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Trump’s immigration order sparks concerns about effects on health care in U.S.

“… our hospitals rely on a steady influx of international physicians to keep running,” said Dr. Ford Vox, a rehabilitation specialist who often writes about medical issues, in a commentary for CNN.

Dozens of demonstrators cheering and hold signs at Dulles International Airport protesting President Trump's executive order.
REUTERS/Mike Theiler

President Donald Trump’s temporary immigration ban — along with reports that the ban may be widened — threatens to have both an immediate and long-term negative impact on health care in the United States, particularly in rural and other areas of the countries where access to quality care is most needed, according to doctors and medical organizations across the country.

“The administration emphasizes it’s preventing only a ‘small percentage’ of global travelers from entering or leaving the country, but our hospitals rely on a steady influx of international physicians to keep running,” said Dr. Ford Vox, a rehabilitation specialist who often writes about medical issues, in a commentary for CNN.

“Our training hospitals posted job listings for 27,860 new medical graduates last year alone, but American medical schools only put out 18,668 graduates,” he added. “International physicians percolate throughout the entire medical system. To highlight just one particularly intense specialty, fully 30% of American transplant surgeons started their careers in foreign medical schools.”

‘Effects could be bleak’

Many doctors were turned away from entering the U.S. immediately after the ban was implemented, as Wired reporter Emily Dreyfuss reports:

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Iranian-born Samira Asgari was on a flight to the US to start work at the Harvard-affiliated Brigham and Women’s Hospital researching tuberculosis treatments when the president signed his executive order. She was forced to return to Switzerland. Seyed Soheil Saeedi Saravi was about to join a cardiology research group at the same hospital when his visa was suspended Saturday. Cleveland Clinic doctor Suha Abushamma, an H-1B visa holder originally from Sudan, was forced back to Saudi Arabia, where she had been visiting family, on Saturday. Boston University reported that two students in its School of Public Health were barred from returning to the US to study. The list goes on.

“The [Association of American Medical Colleges] estimates that [260 resident doctors from the seven banned countries] who may now not be able to practice in the US would each have seen 3,000 patients a year: 780,000 in total,” Dreyfuss adds. “That’s an especially large cut to confront as the new administration and Republican Congress plan to dismantle the Affordable Care Act, which will result in millions losing health insurance. The effects could be bleak: fewer people actively seeking out preventative and nonemergency care; more people showing up to emergency rooms for high-cost and higher-risk treatment. Not to mention, the AAMC projects the US will face a shortage of 90,000 doctors by 2025.”

Here are additional excerpts from media reports on the ban’s potential for disrupting the U.S. health care system:

‘A little-appreciated fact’

“The chaos unleashed by the executive order … reveals a little-appreciated fact about our health care system: We’re heavily reliant on foreigners. They’re our doctors, nurses, and home care aides, and they often work in the remote places where American-born doctors don’t want to go,” write Vox reporters Julia Belluz and Sarah Frostenson.

According to 2015 data from the Migration Policy Institute, the medical profession is particularly reliant on immigrant doctors. Of the active physicians and surgeons here, 30 percent are immigrants. 

India, China, Philippines, Korea, and Pakistan are the top five origin groups for physicians and surgeons,” said Jeanne Batalova, a senior policy analyst and demographer at MPI. But Iran and Syria, two of the seven countries whose citizens are no longer allowed entry to the US, are the sixth and 10th largest contributors, respectively. “So we’re talking about substantial representation from these countries [in the doctor workforce] here.” The ban on these people will likely be felt at hospitals and clinics across the nation, she added.

The contributions immigrants make to medical care start early on, in residency programs, which funnel doctors through training and into jobs. Residents from the seven countries made up 5.7 percent of all international medical graduates in 2015, said Stan Kozakowski, a doctor and the director of medical Education for the American Academy of Family Physicians. …

That’s not a huge number right now, Kozakowski added, but it’s sizable enough. “And if you add in the countries that have been tossed in as possible expansions of the ban — Pakistan, Saudi Arabia, Lebanon, and Egypt — that number goes up to 16.7 percent.”

Not just doctors

“Rural clinics and public safety-net hospitals, in particular, rely on foreign medical school graduates to take care of isolated and vulnerable populations,” report Casey Ross and Max Blau of STAT News. “They often serve as primary care doctors, filling a vital need as more American-born MDs gravitate toward high-paying specialties.”

And it’s not just foreign doctors who are needed: A STAT review of visa requests found that employers seek to bring in thousands of occupational and physical therapists, dentists, pharmacists, and other health professionals each year. In 2014, the last year for which data is available, more than 15,000 foreign health care workers, nearly half of them physicians and surgeons, received H-1B visas, which are designed to bring skilled labor into the US.

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Impact on one state

“An investigation by the Texas Tribune found that more than 1 in 4 doctors who receive a license to practice medicine in Texas come from another country,” writes Seema Yasmin of the Dallas Morning News.

Many are recruited by hospitals and government agencies, such as the Department of Veterans Affairs, to work in rural and medically underserved communities across the state.

It’s hard to know exactly how many Texas doctors hail from the seven countries listed in Friday’s executive order. 

In a memo to staff at the University of Texas at Austin, President Greg Fenves said: “We have 110 students, faculty members and scholars who are citizens of the seven affected countries — Iran, Iraq, Libya, Syria, Yemen, Somalia and Sudan. The talents that brought them to UT are deeply valued, and their perspectives represent an essential part of the university.”

FMI: MedPage Today has published a summary of statements from various medical organizations on their concerns about President Trump’s ban and its potential impact on the delivery of health care in the U.S.