With his polished manner, crisp dark jacket and tie and shoulder-length hair in a neat ponytail, Dr. Muhammad Hassan Majeed easily fits the part of the urbane American professional destined for one day joining the ranks of academia.

“After a decade here, I’m more American than Pakistani,” said Majeed, a psychiatrist at the Joshua Center Thames Valley, a Natchaug Hospital affiliate in Norwich. “Politically and socially, I think of myself more as an American. I love the clothing, the food, the lifestyle.”

Two and a half miles away at United Community & Family Services, married couple Drs. Rachna and Ramindra Walia have found acceptance and professional satisfaction providing pediatric care to some of the old mill city’s poorest residents, even if that sometimes comes with answering questions about their home country.

“I educate them a little, tell them where I’m from and take out my phone to show them where India is,” said Ramindra Walia, who serves as chief medical officer at UCFS while also treating patients. “I tell them, ‘I jumped so far across the world to meet you.’”

Some patients are wary at first, Rachna Walia said, but quickly won over.

“It can be a struggle sometimes,” she said, “but once you end up taking care of them, they develop that confidence in you.”

Seventeen miles to the south, Dr. Maria Luisa Moro-de-Casillas feels especially gratified helping Spanish-speaking patients who come to her office in New London with complex neurological ailments.

“I love being able to give back to the Latin American community and see patients who have had difficulty finding someone who speaks their language,” said the Mexican native, who came to this country with her husband, Norwich surgeon Dr. Sergio Casillas-Romero, in 1997. “You share a connection with them. And it’s very rare for patients to find a neurologist who speaks their language.”

These four are among more than 200,000 immigrant doctors across the country filling a critical role in providing care to millions of patients. Nationwide, about one in four physicians graduated from a foreign medical school, then came to this country for residency or fellowship training and stayed, according to the American Academy of Medical Colleges. In Connecticut, the percentage is even greater: nearly 30 percent. That’s the seventh highest in the country.

“Foreign-born medical graduates serve a very big need,” said Dr. Jeff Gordon, blood and cancer specialist in Waterford who is president of the Connecticut State Medical Society. “Three out of four of them go into direct patient care and work in underserved areas. We really do depend on these doctors.”

The state medical society has joined with its parent organization, the American Medical Association, in raising concerns about recent immigration crackdowns and orders issued by the Trump administration affecting visa programs used by foreign medical school graduates. Lack of clarity and uncertainty created by the actions ultimately could harm patients, the AMA said in a March 7 statement.

“For the past 80 years, international medical graduates have made a consistent and significant contribution to American medicine and help our nation meet its need for health services,” Dr. Andrew Gurman, AMA president, said in an email message. “Ensuring that graduates of foreign medical schools can continue to play a key role in our country is important to the nation’s continued effort to improve patient access to timely medical treatment, especially in rural and underserved areas.”

There are two popular pathways for foreign doctors who come here and ultimately become citizens: the H-1B visa program for foreign workers in technical fields including medicine, and the J1 visa waiver program. That allows doctors who come to the United States for graduate-level specialty training to stay after completing their studies if they agree do a three-year residency in an underserved area. Connecticut has 30 doctors in the J-1 visa waiver program, and 93 with H-1B visas, according to the state Department of Public Health.

Dr. Gordon said recent Trump administration statements and orders, including President Donald Trump’s announcement Tuesday about new limitations to the H-1B visa program, are crimping the flow of foreign medical school graduates.

“There’s a lot of uncertainty about these executive orders that makes it very difficult for immigrant doctors to make their plans,” he said. “These programs have been running well for a long time. We understand the need to do proper vetting, but don’t do it so that it would hurt people and their care.”

The four local doctors couldn’t agree more. By sharing their stories, they hope to make people aware that immigrant doctors like themselves appreciate the opportunities the United States has afforded them, and that they in turn provide vital services this country needs.

'A fair trade-off'

After graduating from medical school in Pakistan in 2007, Dr. Majeed looked to the other side of the globe for the kind of advanced training he wanted.

“Psychiatry gave me the best opportunities to interact with people, and there’s very little training in therapy and psychiatry, and no addiction medicine, in Pakistan,” said Majeed, a 38-year-old Niantic resident who cares mainly for youth and adolescent patients and runs an addiction clinic at the Joshua Center. “I always knew America had the best training.”

After residency at Drexel University and Hahnemann University Hospital in Philadelphia then a fellowship at Long Island Jewish Medical Center, Majeed applied for and obtained a J1 waiver to stay and work in an underserved area for three years. That brought him to the Joshua Center 18 months ago.

“We’re going where American doctors don’t want to work,” he said. “It’s a very fair trade-off” for being allowed to stay in this country.

Ultimately, he said, he’d love to become a citizen, but expects he’ll first have to obtain an H-1B visa and then a Green Card through a sponsoring employer. A frequent contributor of letters and articles to academic journals, including a March 2 letter in the New England Journal of Medicine asking the U.S. government to preserve the visa programs used by immigrant doctors, he hopes to one day teach psychiatry at a college or university.

“It’s a cliché, but this really is the land of opportunity,” he said. “You can create your own opportunities here if you want to work hard.”

While he has felt welcome for most of his time in this country, he and other immigrant doctors with work visas are now feeling insecure about their futures in the United States. Closing the door on immigrant doctors, he said, would hurt both them and the vulnerable patients they serve.

“We are the most motivated and determined to move ahead,” he said. “It’s an advantage to this country to be getting the most motivated, hard-working people.”

'We had no money'

Today, the Walias are comfortably ensconced as upper middle-class professionals in Norwich. A lot of hard work and sacrifice got them there from New Delhi some 20 years ago.

“We were in the lower middle-class in India,” said Rachna Walia, 50. “We came here with four suitcases and our medical school education, and that was it. We had no money. We slept on the carpet for a whole year and then used hand-me-down furniture. It’s taken us 20 years to become legal in this country.”

Growing up, both attended Catholic schools where they were required to learn English, a skill that has served them well in their careers. In 1996, four years after they married, the Walias came to this country for pediatric residency interviews that ended up getting canceled due to a snowstorm. He returned home to India to resume his medical practice there, while she stayed in New York to continue the search. By 1997, she started a residency at a Brooklyn hospital, and her husband joined her there a year later. In between for Rachna Walia came stints at a hospital in Connecticut and a pediatric endocrinology fellowship at another New York hospital. By 2001, their careers were beginning to fall into place, when Ramindra Walia, working on a J1 visa waiver, landed a job as medical director at UCFS. Soon, both Walias were working there. They started a family and began putting down roots in their adopted country.

“We had a rickety old Toyota I drove up to Norwich from New York for my interview,” said Ramindra Walia, 55. “Everything changed after that. They needed a pediatrician, and I was offered the position right then. Now, we are the last pediatricians to have moved into this town. Between us we take care of about 3,000 patients.”

Though both recently became naturalized citizens and feel secure in their status, they believe the visa programs they used when they first came to America worked well, and should be preserved.

“The vetting process is pretty good in this country,” Ramindra Walia said.

Added Rachna Walia, “You want to welcome people but not the wrong people. Of course they have to be screened. “

But doctors and others with H-1B and J1 visas already have been vetted, and shouldn’t have to worry about losing their status, they said.

“People who’ve already gone through the process are being victimized,” Ramindra Walia said. “It would be contradicting your own processes (if the visas are taken away). This is too great a country to go backwards.”

'Always felt welcome'

Like other immigrants doctors, Moro-de-Casillas and her husband came to the United States after medical school in their home country for training in their chosen specialties, she in neurology and he in colorectal surgery, at institutions including Brown and Case Western Reserve universities and the Cleveland Clinic. The various visa programs now under scrutiny served them well, she said, providing them a path to citizenship they obtained a few years ago.

“We have always felt welcome here, though it has been hard work,” said Moro-de-Casillas, 46. “But if you work hard, you do have the opportunity to succeed and do what you really love to do in the U.S."

When they first came to this country, she said, they hadn’t decided whether they’d try to stay permanently or return to Mexico.

“But the doors kept opening for us here,” she said. At her New London practice, which is part of the Northeast Medical Group and affiliated with Lawrence + Memorial Hospital, she is proud of the unique skills she offers patients — not just Spanish language skills, but also expertise in movement disorders, Parkinson’s disease and Alzheimer’s disease.

“I’m providing a subspecialty the community wouldn’t otherwise have,” she said.

She and her husband live in Norwich with their 11-year-old daughter, and visit family in Mexico twice a year. With the lengthy and involved process of becoming a citizen still fresh in her mind, Moro-de-Casillas is empathetic toward the doctors now here on work visas, worried they’ll get caught in legal limbo if the rules are changed.

“It’s was very stressful because it’s so complicated and we didn’t have certainty about our status for several years,” she said. “The hardest part was the uncertainty.”

j.benson@theday.com