Immigrant doctors — and their patients — fear impact of travel ban

Dr. Mohammad Jaber prepares to visit a patient in Sacramento, Calif., in November 2015.
Dr. Mohammad Jaber prepares to visit a patient in Sacramento, Calif. Jaber immigrated from Syria to the United States to pursue a medical degree. (Photo: Max Whittaker/Reuters)

President Trump’s temporary ban on immigration from six Muslim-majority countries has been billed as an effort to keep the U.S. safe from terrorists. But, in what could be one of the many unintended consequences of the so-called travel ban, the executive order could block thousands of immigrant medical professionals from staying in or entering the country, potentially affecting the health care of millions of Americans, especially those in rural areas that strongly supported Trump’s White House bid.

American health care relies heavily on foreign-born labor, especially in rural and high-risk urban areas where hospitals and clinics struggle to fill jobs amid what medical associations describe as a catastrophic shortage of doctors. The shortfall is only projected to grow worse in coming years amid the aging of the Baby Boom generation.

An estimated 25 percent of roughly 850,000 doctors working in the U.S. were born in another country. Of those, more than 7,000 immigrant doctors currently working in the U.S. hail from Iran, Libya, Somalia, Sudan, Syria and Yemen—the six countries included in Trump’s updated immigration order, which he signed Monday.

A new study from a group of Harvard and MIT researchers out this week found many of those doctors work in rural and impoverished parts of Michigan, Ohio, Pennsylvania and West Virginia. All told, those 7,000 doctors provide an estimated 14 million medical appointments per year, according to the study.

While most foreign-born doctors already in the country are unlikely to be directly affected by the order, which bans immigration from six countries for 90 days starting March 16, medical groups are sounding the alarm about the danger that expiring work visas may be delayed or not renewed at all, forcing physicians to leave the country. And they also say the country’s next generation of doctors could be at risk, amid lingering questions about whether students from the affected countries will be allowed to study and work in the U.S.

After a long application process, thousands of medical students from all over the world applying for residencies and fellowships in the U.S. are set to learn March 17 if they were accepted. Of those, roughly 500 are from the six affected countries, according to the Association of American Medical Colleges. While the residents typically start in June, after the 90-day ban is scheduled to expire, officials say many programs are worried about accepting applicants who may be caught up in a long visa application process or, depending on the administration’s next directive, blocked from entering the country at all.

“There’s a lot of uncertainty. I’ve talked to program directors who are looking at good applicants from one of the countries, students who are at the top of their classes and would make great doctors, but they don’t know what to do,” said Atul Grover, a physician and executive vice president of the association. “They worry that if they pick someone, they won’t be allowed to come, and they need people in those positions.”

Foreign medical students who come to the U.S. usually are permitted entry under J1 or H1 visitor visas, which are subject to Trump’s 90-day ban. After their residencies, many immigrant doctors often continue to stay in the U.S. through a visa waiver that allows them to work in the country if they agree to practice for at least three years in underserved areas, which primarily means rural areas where doctors are few and far between.

But last week, a few days before Trump signed the so-called travel ban, U.S. Citizenship and Immigration Services announced it would temporarily suspend expedited processing for several categories of visas including the H1-B, which admits highly skilled people including doctors. According to physician groups, that could have a major impact on foreign-born doctors already working in the U.S. and medical students who are seeking to stay in the U.S. when their residencies end this summer, who often depend on expedited visa processing.

According to those in touch with immigration officials, the entire process is murky. There have been conflicting answers on whether Trump administration officials will demand in-person interviews for visa applications, which has been something Trump frequently mentioned on the campaign trail as part of his plan for “extreme vetting” of those entering the U.S. and could delay an already long and rigorous process.

In the past, foreign-born medical professionals were guided through the system with help from the Department of Health and Human Services, State Department and Homeland Security Department — which worked together to expedite applications because of the need for doctors. But according to Grover, programs are still trying to sort out the rules and have gotten conflicting answers from administration officials who are trying to understand Trump’s immigration rules and which agency handles what.

Unlike the initial travel ban issued on Jan. 27, Trump’s latest executive order on immigration included several “waivers” — including for “undue hardship” and for foreign nationals who have professional obligations. Some physicians and medical groups are pointing to the language as a hopeful sign the Trump administration might be more flexible about entry for doctors and students from the six affected countries.

“We are eager to work with anyone and understand the rules. But there’s a lot of unknowns,” Grover said.

The situation is exacerbated by the existing shortage of doctors in the U.S. Grover and other medical officials have expressed fear that international students blocked from entering the U.S. or alienated by Trump’s rhetoric will simply go to work in other countries like Canada or Australia, which already compete with American hospitals and research institutions for talent.

“Bottom line, we need to train more residents. We need doctors desperately. We don’t have enough people here in the U.S. to fill these jobs,” Grover said. “Talented people might be turned away because of this.”

And then there is the fear among foreign-born doctors who are already practicing here. In a recent letter to the New England Journal of Medicine, two Muslim physicians — Muhammad Majeed, a child psychologist at Natchaug Hospital in Mansfield Center, Conn., and Fahad Saeed, a nephrologist and palliative care physician at the University of Rochester Medical Center in upstate New York — wrote of hearing concerns from their chronically ill patients about whether their doctors would be able to stay in the U.S. and of their own feeling of insecurity about a country that had once welcomed them that now seemed not so friendly.

“This uncertainty undermines confidence in the health care system and potentially erodes the trust that physicians have established with their patients,” they wrote, likening the environment to past biases like anti-Semitism and anti-Catholicism that caused decades of setbacks in science and marginalized “many talented physicians.” The American people, they wrote, “deserve the best physicians to take care of them, regardless of their country of origin or religious background.”

CORRECTION: An earlier version of this story incorrectly stated that the AAMC oversees the National Resident Matching Program, which links medical students with hospitals and teaching institutions. In addition, the story originally stated roughly 1,000 applicants from the six countries included in Trump’s executive order would be affected by the travel ban. A new estimate from the AAMC now says it’s roughly 500.

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