Travel Ban Will Hit U.S. Healthcare Where it Hurts: Primary Care
Eric Beam, M.D.
Of all the people affected by President Donald Trump’s executive order suspending immigration from six Muslim-majority nations, one group is of particular importance to the U.S. health care system: foreign-born doctors and medical trainees.
About one-quarter of the physician workforce is comprised of international medical graduates, which comprise 280,000 doctors in total, according to the American Medical Association (AMA). Many are here on temporary J-1 or H1-B visas, which are affected by the travel ban. These doctors help to correct a critical shortage in primary care providers, particularly in rural parts of America.
Several factors, including the relatively static number of U.S residency slots, the expansion of insurance coverage under the Affordable Care Act, and an aging population have created a demand for health care that far outstrips supply. Under the current conditions, the Association of American Medical Colleges (AAMC) projects a deficit of up to 94,700 physicians by 2025.
The Trump administration’s immigration order, which restricts travel from Iran, Libya, Sudan, Somalia, Syria and Yemen, will curtail an important source of doctors to high-need areas. Without the annual influx of IMGs from these countries, the primary care physician shortage is expected to worsen. The administration has not ruled out adding more countries to the list, according to the White House.
Students who graduate medical school in a foreign country and wish to train at a U.S. residency program must obtain a J-1 visa. At the end of their residency, they may apply for a special waiver program that permits them to stay in the country, provided they agree to work in an underserved community.
Foreign doctors who have already completed training in their home country can immigrate under the H1-B skilled worker visa, which the Trump administration has announced will be subject to further restrictions starting April 3. The travel ban has come at a tricky time for the U.S. residency match on March 17. Programs that are considering accepting IMGs from countries under the travel ban have no guarantee that trainees will be able to enter the country in time to start work on July 1.
This uncertainty has prompted the AMA to request clarification from the Department of Homeland Security regarding the effect of the travel ban on the immigration status of J-1 visa holders. “The AMA is concerned,” the letter reads, “that this executive order is negatively impacting patient access to care and creating unintended consequences for our nation’s health care system.” To date, there has been no response.
There is speculation that the travel ban may have more far-reaching and long-term implications than just its immediate reverberations. Some fear it will cause foreign doctors to sour on the U.S. and look to other places, such as Europe and Canada, for employment. A recent report in Scientific American profiled foreign-born physicians and researchers who now regret their decision to pursue a career here and worry that their visas could be revoked at any time.
The U.S. has long been an attractive destination for foreign doctors seeking a better life, well worth the considerable effort and bureaucratic barriers. What’s more, our health care system relies desperately on this work force to provide care for some of our most vulnerable populations. The coming months and years will reveal just how welcoming a place America is for foreign doctors who want to work here.