Trump’s im­mi­gra­tion ban puts a damper on Match Day

Modern Healthcare - - NEWS - By Adam Ruben­fire

On March 17, med­i­cal stu­dents look­ing to com­plete their res­i­den­cies in the U.S. will learn where they’ll spend their next few years. Match Day is al­ways full of anx­i­ety, but this year, there’s added fear as in­ter­na­tional stu­dents worry about how the Trump ad­min­is­tra­tion’s re­cent ac­tions on im­mi­gra­tion will af­fect their med­i­cal train­ing.

Just last week, Pres­i­dent Don­ald Trump is­sued a re­vised ex­ec­u­tive or­der that pro­hibits is­su­ing new visas to ci­ti­zens of six ma­jor­ity-Mus­lim na­tions for 90 days, be­gin­ning March 16: Iran, Libya, So­ma­lia, Su­dan, Syria and Ye­men. Al­though the ad­min­is­tra­tion in­cluded Iraq in the orig­i­nal or­der, which was blocked in fed­eral court, it is not on the re­vised list.

Hav­ing fewer med­i­cal grad­u­ates able to prac­tice in the U.S. could de­plete staffing in un­der­served ru­ral or ur­ban ar­eas, which of­ten de­pend on in­ter­na­tional med­i­cal grads to fill res­i­den­cies. And many of those doc­tors of­ten serve as pri­mary-care doc­tors. In­ter­na­tional med­i­cal grad­u­ates rep­re­sent roughly 25% of the U.S. physi­cian work­force.

Hos­pi­tals al­ready have re­ported that staffers have been re­fused re-en­try into the U.S. after travel abroad. Sev­eral states have chal­lenged the new or­der in court.

The Na­tional Res­i­dent Match­ing Pro­gram doesn’t col­lect cit­i­zen­ship data. How­ever, the Ed­u­ca­tional Com­mis­sion for For­eign Med­i­cal Grad­u­ates, which pro­vides cer­ti­fi­ca­tion for both U.S. and non-U.S. ci­ti­zens, does.

The com­mis­sion has iden­ti­fied 850 in­ter­na­tional med­i­cal grad­u­ates in the cur­rent match process who are ci­ti­zens of the six coun­tries iden­ti­fied in the ex­ec­u­tive or­der. The com­mis­sion be­lieves that about 100 to 400 who could be matched won’t be able to gain en­try into the coun­try un­der the or­der. The re­main­ing stu­dents have an­other im­mi­gra­tion sta­tus such as refugee or asy­lum sta­tus, or con­di­tional per­ma­nent res­i­dency that will likely al­low them to gain en­try into the U.S. de­spite the or­der.

Even if the or­der isn’t ex­tended past its cur­rent 90-day win­dow, the “ex­treme vet­ting” promised by the Trump ad­min­is­tra­tion could slow the visa ap­pli­ca­tion process for first-year res­i­dents, who be­gin their pro­grams in July, said Dr. Wil­liam Pin­sky, CEO of the com­mis­sion. That could af­fect many other for­eign med­i­cal grad­u­ates.

The un­cer­tainty could also have dis­suaded U.S. res­i­dency di­rec­tors from choos­ing in­ter­na­tional med­i­cal grad­u­ates to fill their spots and likely caused many to rank res­i­dents from the six banned coun­tries lower in their choices for the match pro­gram.

U.S. Cit­i­zen­ship and Im­mi­gra­tion Ser­vices re­cently took ac­tion to sus­pend for six months the ex­pe­dited re­view of H-1B visas of­fered to many for­eign pro­fes­sion­als. Some train­ing hos­pi­tals pe­ti­tion for H-1Bs for their res­i­dents and fellows so they can work in the U.S. after their res­i­dency and don’t have to go back to their home coun­try for two years after their pro­gram, which is re­quired un­der the J-1 im­mi­gra­tion sta­tus that most res­i­dents and fellows ini­tially fall un­der.

All these ac­tions will hurt health sys­tems look­ing to fill physi­cian spots, said Brian Groves, di­rec­tor of the in­ter­na­tional stu­dents and schol­ars of­fice at the Univer­sity of Cal­i­for­nia at San Fran­cisco, which has one of the coun­try’s top aca­demic med­i­cal cen­ters. “To not be able to pre­dict our ca­pa­bil­i­ties for train­ing and teach­ing, it threat­ens UCSF and U.S. pre-em­i­nence in health­care and re­search,” Groves said.

Roughly 20% of physi­cians in Cen­ten­nial, Colo.-based Cen­tura Health’s ru­ral fa­cil­i­ties are in­ter­na­tional med­i­cal grad­u­ates, said Dr. Scott Ell­ner, CEO of Cen­tura’s physi­cian group. The sys­tem has also seen more pri­mary-care res­i­dency spots be­ing filled by for­eign med­i­cal grad­u­ates. U.S. grad­u­ates tend to be more in­ter­ested in spe­cialty res­i­den­cies be­cause they pay bet­ter.

Atul Grover, ex­ec­u­tive vice pres­i­dent of the As­so­ci­a­tion of Amer­i­can Med­i­cal Col­leges, said the is­sue of lim­it­ing physi­cian im­mi­gra­tion goes beyond solv­ing doc­tor shortages. If the U.S. wants to main­tain its promi­nence as a global health­care leader, it needs to pick from the best and the bright­est med­i­cal stu­dents in the world, and it needs to be able to re­cruit physi­cians who serve its many eth­nic com­mu­ni­ties, he said.

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