumption underlying Mala’s comparison seems to be that she was the better doctor
by virtue of her cultural background and her gender. Her medical training in India, Mala
said earlier in her interview, taught her to be more humane and less materialistic than
American doctors. This description of India’s medical education resembles the
descriptions of many other first-generation interviewees who, as I discuss in Chapter
Two, credit Indian culture for their success in U.S. medicine. Moreover, as a woman,
Mala told me, she was able to earn the support and sympathy of female colleagues and,
most importantly, nurses, who helped make her “what I am today.” Thus, in criticizing
her white male colleagues’ weakness as doctors, Mala, like Kishore, is most likely also
denigrating American culture and its men; for both are ultimately unable to prevent
Indian female doctors’ culturally determined success. The two cultures are once again
ranked against each other, just as different castes are ranked against each other in India.
Dr. Vitthal Tukaram also engaged in a similarly implicit ranking of cultures when
he explained that it is “human nature” for people to favor “the familiar” during any
selection process. “I think someone that you are not familiar with --some culture, face,
language, a religion-- you will probably not select that person over someone who is very
much close to you…. [F]or example there are say five or three people of same exact
qualifications like you and I interview you and because you are Indian, I say, ‘Well…I
should take her.’ But they are all equally qualified anyway so that is human nature.”
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This theory of human nature was how Vitthal rationalized the glass ceiling that he
felt he had experienced in the U.S. It is a theory shared by several other first-generation
doctors as well as several of the participants in Bhatia’s study (2007) of professional
Indian immigrants, who observed that all humans discriminate in favor of their own race
so whites are not particularly racist (179-80; 181). Soon before presenting the theory to
me, however, Vitthal recalled knowing several first-generation Indian immigrant doctors
who have advanced to prominent positions in U.S. medical societies and institutions. He
also noted that his own son, a medical student at the time of the interview, would
probably never face a glass ceiling as a doctor who has “grown up here.” Indeed, many
of the first-generation interviewees observed that their children or Indian-American
doctors in general would not encounter a glass ceiling in U.S. medicine.
According to Vitthal’s theory of human nature, Indian immiggrant doctors who
break the glass ceiling defy not only white Americans’ natural inclination towards racial
favoritism, but also the doctors’ own natural preference for “the familiar.” In seeking out
and excelling among the unfamiliar, these doctors trump human nature. What grants
them such power? The answer, for Vitthal and many other first-generation doctors, is
Indian culture, which ultimately prevails over the racial privilege of their white peers and
grants them access to top medical positions, if not during their professional life, then
during that of their children. Indian culture, as discussed in Chapter Two, is what many
first-generation Indian immigrant doctors credit for their popularity with patients in
Southern California, who rarely express any prejudice against them but, instead, mention
knowing a number of very good Indian doctors. “I have yet to…recall anyone saying,
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‘Oh, I had an Indian doctor and he was bad.’ I have never heard that. They always say,
‘Oh, [I] have had an Indian doctor and he was really good.’ So, we have been able to
maintain a good reputation as caring and knowledgeable and competent physicians,”
Vitthal observed.
Although he was one of the few first-generation interviewees not to explicitly
attribute Indian doctors’ “good reputation” to Indian culture, Vitthal’s generalization of
specific qualities to the entire Indian physician population strongly suggests that he too
subscribes to the belief that Indian culture is responsible for Indian doctors’ success.
Indeed, “caring…knowledgeable, and competent” were very similar to the qualities
mentioned by the doctors who did explicitly credit Indian culture for their good patient
relations. Moreover, Vitthal discussed the reputation of Indian doctors as though it is a
legacy, first established by his “predecessors” –Indian immigrant doctors who arrived in
the 1960s—as well as those who, like himself, arrived in the 1970s, and now waiting to
be inherited by the “future generation.” This characterization of Indian doctors’
reputation is reminiscent of Kishore’s description of Indian culture as “timeless, territory-
less.” In both instances, Indians are depicted as possessing an unchanging, hereditary
essence that both defines them and distinguishes them from non Indians. Thus, what
Vitthal calls “reputation” seems to be the equivalent of what other Indian doctors call
“culture.”
Considering that most of the doctors I interviewed regard white doctors to be, in
Vitthal’s words, “of same exact qualifications like” them, culture is the only difference
that they believe could possibly account for their unblemished record of rapport with
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patients. And, as Vitthal implies, it is this record that white Americans eventually cannot
ignore, despite their human nature to always promote their own. For Vitthal and others,
Indian doctors’ popularity with Southern California’s patients –a direct result of their
cultural values—more than makes up for their lack of racial privilege. The glass ceiling
is simply a temporary inconvenience for these doctors, because their superior cultural
character will always break through. This conviction in the indomitability of Indian
culture is echoed in other studies of first-generation professional Indian immigrants, who
vaunt their cultural, religious, and family values as the source of their model minority
status in the U.S. (Bhatia 2007; Kurien 2007; Rudrappa 2004; Prashad 2000; Dasgupta
1998; Bhattacharjee 1998). Here, I have shown how one particular group of professional,
middle-class Indian immigrants --doctors in Southern California—apply this conviction
along with a belief in human nature to rationalize the racism they experience from white
colleagues and medical institutions in the U.S. I have also suggested that maintaining
this conviction in the superiority of Indian culture allows them to reproduce a familiar
framework of social hierarchy, India’s system of caste, but on the larger scale of culture
so that they resist seeing themselves as occupying a subordinate status to their white
peers.
“ [The] United States is Actually More Open and More Tolerant than Even Bombay ”:
Perceiving America as a Meritocracy in Comparison to India
To the majority of the first-generation doctors I interviewed, the racism they have
encountered in the U.S. is simply the reaction of ignorant, low-class or uncultured
individuals to their “foreign” difference. They insisted that U.S. society as a whole is not
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racist, because a non-white racial status in the U.S. has not been a permanent stigma or
rigid barrier to their social mobility, as caste status often is in India. Indeed, these
doctors felt that they had experienced more social and professional acceptance as non-
white doctors in Southern California than they ever could have achieved in India, where
their inherited social status defined them more than did their individual efforts.
Dr. Vinod Hegde was one such doctor, who always felt stigmatized by his
minority status while growing up in Bombay, India. Vinod’s family belonged to an
ethnic group not native to the city. But despite the group’s affluent status and Bombay’s
reputation as a cosmopolitan metropolis, Vinod often felt like a social outcast.
[The] United States is actually more open and more tolerant than even
Bombay. I have found more discrimination in Bombay…I was part
of a[n] ethnic subset who were very successful in Bombay, and…the
local people …would resent the people who they thought…came
from outside. So, as a child, I always grew up with a degree of
apprehension. And they would have these riots. …[R]eligion wise
[we] were the same, but they were people who are local…[and] they
were deprived of jobs. So, they resented people with my family name
who would come to the city and…were very successful…used to run
large restaurants, and…[were] very wealthy, with my exception….
[S]o, I always, as a child, had this disquieting …unease… [O]ften
they would have riots and I would feel, ‘Gee, with a name like that,’ I
would feel singled…out.
Comparatively, Vinod has never felt so singled out in the U.S., even as a non-
white immigrant. He told me that Southern Californians notice his youthful appearance,
his height (he is taller than most Indians they know) and his title as “Academic Senate
Chair” at the university where he works, but rarely do they mention his family name or
his skin color. In the U.S., his individual characteristics and efforts matter more than his
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ethnic group status. Thus, for Vinod, the U.S., unlike caste-structured India, is a
meritocracy in which minority status presents no barriers.
The U.S. has also been a meritocracy for Dr. Sanjit Johal, a turbaned Sikh
physician who, in 2006, became the first Indian president of the State Medical
Organization of California (SMOC). During his inauguration speech, Sanjit said that he
feels more acceptance here in the U.S. than in India, where Sikhs are an ethnic and
religious minority. He gave this speech at the evening banquet of the 2006 California
Association of Minority Physicians’ (CAMP’s) annual Minority Doctors’ Convention. As
an introduction to Sanjit, other CAMP members spoke of Sanjit’s accomplishments in the
U.S., focusing on his personal achievements. They spoke of the two large homes he
owns; his beautiful wife and two kids; the ski lodge to which he often takes other doctors;
and the visit that then president Bill Clinton made to his home. While they and Sanjit
spoke, a slide show with photographic evidence of these accomplishments played in the
background. To these doctors, Sanjit is proof that anyone, even a brown-skinned man in
a turban who faced hostility in his country of origin, can rise to the top in the U.S.
Sanjit’s inauguration was as much a celebration of the United States’ open meritocracy as
it was a celebration of Sanjit as an accomplished individual. And it stood in rather stark
contrast to the two days of convention sessions critiquing the inherent inequalities of the
U.S. health care system. Sanjit’s inauguration seemed to challenge the very notion of
racial disparities in the U.S.
The professional trajectories of several doctors I interviewed also challenge this
notion, even though these doctors were not marked as ethnic minorities in India. Dr.
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Ram Ramadasu, Andy, and Kishore also mentioned feeling marginalized in India but
because of their family’s class or occupational status (which, in India, is often directly
tied to caste status). None of their families enjoyed a professional status in India. Andy
said that his family was “lower middle class” and his uncles doubted he had the abilities
or the family finances to become a doctor. Ram’s family could afford only “suboptimal
care” when his younger brother was suffering from a gastrointestinal infection, which led
to the brother’s death. Although comparatively more wealthy, Kishore’s entrepreneurial,
landowning family did not support his desire to become a doctor, especially after his
father’s death (when Kishore was eleven). Kishore was expected to continue his father’s
businesses and service in the local politics of his South Indian community.
All three doctors credit the U.S. for facilitating their pursuit of medicine, not only
financially, but also in terms of professional growth and opportunities. “The type of the
care that I provide [neonatalogy] is available in many places in this country, and…was
not available in India,” Ram explained. “[In India], I could not make use of the training,
the expertise that I had at that time." Now Ram has made use of his training and
expertise in pediatrics and neonatology for over forty years, in many different regions of
the U.S., where, he said, he has never faced racism but has always been “well respected
by the colleagues and the patients, and the population in general.”
Similarly, Andy told me that he has felt respected and accepted wherever he has
worked in the U.S. Moreover, the U.S. allowed him to “make some money” while he
was completing his medical residency, so he didn’t have to financially burden his family
during his postgraduate education. Although he admitted to initially feeling guilty for
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“abandoning” India and marrying a white-American woman (during the late 1960s and
early 1970s), he now realizes that he is “a much better help to India by staying here [in
the U.S.]” than he ever could have been, had he stayed in India. As a U.S. physician,
Andy has been able to send remittances and donations to his family and community in
India, as well as help other Indian physicians find jobs in the U.S.
For Andy and Ram, therefore, the U.S. has been far more egalitarian and generous
in its occupational and economic opportunities than their native India, where their
families’ disadvantaged class status and the post-Independence lack of training in
medical specialties precluded their success as specialized physicians. The U.S., in
contrast, has continually rewarded these doctors, professionally and financially, for their
commitment to medical specialties considered to be under pursued by native-born
Americans. In Kishore’s words: “…[I]n America… their religion is money [laughs]….
[T]heir focus is not so much who we [Hindus] are or what's … [our] background.... [It’s]
more of where is the opportunity for me to prosper? So the mindset of American
people ... [is] make money, enjoy life…. They don't care [if you’re] white or non-white
in this country, as long as you are good at what you do.” Kishore’s words succinctly
capture the perspective of most my first-generation interviewees. As financially
successful non-white doctors, they see the U.S. as a society in which an individual’s
professional merit matters more than his or her race.
Indeed, race matters more in postcolonial India, which overtly favors whites over
its own people, according to Dr. Amitabh Basu. Amitabh recalled being invited to India,
not long before his interview with me, to give a lecture. He was told that he had only
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fifteen minutes to speak, while “another chair, who’s junior, who I would…say, is not as
well known, at least I think, and from a lesser regarded university was given one hour
with all the airfares paid and things like that, because the guy is white.” As citizens of a
formerly colonized nation, the organizers of the lecture seemed to have internalized what
Memmi has described as “[l]ove of the colonizer… subtended by a complex of feelings
ranging from shame to self-hate” (1965, 121). By showing love and admiration for
whites –the race that colonized India for centuries—postcolonial Indians (such as those
who snubbed Amitabh) strive to gain an equal status with white Westerners, Memmi
suggests (122, 127). But Amitabh saw Indians’ privileging of white doctors as “reverse
discrimination,” not a response to white colonialism and its legacy. India, he implied,
will never be the colorblind meritocracy that is the U.S.:
…[I]n India, if someone came from Ghana or an African country, and
graduated there, would he ever be the chair of a very prominent
institution? The answer is no, [I] can tell you, however good that
person is….You see me, I’m a foreign graduate [in the U.S.]. We
don’t even interview foreign graduates [in India], or we don’t take
them in a residency. And here, I’m a world chair, and my teacher,
when I came to do a fellowship, wanted the job. But they superseded
[him], and I became the chair. And he had to report [to] me. This
will never happen in India. So we have to look at the positive aspects
of this country as well.
Many of the female first-generation interviewees seemed to heed Amitabh’s
advice “to look at the positive aspects” of the U.S. Although they spent much of their
interviews recounting the double marginalization they experienced in U.S. medical
institutions, they also told me that if they had never come to the U.S., they would not
have realized their full professional potential as doctors. Dr. Susheela “Sue” Vellu, for
example, suggested that if she had stayed in India, her gender and possibly also her
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family’s class status would have precluded the professional opportunities she has enjoyed
in the U.S.
One thing I disliked was rich people’s ability to get anything they
liked in India. Corruption, power, influence were a common theme
with rich people [in India]. That was disgusting to me. Also, the way
a woman had to walk behind a man bothered me, but I heard that in
America –I saw it in the movies-- if you had the ability to perform …
you have the opportunity regardless of wealth and socioeconomic
status. I still believe in this, about America.... But boy was I wrong
about male-female equality. You see it [gender inequality] around
every day….
As a woman, you need more validation of your credentials than a man
for the same position. But there are great people who put me on the
[hospital] Board; that is the greatness of America. It recognizes the
competence of foreigners and gives them opportunity. [I’ve been]
President of the Anesthesia Group, Medical Director of the
Anesthesia Group, and on the Board of Trustees for six years.

Sue’s sentiments were echoed in the responses of nearly all the other first-
generation Indian female interviewees. After narrating their many experiences with
prejudice and discrimination as “foreign female” physicians, these interviewees professed
feeling no regrets for pursuing their careers in the U.S., because it has provided them
with opportunities for professional growth that they would never have known in India,
given their gender and the limitations of Indian medicine in the mid twentieth century.
Unlike the social barriers of India, the glass ceilings they faced in the U.S. were usually
temporary and able to be broken, they claimed, as long as they worked hard and proved
themselves as competent physicians. Whatever they can’t break, several added, their
children will. Dr. Lakshmi Kamma observed: “I think there is prejudice…[Americans]
prefer the local....But once…[Indian doctors’] talents are recognized in some places…
then…[the Americans] learn to appreciate them. But in the beginning, I think [Indian
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doctors] had to work hard to prove themselves. But I think it’s mostly the first generation
because once second generations are coming --the doctors-- I don’t think there is
discrimination because they’re local trained...”
Linda and Peter argued that even first-generation Indian immigrant doctors face
no discrimination in America’s medical meritocracy. Considering that “any” Indian
immigrant doctor can enjoy a university position in the U.S., they explained, it is
incorrect to even suggest that Indian doctors experience prejudice or discrimination.
Lata: …So what do you think is the best way for Indian immigrant
doctors to address problems of professional prejudice and
discrimination?
…
Peter: … How can you say that? I mean I …hate to, to [laughs a bit]
counteract that question, in the sense, you know, if you really
look at the … Indian doctors …anywhere in the world,
especially in America.
Linda: They have done extremely well, so I don’t know how you can
say.
P: I mean, [they’re] in [the] top of…most institutions….Very
well known institutions…and, if somebody is so prejudiced …
They would never rise, rise up to that stage.
L: How would they all get there?…[T]hen, the other thing is
actually … it’s quite the opposite, if you really ask me.…
where[as], if you are back in India, half of these people who
are in the universities….Will never make it to even a
lectureship, because…in India … to be a university professor,
you have to be academically…the cream of the crop. … Here,
it so happens that the Indians who stick with the university, at
least, you know, fifteen years ago … [w]ere not necessarily the
cream of the crop at all. … You know, anybody could get a
position in the universities and stick on. … There are Indians
everywhere.
P: Everywhere!
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L: … I mean [I] really don’t feel that. … there is… I mean, in
practicality that prejudice is really … of any significance….
Individually, here and there, maybe.
P: …There may be some here and there…It’s usually…personal.
Indeed, “personal” and “individual” were words often used by the first-generation
interviewees. In their interpretation of the U.S. as a medical meritocracy, racism, unlike
casteism in India, is not a systemic social problem. Instead, it is the personal problem of
individual Indian immigrant doctors who, in their view, often cause the biases they suffer
by resisting assimilation and exhibiting a poor work ethic. Sunita, for example,
admonished the Indian medical community for “sticking to their own” and not
“mingling” with the social and political groups of their medical institutions or even their
local communities. “I think we need…more participation, more involvement," Lakshmi
observed. “Places where…[Indian doctors] are involved, I think they are doing pretty
well." These comments resemble those of the Indian professionals in Bhatia’s study, who
said that, in order not to encounter a glass ceiling, Indian immigrants should emulate
those aspects of American professional culture, such as networking, that will help them
advance in their careers (167-8). If they fail to do this, then, according to Amitabh, they
“can’t always play the discrimination card.” The doctors I interviewed, like Bhatia’s
participants, believe, as does Dr. Leela Arora, that “[e]ssentially, you have to be good in
your work. So, if you're good in your work...nobody can…either put you down or
discriminate."
Once again, racial discrimination is described as the problem of individuals who
are somehow weak, inferior, or “low class,” even when these individuals share the same
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occupational status and ethnicity as the interviewees. The first-generation Indian
immigrant doctors I interviewed hardly acknowledge that many other non-white
Americans do not share their human capital nor the shelter from racism that it provides.
These doctors seem to assume that other hard-working and, thus, deserving non whites
also seldom experience racism that is professionally damaging.
At the January 2007 inaugural meeting of the Orange County Indian Doctors’
Club (OC-IDOC), the new president for the year, Dr. Mohan Devani, invited the then
president of the California Association of Minority Physicians (CAMP), an African-
American doctor, to give the main presentation of the meeting. This was the first and
only time, during my eighteen months of attending the meetings of two Southern
California Indian doctors’ organizations (from May 2006 to November 2007), that an
African-American doctor had been invited to present. To my surprise, and most likely
the surprise of OC-IDOC members, the CAMP President, Dr. Harold Forrest, did not give
a CME (Continuing Medical Education) presentation on a medical topic, nor did he
discuss health insurance policies or financial options for physicians, as some past
speakers had. Rather, he discussed the paucity of inner-city students of color pursuing
medicine and nursing. He urged OC-IDOC members to help start a mentoring program,
just like one that the American Medical Association started in an inner-city high school in
Chicago, to encourage inner-city students in Southern California to consider careers in
health care. Indian doctors, Harold said, are one out of every four physicians in
California, so their participation is crucial to the success of the program.
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However, OC-IDOC members did not respond well. When Harold tried to
demonstrate the dire circumstances of today’s “Black and Brown kids” by saying that the
question asked of these kids is not “What do you want to be when you grow up?” but
“What do you want to be if you grow up?” the audience responded with laughter. During
the “Question and Answer” period after the presentation, members were argumentative
and critical, not supportive and full of praise as they often are after other non-medical
presentations. An OC-IDOC member who has also been a leader in several city and
county medical organizations in Southern California asked why he and these
organizations have never heard of CAMP, even though their memberships are racially
diverse. Harold and Dr. Suresh Agarwal –an OC-IDOC member who was Vice Chair of
CAMP at the time-- said that thus far, CAMP has only reached out to ethnic medical
organizations, such as IDOCs, not county and city medical organizations, to which the
inquirer responded that CAMP needs to do a better job of networking.
The second question, also asked by a first-generation male member of OC-IDOC,
was how mentors would be selected for the program, because not all doctors who want to
be mentors have the ability to be good mentors. Harold replied that once the mentoring
program is implemented, there will be criteria for selecting mentors. I couldn’t hear the
third question, because there were too many background conversations at that point. But
what I never heard expressed was support of the program or an interest in participating.
When I said goodbye to Mohan, after dinner, he seemed frustrated, but he didn’t explain
why and I decided it best not to ask.
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It appears that OC-IDOC members do not want to participate in a program for
helping disadvantaged communities of color, in non-clinical environments, because doing
so would require that the doctors admit, on some level, that U.S. society is not a
meritocracy that gives all non whites the same educational and occupational
opportunities. Some OC-IDOC members probably feel that they do enough for
communities of color by seeing them as patients, sometimes at no or low cost, in clinical
settings where they are clearly in a position of superiority. Other members may feel that
inner-city youth are responsible for their own fates and mentoring these “low-class,”
undeserving students will not help those of poor character succeed in the field of health
care. Still others are likely reluctant to make time in their busy schedules to participate in
a program that won’t advance their own occupational or professional status in any way.
Perhaps they fear that regularly associating with stigmatized groups of non whites could
actually damage their occupational and professional status, as others might associate
them with these “low-class” groups. Whatever their reasons, most of the OC-IDOC
members were not compelled to join CAMP in its effort to increase the number of Black
and Latino doctors in Southern California.
No doubt the members of OC-IDOC, like the doctors quoted in this section,
believe that America provides inner-city Blacks and Latinos the same opportunities to
succeed in medicine that it has given them; these other non-white groups just need to take
advantage of those opportunities through working hard and rising above their depraved
class and cultural backgrounds. After all, most first-generation Indian doctors implicitly
argue, they have become accomplished doctors in the U.S. despite the poor social status
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that many suffered in India; and if they have now “made it” as non-white immigrant
doctors in America, then certainly other non-white groups, especially those who are
native-born Americans, can “make it” too. As educated, English-speaking immigrants
who entered the U.S. under “skilled occupation” categories, the first-generation Indian
immigrant doctors I interviewed did not describe regular encounters with racism that is
clearly occupationally threatening. Thus, they have difficulty empathizing with other non
whites who say that they do regularly experience racism that frustrates their educational
and occupational goals. For these doctors, racism –both its perpetration and its
lamentation-- is the problem of low-class, culturally inferior individuals.
Conclusion
Previous scholarship in Immigration and Asian American Studies suggests that
Asian immigrants, as non-white Americans, eventually develop an understanding of
white racism as a structural problem of the U.S. The first-generation Indian immigrant
doctors I interviewed, however, have so deeply internalized the caste ideologies of India
that even after thirty plus years in the U.S., they rationalize racism as the problem of
individuals deficient in class or culture. In ranking racist whites as inferior individuals –
without critiquing white America as a whole—these doctors affirm their upper middle-
class status while also disavowing their inferior racial status in the U.S. First generation
Indian immigrant doctors focus on their prestigious occupational status in an effort to
reject their racialization as inferior to whites. As demonstrated by the quotes in this
chapter, incidents of racial prejudice and discrimination do have a deep and lasting
impact on the psyche of Indian immigrant doctors, many of whom experienced casteism,
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but not racism, while growing up as a member of India’s racial majority. These painful
incidents appear to be incongruous with the economic opportunities that America has
made available to professional Indian immigrants. Thus, invoking caste-based
hierarchies to emphasize their occupational and class superiority to most whites is a way
for these doctors to cope with their sudden racial minoritization and the incongruity it
presents. First-generation Indian immigrant doctors believe in the power of the white
coat to serve as the most visible marker of their American identity.
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Chapter Six:
“When You're Out in the Workplace, Just Assimilate”: Resisting
Racism through Generational Distancing
The son of a Nepali diplomat, Dr. Rajendra “Roger” Pandey was born in
Washington D.C. but lived in many different countries before returning to D.C. during
his high school years and deciding to make the U.S. his home. Always a racial and
ethnic minority wherever he lived, Roger –now a spine specialist in Southern
California-- said that the best way to avoid experiencing racial prejudice and
discrimination is to assimilate into the majority culture of any host society. Roger
explained that the main reason Indian doctors, particularly the first generation,
encounter racism in the U.S. is because they are too attached to their foreign, Indian
culture.
I think that’s a problem that first-generation [Indian] docs run into is
they’re too ethno-centric. … I think there’s a difference between
being proud of your heritage and just constantly hanging out with
your own kind.... When in Rome do as the Romans, you know? It
doesn’t mean you have to sell out and not be who you are, but just act
like everybody else does.... You just assimilate [laughs]. Just show
them that, you know, you’re an American and it doesn’t matter what
your heritage is. You can be proud of it. Go to temple, you know,
have pujas (Hindu religious ceremonies) and so on. But when you’re
out in the workplace, don’t feel like you have to…be like – I mean
even stuff like wearing certain clothes, like you don’t have to wear
Indian clothes all the time. Or even a turban... Most – at least second
generation Indians, they assimilate like no other ethnic group and so
they’re all doing very well.
Many of the other 24 second-generation Indian doctors I interviewed in Southern
California shared similar views, interpreting racism in the workplace as the result of
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appearing too foreign –too Indian-- and not assimilating into American medical culture.
As shown in Chapter Three, the second-generation interviewees most often experienced
professional discrimination when they were assumed to be Indian Foreign Medical
Graduates (FMGs) because of their race. Racially conflated with first-generation Indian
immigrant doctors –a large and established presence in U.S. medicine-- second-
generation doctors found that both their medical credentials and their assimilation into
white America were consistently questioned. In response, they worked to distinguish
themselves from first-generation Indian immigrant physicians and thereby prove their
greater identification with non Indians in the professional sphere. Specifically, they
employed three strategies of “generational distancing” in an effort to gain occupational
citizenship (access to most of the same rights and privileges as white Americans, based
on professional status and economic contributions). These three strategies were: 1.
rejecting the medical specialties chosen and recommended by the first generation, in
favor of pursuing specialties with few other Indians; 2. adopting a more service-oriented
philosophy than a money-oriented philosophy in making professional decisions; and 3.
limiting their participation in local Indian Doctors' Clubs (IDOCs). According to the
second-generation interviewees, these strategies helped them resist racism based on the
stereotype that Asian Americans are “perpetual foreigners” who constitute a “yellow
peril,” or a threat to the social, political, and economic predominance of whites in the
U.S. (Dhingra 2007: 17)
The Indian Americans in Dhingra's study (2007) of Asian American
professionals in Texas were also strategic in their representations of ethnic identity at
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work. These professionals selectively displayed and identified with both Indian and
American cultures --or practiced what Dhingra calls “lived hybridity”-- in order to avoid
professional discrimination based on race. But most of the Indian-American
professionals of Dhingra's study were not in professions that also included a large
number of first generation Indian immigrants. Thus, being racially lumped with the
foreign-trained first generation was not of great concern.
As Asian Americans pursuing a profession in which first-generation immigrants
of their same ethnicity are highly visible, the Indian Americans I interviewed rarely
expressed their Indian identity, or practiced lived hybridity, at work. Rather, they
distanced themselves from all things and all people Indian so as to be perceived as good
American doctors instead of ethnocentric, inferior foreign doctors. For Indian-
American doctors in Southern California, unlike Indian-American professionals at large,
whom they identified with ethnically conveyed how they identified ethnically. And
while at work, these doctors rarely chose to identify with first-generation Indian
immigrants.
“There's not too Many Indians in That”: Choosing a Different Specialty
One of the strategies that second-generation Indian doctors used to distance
themselves from the first generation was to choose medical specialties pursued by few
other Indians. Indeed, there was little overlap in specialties between the first-generation
interviewees and the second generation. Whereas approximately half of the first-
generation doctors I interviewed were in surgical specialties, less than a third of the
second-generation doctors were in surgical fields (Table 1).
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Interviewed Doctors' Specialties by Generation
Surgical Specialty Non Surgical
Specialty
Specialty Involving
Some Surgery
First Generation
Doctors
11 11 5
Second Generation
Doctors
4 18 4
The second generation preferred to practice less technical, more patient-centered
medicine, such as pediatrics, family medicine, and internal medicine. This is, in part, a
response to the current need for generalist physicians in inner-city areas of Southern
California (Coffman, Young et. al. 1997; Grumbach, Coffman et. al. 1998). It is also a
reflection of the second-generation doctors' familiarity and facility with American
English and, in many cases, basic conversational and medical Spanish –all signs of their
assimilation into not only America at large but also Southern California.
But most importantly, for the second-generation doctors themselves, choosing to
practice less surgical specialties was a way to distinguish themselves from first-
generation Indian immigrants –both other doctors and their parents and community
members who had pressured them to pursue medicine. As Indian-American pediatrician
Dr. Shantali Bharat explained, she did not want non Indians to see her as “Oh, another
Indian doctor...” who is “just doing this because my parents made me.” “I'm not the
kind of person who lets people sway me into doing things,” she declared. So, to
“differentiate” herself from other Indian doctors, Shantali not only specialized in
pediatrics (a common specialty among the second-generation interviewees but not the
first generation), she also participated in a “community health and advocacy training
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program” at a Southern California university. This program was “a separate track
within pediatrics” in which she was happy to be the “only Indian person in [the] group.”
Like Shantali, most second-generation interviewees felt they had sufficiently
honored their parents’ wishes, and also secured their continued membership in the
ethnic community, by entering medical school. Ethnic expectations thus fulfilled, the
doctors went on to assert their independence from the first generation by letting their
own interests and desires determine their choice of specialty, not the older immigrants’
desire that they pursue only the most lucrative fields.
For example, after having her father, also a doctor, dictate many of her career-
related decisions, rheumatologist Dr. Vanita Ramanathan felt that her medical specialty
should be her choice alone.
…[In college, I majored in] Microbiology, minor[ed] in Theater. I
wasn’t allowed to do a double major in Theater because Dad said
that he wasn’t gonna pay for an extra year....just four years. But if I
could have stayed for one more year I would have double majored....
[W]hen I got into medical school… [my parents] were generally
very happy for me and in some ways [it] sort of validated my
existence…. I mean, I always felt that I could do whatever I wanted
to do [as far as specialty]. I could be a surgeon if I wanted to, I could
be a cardiologist if I wanted to, I could go into GI [gastroenterology]
if I wanted to. Those were the two fields that my dad really wanted
me to go into. He was quite disappointed that I chose rheumatology
[a specialty dealing with connective tissue disorders], and was
aghast when I told him I was thinking about geriatrics, because those
are two fields where you’re not doing a lot of procedures and you’re
not gonna be making a lot of money….
In ultimately favoring her own medical inclinations over her father’s wishes,
Vanita exercised some agency in her professional life and asserted her independence,
from both her parents and the local community of Indian immigrant doctors. But this is
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not a simple case of assimilation, or rejecting one set of cultural expectations for
another; Vanita, like the other second-generation interviewees, was clearly concerned
with maintaining many of the ethnic norms of her family and the Indian community.
Indeed, when explaining why she decided to become a doctor, Vanita herself expressed
a desire to “make…good money.” The second-generation doctors, therefore, recognized
the benefits they derived from conforming to the professional expectations of the first
generation. The first generation, as many noted, were responsible for the strong national
reputation that Indian doctors have today –a reputation that allowed the second-
generation doctors to experience a high degree of occupational citizenship in the U.S.,
particularly among patients.
Moreover, as a few second-generation interviewees observed, it was the financial
success of their parents (many of whom are doctors themselves) that allowed them not
to fixate on the financial returns of their preferred fields; they could, after all, always
count on their parents for monetary support (as Vanita did, during college).
Nevertheless, many second-generation interviewees stressed that they are more
American than they are Indian, and, thus, feel compelled to establish their individualism
–that most American of cultural traits—if only within the professional sphere. Indeed,
despite emphasizing his respect and connections with the first generation throughout his
interview, Dr. Deepak Chandramohan said that the decision to specialize in podiatry was
entirely his own.
Podiatry alone was my own decision, which was...a pretty huge
choice. Not too many Indians in podiatry...not very common to have
an Indian podiatrist....Now there’s more and more getting into it. I
think it’s becoming more of a popular profession now...in the Indian
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community too.... Before it was like, 'Oh, okay.' [laughs]. I think they
would have been like that with any specialty, but I think especially
podiatry, because a lot of them didn’t know it was separate from
regular medical school.... And I remember having Indian friends of
mine that actually went to DO school, Doctor of Osteopathic
Medicine, and they had no clue either. 'It’s a doctor, right?” 'Okay,
then, fine.' That was the common thing: 'A doctor? Okay, fine.' The
only ones that were like, 'Are you sure?' were the ones that were
already doctors, like, 'I don’t know, because we trained in India and
we’re here and I don’t know if it’s the same. Is it the same?' That kind
of response..... So when I went to New York [for podiatry school], it
was basically all my decision.... I didn’t care what anyone said at that
point. I just wanted to do what I felt was right for me.
For Deepak, specializing in podiatry not only asserted his autonomy from the
Indian immigrant community but also exempted him from heavy competition with other
Indian Americans for admission into specialty training. Deepak remarked that
acceptance into medical institutions was becoming increasingly competitive, especially
in Southern California, which is home to several prestigious medical schools as well as
a large population of Indians (UnivSource 2009; Améredia 2008). Considering the
negative reaction of white Americans to large concentrations of Asians in well-paying
sectors of the U.S. economy –a basis of the “yellow peril” stereotype-- it can be inferred
that U.S. institutions of medicine refrain from admitting both generations of Indian
doctors into only the highest-paying fields. Thus, choosing specialties with “not too
many Indians in” it is a professional strategy as well as a racial strategy for the second-
generation interviewees: it increases their chances of being accepted into specialized
medical programs.
However, most of the interviewees –cushioned by the financial security of their
parents-- focused on the racially strategic aspect of their specialty decisions: avoiding
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association with the seemingly opportunistic and mercenary first generation –the
“yellow peril”-- who, favoring medical procedure over patients, appeared to be more
interested in America’s money than its people. Indeed, Vanita, in continuing to explain
why she chose to specialize in rheumatology, observed that most first-generation Indian
doctors she knew (including her father) regarded all lower-paying medical specialties
with disdain.
[My father] thinks that he made a mistake in going into pathology.
He thinks he should have done cardiology or GI where he could have
made a lot of money…. But generally I think overall, and this may
be incorrect, but I think there’s this strong drive for Indians to go and
make a lot of money and not for academics, because if you’re in
academics you’re not doing the right thing because you weren’t able
to go out and make money…
Vanita and the majority of second-generation interviewees were more concerned
with “doing the right thing” for themselves –and, consequently, for individualistically
oriented (white) America-- than for first-generation Indian immigrants, including their
own parents. As Dhingra (2007) and Ho (2003) note, the second generation does not
entirely reject the model minority stereotype; indeed, they strive to conform to it in
professional realms, but only as it is defined by white America. As the interviewees of
my study indicate, the second generation does often reject co-ethnic definitions of
model minorityhood, especially those of first-generation co-ethnics.
To illustrate just how much of a breach from first-generation expectations
choosing a non-lucrative medical specialty can be, I end this section with a quote from
Dr. Nikhila Sangam. Although Nikhila is a successful child psychiatrist in Southern
California, her relatives continually derided her choice of specialty, often asking her
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when she would become “a real doctor.”
[M]y parents wanted me to go into medicine, and I was interested in
psychiatry, so I kind of went into medicine to be a psychiatrist….
[There] was never a…moment that I told them that I’m going to be a
doctor. I think that they just kind of assumed that I was going to be
a doctor. I was always expressing interest in it…so there was never
any shock or surprise….[except] [p]robably in picking my
specialty… I mean, there’s the pride in your child or your relative
that they’re going to be a doctor, but when they pick psychiatry, it’s
almost like a stigma or an embarrassment. You know, ‘Why did you
go into medicine to do that?’...And so no one was happy... The
perception of psychiatry is kind of distorted...towards it being
something that …is not helpful and is not medical, so it’s not
something that people want their children to go into.... My father
still asks me when I’m going to be a real doctor, so I think they [my
parents] still feel that way.... My uncle makes fun of psychiatry in
my presence, I mean, he makes fun of me in my presence. You just
kind of develop a thick skin....
The pay and prestige hierarchy of medical specialties was so significant to many
first-generation Indian immigrants, that their children's decision to pursue medicine
failed to win their approval if the children's specialization was not at the top of this
hierarchy. Deciding to specialize in lower-paying fields with few other Indians was thus
indeed “a pretty huge choice,” as Deepak worded it, for many second-generation
interviewees. It was a choice that demonstrated their strong identification with
American individualism and their desire not to be perceived as “Oh, another Indian
doctor” by the non-Indian public –a perception potentially resulting in professional
discrimination and a loss of occupational citizenship.
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“Medicine Has the Potential to Be Service…Money’s not the Only Thing” :
Service Over Salary
In addition to choosing non-lucrative generalist specialties, another way that
Indian-American doctors separated themselves from the first generation and its focus on
financial return was by approaching medicine as service. Unlike the majority of first-
generation doctors I interviewed, most second-generation interviewees were either
already treating or planning to treat underserved communities of color, not only in
Southern California and India, but also in other regions around the world. Indeed,
several interviewees told me that it was their desire to help people in need, more than
financial security, that motivated them to become doctors.
Dr. Sushil Ramachandran, a second-generation pediatrician, was one such
interviewee. The son of a first-generation Indian immigrant pediatrician, Sushil never
cited family influence or pressure as reasons he decided to pursue medicine. He did not
mention scientific ability or interests either. According to Sushil, his decision to
become a doctor was based solely on his desire to serve others.
I decided [to become a doctor] in the summer after my freshman
year of college. I didn’t really know what I wanted to do when I first
started college. That summer I did a volunteer program in rural
Honduras, and I think it was just probably the isolation of it all,
reflecting at that time what would be a good use of my skills, what
would be something worthwhile to do. Being there and thinking
about their access to health care, which is very minimal, and how it
would be a great thing to do. That’s probably the typical thing that
most people say, using science for the welfare of other people,
basically.
This was not “the typical thing that most” first-generation interviewees said,
however, in response to my asking them why they decided to pursue medicine. Rather,
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the majority of these doctors cited the limited professional options available to
scientifically inclined students in India, during their youth: they could pursue either
medicine or engineering; and women were often restricted to obstetrics-gynecology or
pediatrics as their specialty options. First-generation interviewees also mentioned
family poverty and illness, as well as a parental emphasis on education and financial
security as reasons they pursued medicine. Few mentioned “using science for the
welfare of other people” outside of family, although many wanted to become involved
in charitable activities after retirement. In deciding to enter medicine, however, service
to themselves and family members took priority over service to others.
Indeed, internist Dr. Sunil Subramanya observed that first-generation Indian
immigrants entered medicine (and the U.S.) with different concerns than did the second
generation, because the former had to focus on their own professional and financial
survival before they could focus on the survival of others. As the American children of
these immigrant professionals, however, the second generation were not so preoccupied
with their own survival, and could afford to think about larger social issues. According
to Sunil,
The people who migrated here, if they were…professional, they
don’t exactly have that kind of…[race and class] analysis, you
know?… …[I]f you talk about, like, race and HIV and…the politics
about who’s getting disease…a lot of them…at least in L.A., like,
the wealthier doctors, you won’t see that fire, that, ‘Like, wow!
Medicine has the potential to be this thing where you have…a
service perspective…’…[T]hat’s not part of their perspective on
stuff:…who’s poor and why. It’s just not part of the conversation…
[O]ur [second] generation…we have that opportunity that [the first
generation has]…paved the path for…I haven’t had to struggle
much. So when I think about what makes a life it’s a lot more
complex or there’s a lot more things to it than just coming in,
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making a good living, making sure that I’m stable and making my
way in…a new country…‘cause you see all these…second-
generation South Asians that are…going back to India and doing all
this stuff. And there’s so many examples of people that [say], ‘Oh,
money’s not the only thing, so there’s got to be other things because
I’ve grown up with a lot of money.’
In addition to reflecting their class privilege, the second-generation doctors'
desire to serve others also reflects the context of contemporary health care in Southern
California, where, as noted above, there is a great need for physicians in inner-city
communities of color (Coffman, Young et. al. 1997; Grumbach, Coffman et. al. 1998).
Furthermore, several first and second-generation interviewees said that starting a solo
medical practice in Southern California’s wealthy suburbs is much more difficult today
than it was in the 1970s and ‘80s, when the first-generation doctors began their careers.
As I explain in Chapter Two, the rising cost of health insurance as well as the growth of
managed care facilities, safety-net providers, and group practices are quickly rendering
the solo suburban physician obsolete (Boulis and Jacobs 2008: 27; Mechanic 2003;
Tanne 2007; Starr 1982: 445, 446). Working in a hospital or community clinic is a more
immediately feasible option, although the second-generation doctors who were medical
residents –a third of the interviewees—may not have remained in urban hospitals and
clinics once their residencies ended.
Free of dire financial pressures, the second generation could respond to
institutional pressures to treat the medically underserved. Nevertheless, their
professional decisions suggest that even without institutional steering, they would have
chosen to work in low-income communities of color. Pediatrician Dr. Sucheta Ram, for
example, gave up her job at a large Orange County Health Management Organization
155
(HMO) that served primarily white, “affluent, upper middle-class families,” and chose to
work at a pediatric hospital serving primarily uninsured and state-insured Latinos
instead. Sucheta told me that she was not content treating the children of educated,
wealthy white families at the HMO, even though she soon would have earned a six-
figure salary had she stayed. Most of these children, she said, were quite healthy and
not in need of much medical care. But they would come to see her because their parents
were convinced their children were suffering, often from imagined allergies or asthma;
and the parents wanted Sucheta's official medical approval of their diagnosis, usually
based on Internet research. She felt that she wasn’t really helping people, while working
at the HMO. Instead, she felt that she was assisting wealthy parents in pathologizing
their healthy kids. She was happier in an academic hospital environment, even though
the pay was less.
For Sucheta and several other second-generation interviewees, growing up as an
American of color –and experiencing racial stigma-- made them sensitive to the needs of
other people of color, besides making them resistant to working in the predominantly
white suburbs of their youth. As plastic surgeon Dr. Vishal Bhaskar's recollections
suggest, many Indian-American doctors grew up experiencing a lot of racial teasing,
while attending predominantly white, suburban schools.
Early on in … middle school and… high school, I think at that time
there was a fair bit of prejudice, I mean pretty significant…. In
middle school and high school...kids only saw [Indians in movies,
like] Indiana Jones [and the Temple of Doom]...[makes whooping,
Native American war cry sounds]... I was in suburban Philadelphia,
kind of a rich area, and it was pretty fairly significant, [the] prejudice
there... Since then I haven’t noticed any [prejudice]– you know,
pretty much treated like everybody else for the most part…. And
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then [while doing medical training with the U.S. Air Force], the
military takes pains to a great degree to make sure there’s no
difference in the way people are treated, so I had a fairly good
experience. And so all my practice has been there, and then at [his
residency institution in urban Los Angeles] no problems.
Vishal's remarks indicate that the money and class privilege of the first
generation could not prevent the second generation from experiencing racial prejudice;
but the second generation's professional decisions could. The Indian-American
professionals could choose not to work in rich, white suburbs, thus distancing
themselves from the racism they had experienced as children and, at the same time,
distancing themselves from some of the financially driven priorities of their parents. As
shown in Chapter Two, Indian physicians receive great gratitude and respect from low-
income patients of color, who have little choice in health care providers. It is this
reception, in great part, that motivates the second generation to serve urban communities
of color. Many class-conscious first-generation doctors, in contrast, treat low-income
patients of color primarily because changes in the structure of Southern California's
health care require them to do so. Otherwise, as explained in Chapter Five, they would
prefer to work in predominantly white, suburban neighborhoods; and many had
practiced in such areas when they first arrived in Southern California in the 1970s and
1980s.
Thus, a philosophy of service not only distanced second-generation doctors from
the first generation's perceived obsession with money and from the image of “yellow
peril,” it also distanced them from white racism. Many second-generation doctors chose
to treat low-income communities of color rather than middle-class white suburbanites,
157
whom they associated with racial privilege and prejudice. And this choice, in addition
to putting physical distance between whites and themselves, also demonstrated a
commitment to the welfare of communities other than their own (i.e. Indian co ethnics).
Like Dr. Roger Pandey (quoted in the introduction to this chapter), many interviewees,
of both generations, accused the first-generation doctors of being too ethnocentric –too
detached from non Indians and their concerns-- and thus susceptible to racial
marginalization in the U.S. By taking an interest in the medical needs of many different
ethnicities, the second-generation interviewees strove to avoid such marginalization.
It is important to note, however, that practicing service through medicine still
allowed the second generation to participate and benefit from white-American
institutions. Indeed, many chose to train and work in prestigious institutions of
medicine, and chose to live in predominantly white, middle-class suburbs even if they
did not serve them. Treating the medically underserved, therefore, was just as strategic
as it was altruistic.
“I Had Nowhere to Sit”: Leaving IDOCs and NAIDA to First-Generation Males
A third strategy that the second generation used to distance themselves from first
generation doctors and their perceived ethnocentrism was not to join Indian Doctors’
Clubs or IDOCs. In Southern California there are three major IDOCs --professional
organizations affiliated with the National Association of Indian Doctors in America, or
NAIDA, which is the largest ethnic medical association in the U.S. The professional
objective of these organizations is to help advance the medical careers of Indian doctors
in the U.S., principally by sponsoring Continuing Medical Education lectures (CMEs);
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providing a forum for networking with co-ethnic physicians; and arranging charitable
service projects (usually half-day “Health Fairs” in South Asian American communities)
(OC-IDOC 2005; LA-IDOC n.d.). 1
However, the majority of doctors I interviewed, of both generations, described
these organizations as primarily social, with no clear professional goals. Indeed, the
mostly first-generation doctors at the Southern California IDOC meetings I attended,
from May 2006 to November 2007, treated these meetings as opportunities to catch up
with co-ethnic colleagues and friends, eat a sumptuous Indian buffet dinner (provided at
every meeting), and enjoy the occasional Hindi music or dance activity. The CMEs and
organizational announcements were often of secondary importance, despite the efforts
of IDOC officers (usually first-generation males) to command the members’ attention.
Away from the hospital and the clinic, and in a majority co-ethnic space, members
resisted thinking and behaving according to the standards of American professional
culture. They instead felt free to conduct themselves as they would in other informal
Indian and Indian-American gatherings, as Dr. Archana Somani, a second-generation
doctor, observed: “[At IDOC meetings], [p]eople would literally talk; the wives would
sit in the back and talk during the whole time the poor [CME] guest lecturer was
speaking... And…people would bring their kids. There were so many times when I’d
walk in, I had nowhere to sit, let alone sit and eat.”
The IDOCs literally didn’t have a place for second-generation Indian female
doctors like Archana; even the first-generation women who attended were relegated to
the status of “the wives” who sat in the back.
2
As Archana’s quote suggests, IDOCs are
159
primarily for first-generation male doctors to exercise the power, pride, and privilege
they had lost in entering the white male-dominated workspace (George 2005; Espiritu
2003a: 87-88).
Indeed, pediatrician Dr. Shantali Bharat described the typical member of NAIDA
(the umbrella organization for regional IDOCs) as being first generation, male,
apolitical, and only interested in Indian food, Indian culture, and American money.
[It] would be great if NAIDA...voices their support for Obama [in
the 2008 elections], that would be really nice. But...I just feel like
most of those uncles [first-generation men] are like, 'No I’m just
really interested in my money. I’m not really interested in making a
political statement at all. I’m just here for...my fashion show and my
food and my money.'... [T]hat is how I view the typical person who
goes to NAIDA. So I don’t even know who goes from my age
group, but based on the guy that told me about it, I was just like, you
know, he sort of fit the bill of like the kind of person, because he is
kind of slowly turning into his father... I just feel like it’s great if
NAIDA does support a political cause--that’s wonderful. But...I just
couldn’t get involved in [the organization] because I don’t believe in
it enough. I don’t believe in the ability of that group of people
to...really effect change and to really care about a cause outside of
their own...little life...
For second-generation interviewees, the chauvinism of IDOCs is symptomatic of
the national attitude of first-generation Indian immigrant male doctors. Indeed, other
studies of national Indian immigrant organizations have also noted that they primarily
serve the interests of first-generation men, who are their founders and leaders
(Bhattacharjee 1998, Kurien 2007: 187). Indian immigrant women and the second
generation play minimal roles.
Nevertheless, several second-generation doctors said that the first-generation
male members of IDOCs often urged them to become active members and leaders. But
160
when they tried, their interests –often more professional and political than social or
cultural-- were not taken seriously.
According to second-generation radiologist Dr. Vandana Parekh, all Indian-
American organizations are “meat markets” in which single second-generation members
are encouraged to meet potential mates: “I think all these...Indian organizations are just
meat markets. [Laughs]….Yeah, that’s pretty much what those organizations are, I
think. You know, nobody talks about the conferences or anything. It’s about going
there [and] meeting people.”
Dr. Sushil Ramachandran felt similarly, adding that the purely social agenda of
second-generation NAIDA participants deterred him from joining the organization:
I think [NAIDA]—it’s a social club. [Laughs] It seems like it, to me.
And I used to go to their meetings with my parents. So definitely, I
don’t know what it’s like now, but it was a— [pause] for the kids, at
least, it was just basically partying. I don’t know what it is for the
young professional doctors in the group now. I don’t know what
they’re up to....I don’t really, because I find it a little sketchy, just
because I—I’m leery of any kind of Indian so-called professional
organizations whose real aim is just to set people up on dates. I don’t
want to be involved with that at all.
Thus, both male and female second-generation interviewees shared similar
frustrations regarding the social emphasis of NAIDA. And a few, like Archana,
objected to members' lack of interest in the CME lectures. Many of the CME lecturers
at IDOCs are invited speakers who are not Indian. In an e-mail that Archana wrote to
one of the IDOCs, she implied that the organization gave non-Indian guest lecturers a
negative impression of Indian doctors: “I [had] said, ‘It’s embarrassing being here.
These speakers come from [a prestigious local university], these big doctors, to talk, and
161
everybody’s talking in the back. What are you showing? It’s disrespectful.' ”
Here, Archana's e-mail suggests that IDOCs give prestigious, non-Indian guests
a poor impression of not just the organizations themselves, but of the Indian medical
community as a whole. Her comments, as well as those quoted above, indicate
the second generation interviewees' belief that IDOCs, as medical organizations, should
adhere to the same professional norms as non-Indian medical organizations.
To these Indian-American doctors, IDOCs and NAIDA are not sufficiently hidden from
the white-American public eye to be “safe spaces” for expressing Indian cultural and
social norms.
Rudrappa (2002) observed that for Indian Americans “being Indian” was a
weekend activity, limited to the private and co-ethnic community spheres where they
did not fear the racial prejudice of white-American peers. When with these peers at
work or school, however, the second-generation learned to suppress their Indianness and
assimilate to white-American social and professional behavior. Keeping their public
American life separate from their private Indian one was an effective strategy for
minimizing their susceptibility to white racism.
NAIDA and IDOCs threaten this strategy, however, with their blending of
professional, social, and cultural activities. As purportedly medical organizations that
invite and host white-American guests, IDOCs should reject Indian social and cultural
norms in favor of white-American professional norms, according to the second
generation. They should also express an interest in U.S. medical culture and politics as
defined by white-American institutions, the younger doctors implied. Otherwise, they
162
worried, white guests would come to view all Indian doctors as too foreign, too
ethnocentric, and too unprofessional –in other words, perpetual foreigners and yellow
perils.
The Indian-American doctors objected not so much to the IDOC members’
behavior itself, as they did to the members’ failure to suppress that behavior in an
ostensibly professional forum, in front of non Indians. In IDOC meetings, second-
generation Indian doctors could not selectively interpret and display their ethnic culture
for non-Indian colleagues. In other words, they could not practice “lived hybridity”
(Dhingra 2007). They had very little agency in IDOCs. Therefore, rather than risk
being associated with these racially vulnerable, first-generation male-dominated groups,
most second-generation interviewees refused active membership in IDOCs, attending
only the occasional meeting or event.
Conclusion
The second-generation Indian doctors I interviewed employed three strategies to
avoid negative racial lumping with the first generation: 1. pursuing non-surgical
medical specialties with few other Indians; 2. practicing medicine as service in low-
income communities of color; and 3. refusing active membership in first-generation
male-dominated Indian Doctors' Clubs. All three strategies made the Indian-American
physicians appear more (white) American than Indian and helped to minimize their
vulnerability to white racism. In other words, the second generation's distancing from
the first increased their occupational citizenship.
I should emphasize that these three strategies can not be reduced to a simple case
163
of inter-generational conflict resulting from second-generation assimilation. Choosing
non-surgical specialties; practicing medicine as service; and avoiding IDOCs are a
response to the racial prejudice that the second-generation Indian doctors experienced in
their youth. They are also a response to the racial discrimination that some said they
experienced in U.S. institutions of medicine. Moreover, the structural constraints of
contemporary health care in Southern California supported these strategies. The need
for more medical generalists in low-income communities of color steers Indian-
American doctors to these areas, and away from the white, suburban neighborhoods in
which many first-generation physicians work.
Furthermore, outside of professional spheres, in private and community spaces,
the second-generation interviewees associated closely and regularly with the first
generation medical community. Indeed, many of these interviewees mentioned
socializing with first-generation Indian immigrant physicians, but usually away from the
gaze of the white-American public.
164
Chapter Six Endnotes
1.
To preserve the anonymity of all Indian doctors’ organizations mentioned, I provide pseudo-
citations with partially correct information (such as the year of publication). In this way, I
indicate that the source of the cited information is the organization itself, without making the
organization readily identifiable.
2.
Since my fieldwork, the status of first-generation immigrant women in IDOCs seems to have
changed, as several are now in leadership positions.
165
Conclusion:
Racializing the American Physician
This study shows that occupational status alone does not determine the racial
treatment of first and second-generation Indian doctors in the U.S. Rather, the doctors'
occupational status intersects with their gender, immigrant generation, and degree of
situational authority in a given context to determine their U.S. racial experience. As
explained in Chapter Two, only in the context of clinical interactions with patients do the
Indian doctors' occupational status and situational authority receive much greater
recognition than their gender, immigrant generation, or race. This leads to their
unequivocal racial acceptance from patients –what I call occupational citizenship. I
define occupational citizenship as racial acceptance based on a high professional status
and situational authority. And in Chapters Three and Four, I demonstrate that the doctors
experience limited or delayed occupational citizenship when interacting with colleagues,
nurses, and medical institutions, as well as during their encounters in public. In these
contexts, the doctors' race, gender, and immigrant generation define them more than their
occupational status defines them.
In addition to discussing Indian doctors' racial treatment by others, this study also
discusses the doctors' interpretation of and response to others' race-based conduct.
According to Omi and Winant's racial formation theory (1994), racialization, or the
processes by which a group comes to be identified as a racial minority, is a product of not
only sociopolitical forces external to the group, but also the group's reactions to these
forces. As shown in Chapters Five and Six, the doctors' responses to their racial
166
treatment in the U.S. vary by generation: the first-generation doctors interpret the racism
they experience as the impotent lashing out of individual, lower-class whites who are
simply ignorant, or jealous of the physicians' occupational status. In contrast, the second-
generation doctors view the racism they experience as resulting from first-generation
doctors' ethnocentrism and foreign mannerisms, both of which stigmatize Indian doctors
as a whole as unwilling to assimilate into (white) American professional cultures. In both
cases, the Indian doctors I interviewed seldom described the racism they experienced as a
systemic, social and political problem of the U.S., nor did they express a desire to
politically mobilize around racial issues. Neither generation felt they were at significant
risk of losing their occupational citizenship.
Derived primarily from interviews with fifty-two first and second-generation
Indian doctors in Southern California, the principal findings of this study mostly address
the second of the three guiding questions with which I began my research:
How do first and second generation Indian physicians interpret their inter-
ethnic relations with staff and patients in various professional contexts?
And how do these interpretations affect both the physicians’ gendered
ethnic identities and their perceptions of non Indians’ gendered ethnic
identities?
As my findings demonstrate, inter-ethnic relations with colleagues and in public
shape Indian physicians' racialization as much their inter-ethnic relations with patients
and staff. And the doctors' interpretations of these relations vary by group and context,
with patients making the doctors feel that they are respected cultural contributors to
167
American medicine and society, but staff, colleagues, and the general public making them
feel that only their work is of value, while their non-white presence is not. In all cases,
the doctors perceive that their race and ethnicity prevent them from completely
identifying, or being identified, as “Americans.”
My findings also show that in addition to inter-ethnic relations, the doctors'
professional histories, gender, and generation shape their U.S. identity, as does the
institutional structure of U.S. health care, particularly the doctor-patient hierarchy of
Western medicine. All of these factors intersect with race, ethnicity, and occupational
status to determine Indian doctors' identity formation in the U.S., indicating that the
physicians experience racialization along multiple dimensions. The first and third of my
guiding research questions, therefore, receive attention in my focused discussion of
question number two (above). The first question is:
What are the professional motivations, histories, and narratives of post-
1965 Indian physicians in Southern California, and how do they vary
according to immigrant generation and gender?
Although my findings do not directly answer this question, they do suggest that
the professional motivations, histories, and narratives of Indian doctors are largely the
products of U.S. and Indian medicine's gendered social hierarchies. The doctors are
steered into certain specialties and medical institutions based on their gender and
generation, with first-generation male doctors most likely to practice surgical specialties
in private clinics –and thus garner the greatest income and prestige. Second-generation
female doctors, in contrast, are most likely to practice non-surgical, feminized specialties
168
in public hospitals and clinics. Any discussion of Indian doctors' racialization, therefore,
must also consider their immigrant generation and gender. Intersectionality is key.
The third guiding question with which I began my research is:
How do Indian physicians interpret their relationships with patients in
terms of the traditional Western doctor-patient hierarchy of patient
submission to physician authority, and how do these interpretations vary
according to the doctors’ immigrant generation and their gender?
Again, although my findings do not directly address this question, my discussion
of the doctors' inter-ethnic patient interactions (Chapter Two) shows that the traditional
doctor-patient hierarchy of Western medicine partly explains the doctors' positive
racialization by their patients. According to the physicians, their mostly non-white,
uninsured patient population in Southern California privileges their medical authority
over their racial or gender status. Indeed, so entrenched is the hierarchical relationship
between doctor and patient –and the resulting reverence of doctors' medical authority--
that Southern California's patients have come to perceive their non-white doctors'
“foreign” attributes as positive traits that add to the physicians' talent for healing rather
than detract from it. It is a perception that the doctors I interviewed share. Southern
California's Indian physicians believe that their “cultural values” make them superior
healers, whose medical authority receives immediate recognition and respect from
patients.
In discussing Indian doctors' racialization in terms of various contexts and
multiple social factors, I provide a more complex and nuanced portrait of Asian American
169
professionals' racial experience than does Koshy (2001) (quoted in Chapter One). Koshy
describes “incoming middle and upper-class Asian immigrants” as being
“insulate[d]...from the harshest effects of the experiences from which the antiracist
discourses of the civil rights movement derive” due to their class status (192). My
findings suggest that in post-9/11 Southern California, this insulation is partial and
situational, limited to those contexts in which an Asian professional's class status is
readily recognizable and clearly above the class status of others in the same setting.
Although the racism my interviewees experienced outside of these contexts does not
currently approximate “the harshest...experiences” of other non-white races in the U.S.,
this may change as racial hate crimes, anti-immigrant sentiment, and Southern
California's non-white population all continue to grow (Hsu 2009). Indeed, as shown in
Chapter Four, racially ambiguous Indians often “pass” for African Americans, Latinos,
and Middle Eastern Muslims –three minority groups who are frequently the targets of
hate crimes in the U.S. (AFP 2009).
Moreover, the young Indian-American doctors I interviewed treat primarily non-
white, urban patient communities in Southern California, not only in response to the
region's health care needs, but also by the doctors' own choice. Many of these doctors
prefer to work in underprivileged communities of color rather than wealthy white
suburbs. As explained in Chapter Six, Indian-American doctors feel that they are of
better service to disadvantaged populations than to white suburbanites –those responsible
for the racial prejudice they experienced as youth. The second-generation preference for
treating the underserved will likely compel these doctors not to “bypass the arenas where
170
the politics of race is engaged in a sustained way,” as Koshy maintains (2001: 192).
Indeed, like Dr. Shantali Bharat, several Indian-American doctors I interviewed were
already involved in health care advocacy, which they said they enjoyed not only because
it distinguished them from the first-generation Indian physicians, but also because it
distanced them from wealthy white patients whom they considered to be spoiled and self-
pathologizing.
Will Indian-American physicians of the second generation, unlike the first,
gradually subscribe to the “antiracist discourses of the civil rights movement” and
politically mobilize around racial issues with other non whites? The answer lies in their
future career trajectories. The oldest of the second-generation doctors I interviewed were
in their late thirties and still relatively new to medical practice. Following up with these
physicians in ten to twenty years, when they are established doctors of the same age as
the first-generation interviewees, would provide the qualitative data necessary to address
this question. It would also allow scholars to draw further comparisons between the first
generation of Indian doctors and the second.
Moreover, a longitudinal analysis of Indian-American doctors' racial formation
could offer important theoretical contributions to studies of immigration, Asian American
Studies, and the sociology of occupations. Were the doctors to express a greater desire to
mobilize politically against structural injustice, this shift in racial consciousness would
suggest that their racialization is not only contextually and situationally determined, but
also temporally determined –subject to change over the course of one's professional life.
Longitudinal changes in the racial identity of contemporary non-white immigrant groups
171
have received little attention in scholarship on race and ethnicity in the U.S. A follow-up
study of Indian-American doctors' racial formation could begin to focus attention on such
changes.
Future studies of Indian doctors' U.S. racialization could also further investigate
the racial positioning of these non-white professionals. Kim's theory of racial
triangulation (1999) posits that Asian Americans occupy a fixed position between whites
and Blacks in America's racial hierarchy. Building on this theory, I suggest that Indian
physicians oscillate between being positioned higher than whites, because of their
prestigious occupational status, and being positioned equal to Blacks because of their
phenotype. But like other Asian Americans, the doctors always occupy a position below
both Blacks and whites in the U.S. hierarchy of national belonging; and their “foreign”
culture is used both to justify their professional superiority to whites and to lump them
with Blacks in terms of racial and cultural “inferiority.” Thus, while Kim argues that her
model of racial triangulation applies to all Asian ethnicities in the U.S., I propose that the
racialization of South Asians conforms to that of other Asian-American ethnicities only
as far as “civic ostracism” based on presumed “foreignness.” Otherwise, the racialization
of South Asian Americans approximates the racialization of African Americans as far as
“relative devalorization.”
Future research on professional Indians, therefore, should not only consider the
role of occupational status in these doctors’ racialization --particularly in non-
professional spheres-- but should also consider their racialization in comparison to the
racial experiences of non-Asian professionals. The great concern and effort of Indian
172
professionals to distance themselves from more stigmatized racial minorities should alert
scholars to the potential similarities in racialization among these non-white groups rather
than result in a reproduction of racial distancing in South Asian Americanists’ scholarly
work.
Beyond academic scholarship, further research on the racialization of Indian
doctors would challenge the U.S. public to recognize the diversity of its physician
workforce. The 2008 election of Barack Obama as president of the U.S. ushered in a
furious national debate over health care reform. As Americans discuss the pros and cons
of a government-funded public option for health insurance, nearly all major players have
come under scrutiny: private insurance companies, the Medicare and Medicaid
programs, the American Medical Association, an increasingly uninsured, undocumented
non white patient population, and even the socialized health care systems of other
nations. Yet one major player remains relatively lost in the debate: the non-white
physician.
Assumed equal in professional status, all doctors are expected to experience
health care reform in similar ways, regardless of race. Thus far, the health care debates
have rarely featured the individual opinions of non-white physicians, and, consequently,
have left the stereotypical image of American doctors intact: objective, autonomous,
prestigious, well-paid, white, and male.
But as this study shows, this image belies the reality of America's physician
workforce. This workforce is becoming increasingly diverse, with a large number of
non-white, immigrant physicians, both female and male, in a variety of specialties. For
173
the American public, this means that the gendered racial politics of the U.S. strongly
determine the professional decisions of all physicians, white or not. And the doctors'
choices, in turn, determine patients' choices in health care. The highly individualized
doctor-patient interaction does not stand outside of racial politics. Yet the American
public still imagines these interactions to be apolitical and clinical. It also imagines U.S.
doctors to be a monolithic entity, identifying with their profession more than their race,
ethnicity, immigrant status, or gender.
It is my hope that future studies of U.S. physicians will continue to expose the
fractures in this imagined monolith. Occupational and class status alone do not define
American doctors. They too are racialized, gendered citizens. As discussions
surrounding health care reform continue, Americans should not fail to consider the
diverse experiences, perspectives, and politics of their doctors.
174
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Appendix A:
On Methods
This dissertation draws from 52 semi-structured interviews with first and second-
generation Indian immigrant doctors in Southern California: 14 men and 13 women of
the first generation and 12 men and 13 women of the second generation.
1
All had been
living and practicing medicine in Southern California for an average of 10 years before
my interviews between September 2006 and August 2007 . The main research question I
sought to answer through these interviews was how Indian immigrant doctors experience
racialization as non-white immigrant professionals living and working in one of the most
diverse regions of the US. Specific interview questions centered on: 1. reasons and
motivations for pursuing medicine in the US, specifically Southern California; and 2.
experiences with ethnic and gender prejudice and discrimination in various US contexts.
These contexts included clinical interactions with patients; interactions with staff,
colleagues, and medical institutions; and interactions in public, outside the professional
realm.
Interviews revealed that some doctors had lived and worked in other racially
diverse cities –mostly New York or Chicago-- before moving to Southern California.
Several doctors recounted their racial experiences in professional and public settings of
these other cities. Although most incidents did not differ significantly from the racial
experiences they or the other interviewees had had in Southern California, interactions
with diverse non-white patient populations, particularly Latinos, were limited in other
regions. Thus, the findings presented here are only partially generalizable to Indian
193
immigrant physicians in other metropolitan areas of the US. I chose to limit my study to
Southern California because of its large but dispersed South Asian population
2
(Améredia 2008; Marger 2009); its significant number of established Indian immigrant
physicians, as evidenced by the presence of three Indian medical associations in the
region; and its overall diversity of race and class (Sears 2002).
3

I met most of the interviewees at the meetings of two of Southern California’s
Indian medical associations. From May 2006 to November 2007, I attended nearly all the
monthly meetings of the two associations. Snowball sampling allowed me to contact the
other interviewees. At the end of all interviews, which averaged approximately 90
minutes in length, I asked interviewees if they could recommend any colleagues for my
study. My partial insider status as an Indian American whose father is a first-generation
Indian immigrant doctor seemed to help my interviewees trust and relate to me. Zinn
(1979) observed that non-white minorities often feel they can be less reserved and
guarded with a researcher of their same minority group. Indeed, many of the interviewees
said that they appreciated being able to share their experiences with a fellow Indian
American; they felt it was important that a member of the community document these
experiences, because few outside of the community had ever expressed an interest in
their professional struggles.
Although some objected to my asking about the prejudice and discrimination they
had faced, implying that such questions only served to bring negative attention to Indian
doctors in the US, most were generous with their time and responses, often allowing me
to interview them in their offices or homes, without remuneration. Interviews were
194
entirely in English and fully transcribed. I then coded the transcripts, first for the doctors’
racial experiences in professional versus non- professional public contexts, again for
specific public contexts, and lastly, for gender –the importance of which emerged during
the process of coding. I did not begin my study thinking that the gendered experiences of
Indian immigrant doctors would constitute a significant aspect of my study. However,
while coding interview transcripts according to a grounded theory approach –that is,
allowing the transcripts themselves to determine the analytic structure of my research
(Charmaz 2001)—I realized how gender played a crucial role in the racialization of
Indian immigrant physicians in both professional and public spheres.
195
Appendix B:
Interview Guide
Guide for Interview(s) on the Professional Motivations, Histories, and Narratives of
Indian Immigrant Doctors:
1. Could you please tell me why you decided to become a doctor?
(Follow up, if necessary:
--Is or was anyone else in your family a doctor? (Who?)
--What kind of doctor?
--Do you know why he/she became a doctor?)
2. How did your family and friends [in India] react to your wanting to become a doctor?
(Follow up, if necessary:
--Did they say anything about being a boy/girl and becoming a doctor?)
3. Could you describe the medical education and training you received [in India and] in
the U.S.?
(Follow up, if necessary:
--Where did you receive it?
--Major philosophies and missions?
--How would you compare these to those of other schools, in India and the
U.S.?
Questions 4-6 for first generation only:
4. Why did you decide to move to the U.S.?
(Follow up, if necessary:
--What were your professional reasons for moving to the U.S.?
--What were your personal and family reasons for moving to the U.S.?
196
--Did you have any political reasons for moving to the U.S.?)
5. How did your family and friends react to your saying you wanted to move to the U.S.?
(Follow up, if necessary:
--Did they bring up anything related to your gender? Your age? Your
marital status? Other family members in the U.S. at the time?)
6. How do you feel about the process you had to go through –professionally, legally, and
personally—to move to the U.S.?
(Follow up, if necessary:
Do you feel that the process you went through was the same as that of
your peers in medicine who also sought to move to the U.S.? Why or why
not?
7. What has been your experience as an Indian [-American] male/female [immigrant] in
each place you’ve lived, worked, or studied in the U.S.?
(Follow up, if necessary:
--What were you doing, professionally, in each place?
--How long were you in each place?
--How did people in each place respond to you?
--How did you respond to them?
--What were the reasons behind each of your moves?
--2
nd
generation only, if necessary: Do any of these reasons have to do
with your family? Your ethnicity? The Indian-American community?
Or your gender?)
[STOP HERE AND MOVE ON TO NEXT SET OF QUESTIONS, IF NECESSARY]
Question 8 for first generation only:
8. What are your general feelings about studying, working, and living in the U.S.?
How would you compare and Would you be able to compare and
197
contrast it to studying, working, contrast it to your general feelings
and living in India? about studying, working, and living
in India?
9. How much longer do you plan to continue living and working here in ________?
Why?
(Follow up, if necessary: Where would you like to live and work next and why?)
10 … Any other relevant questions I think of in the course of doing research.
11. Is there anything else you’d like to add?
Guide for Interview(s) on the Inter-Ethnic Relations between Indian Immigrant Doctors
and their Patients and Staff
1. Could you tell me about the community in which you practice?
(Ages, gender, class, ethnicity, and common ailments of members?)
2. How would you describe your relationship with this community?
3. Does the ethnic composition of your patient population reflect the ethnic composition
of _____________’s population? Why or why not?
4. How do your patients react to having an Indian (American) doctor? Any usual
comments?
5. Do most of your patients know you’re from India/Indian American without your
having to tell them? Why or why not?
(Follow up, if necessary:
--What do they usually think your ethnicity is? Why?)
--Do their reactions and comments change over time?
--How do most of your patients refer to, or label, your ethnicity?
6. If a patient doesn’t refer to your ethnicity as you prefer, do you say anything?
What do you say and why?
7. Do you find that your patients’ perceptions of you and interactions with you vary
according to the patients’ ethnicity, class, and gender?
198
(Follow up, if necessary:
--How?
--Why not?)
8. Do you think that a patient’s ethnicity, class, and gender affect how you perceive and
interact with him or her?
(Follow up, if necessary:
--How?
--Why not?)
9. Would you please share any experiences you’ve had with patients or community
members who have expressed prejudice against you or discriminated against you?
(Follow up, if necessary:
--Give examples of what my father has experienced.
--How did you feel about those experiences at the time?
--How do you feel about them now?)
[STOP HERE AND MOVE ON TO NEXT SET OF QUESTIONS, IF NECESSARY]
10. How would you describe your interactions with your staff and colleagues?
(How do ethnic, gender, and age differences affect these interactions?)
11. Do you think your patients communicate and behave differently around your staff
and colleagues than they do around you?
(Follow up, if necessary:
--How?
--Why not?)
12. Would you mind sharing any experiences you’ve had with staff, colleagues, or
health care institutions that have expressed prejudice against you or discriminated
against you?
199
(Follow up, if necessary:
--How did you feel about those experiences at the time?
--How do you feel about them now?)
-- How would you compare your experiences to local, state, or
national cases of professional discrimination against Indian
immigrant physicians?
13. What do you think is the best way for Indian immigrant physicians to address
problems of professional prejudice and discrimination?
14. Could you please describe the professional medical organizations you belong to?
(Follow up, if necessary:
--Which ones?
--What is your role or position in these organizations?
--Why not?
--What are the main objectives and concerns of the professional
organizations you belong to?
-- Have you heard of the American Association of Physicians of
Indian Origin (AAPI)? What is your opinion of it?
15. Do you think that these organizations –or professional medical organizations I
general—effectively address Indian immigrant and Indian-American doctors’
problems with prejudice, discrimination, or inter-ethnic interactions?
(Follow up, if necessary:
--Why or why not?)
16.… Any other relevant questions I think of in the course of doing research.
17. Is there anything else you’d like to add?
Guide for Interview(s) on Indian Immigrant Physicians’ Relationships with Patients in
terms of the Western Doctor-Patient Hierarchy
200
1. What do you consider to be ideal patient behavior?
2. Do most of your patients conform to this ideal? Why or why not?
(Follow up: What do you think determines how patients interact with you?)
3. How do you think your being an Indian immigrant/Indian-American male/female
doctor affects or determines your patients’ behavior?
4. How well did your medical education prepare you for patient-doctor consultations?
Explain.
5. If it were up to you, how would you prepare new doctors for these professional
interactions?
6. Tell them briefly about Talcott Parsons and his concept of the “sick role.” What do
you think?
7. Should patients take an active role in determining medical care choices? Why or why
not?
8. How do you feel about alternative medical practices and treatment?
(Deepak Chopra? Yoga?)
9. … Any other relevant questions I think of during the course of my research.
10. Is there anything else you would like to add?
11. Do you know of any other first or second-generation Indian immigrant physicians in
Southern California who might be interested in my interviewing them?
(Follow up: Could you please provide their contact information?)
12. Would you be willing to allow me to observe your professional activities in your
office/clinic, outside of examination rooms, some time?
If interested, provide more details:
I would like to come to your place of work three to five times over the next [time
remaining in research phase] and sit in your waiting room, front office, or another
publicly accessible place for three to eight hours each time. Of course, you can
decide how many times I come, how long I spend each time, and where, exactly, I
sit. I will be observing and taking written notes on the day-to-day operations of
201
your place of work, particularly your role in these operations, and your interactions
with staff, colleagues, and patients.
I will, of course, respect doctor-patient confidentiality by never being present in an
examination room, when you are with a patient. I will remain in spaces that are
accessible and open to the general public. Furthermore, I will never ask for patients'
health, medical, or personal information (such as names, addresses, phone numbers,
or insurance details). Should I come to know any such information during my
observations, it will be kept strictly confidential. Only I will have access to it. In
any transcripts and written or published material containing this information, I will
use pseudonyms for the patients and will make sure that they are not readily
identifiable.
The actual address and name of your place of work will be kept confidential. Only
my faculty advisor and I will have access to this information. I will not reveal this
information in any material I transcribe, write, or publish based on this research.
Also, in any transcribed, written, or published material based on this research, I will
use pseudonyms for you as well as the names of any individuals or any businesses,
organizations, and institutions mentioned during my observations. I will never
reveal specific addresses in my typed/transcribed notes, writings, and publications
based on this research.
202

Abstract (if available)

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Asset Metadata

Creator Murti, Lata (author)

Core Title With and without the white coat: the racialization of southern California's Indian physicians

School College of Letters, Arts and Sciences

Degree Doctor of Philosophy

Degree Program American Studies and Ethnicity

Degree Conferral Date 2010-05

Publication Date 04/22/2010

Defense Date 03/04/2010

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Asian Americans,Asian Indian,doctors,immigrants,OAI-PMH Harvest,occupational status,physicians,professionals,racialization,southern California

Place Name California (states), India (countries)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Hondagneu-Sotelo, Pierrette (committee chair), Iwamura, Jane Naomi (committee chair), Jaikumar, Priya (committee member), Saito, Leland T. (committee member)

Creator Email latamurti@gmail.com,lmurti@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-m2939

Unique identifier UC1102624

Identifier etd-Murti-3499 (filename),usctheses-m40 (legacy collection record id),usctheses-c127-316411 (legacy record id),usctheses-m2939 (legacy record id)

Legacy Identifier etd-Murti-3499.pdf

Dmrecord 316411

Document Type Dissertation

Rights Murti, Lata

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Repository Name Libraries, University of Southern California

Repository Location Los Angeles, California

Repository Email cisadmin@lib.usc.edu