New Trump Travel Ban Still Affects Foreign Medical Residents

Ken Terry

March 09, 2017

President Donald Trump's revised executive order banning travel to the United States from six Muslim-majority countries will affect hundreds of international medical graduates (IMGs) who will be accepted into US residency programs on March 17, according to the American Medical Association (AMA) and organizations involved in graduate medical training. In addition, the government's temporary suspension of expedited processing of H-1B visas will make it difficult for all IMGs graduating from residency programs this year to take jobs practicing in underserved areas.

The AMA, the Association of American Medical Colleges (AAMC), the Accreditation Council for Graduate Medical Education (ACGME), and the Educational Commission for Foreign Medical Graduates (ECFMG) are trying to persuade the Trump administration to grant waivers to the executive order for IMGs from the six countries so they can get visas and join the residency programs they have been invited to join on July 1.

According to Atul Grover, MD, PhD, executive vice president of the AAMC, the State Department, the Department of Homeland Security, and the Department of Health and Human Services are "listening" to the medical associations' plea. However, he told Medscape Medical News, "It takes a little time for some of these executive orders to be fleshed out at the agency level, in terms of what leeway the department or agency has. So they're figuring that out and they're listening."

On March 5, President Trump signed a revised order banning travel from Iran, Lybia, Somalia, Sudan, Syria, and Yemen after US courts blocked his earlier order affecting seven nations. (Iraq was dropped from the original order after the US military expressed concern about its impact on the joint war against the Islamic State.) Under the new executive order, the processing of visas for residents of the six countries will be suspended for 90 days while the U. evaluates its security procedures. In addition, Syrian refugees cannot enter the United States for 120 days.

Among those banned from the United States for the next 3 months are about 850 IMGs who applied to the National Resident Matching Program after being rigorously vetted by the Educational Commission for Foreign Medical Graduates (ECFMG), William Pinsky, MD, president and CEO of ECFMG, told Medscape Medical News. On average, about half of IMGs who apply to the match are accepted, he said, so more than 400 IMGs from the affected countries are likely to be matched to a residency program. But, unless the government decides to grant waivers, they will be unable to travel to the United States by July 1, when these programs begin their new year.

This is only one of the issues raised by the travel ban that concern the medical community. Drs Grover and Pinsky said their organizations were also worried that the length of the ban could be extended or that it could be expanded to include more Muslim-majority countries.

Whether that happens or not, the United States desperately needs IMGs to make up for the shortfall of US medical graduates to fill residency training positions and, later on, to care for patients, noted Dr Grover. Currently, IMGs take nearly 25% of these residency positions, and many of them stay in the United States "That could be impacted if people are not allowed to come, or we put in big hurdles, or they get the perception they're not welcome here, and choose to go to Canada or the UK or Australia," he said.

Usually, he added, "the US gets the pick of the crop"— the best doctors-in-training from around the world. But that situation might not continue, he said, if some IMGs think they're not welcome or that their countries might be placed under the travel ban in the future.

Any expansion of the travel ban would have a chilling effect, Dr Pinsky said. "Depending on how that works out, when we look at next year's match, will we have the same enthusiasm and number of people applying that we've had in the past?" he asked.

Visas Affect Postgraduate Plans

Meanwhile, IMGs who graduate from US residency programs this summer also may have to reconsider their plans because of a decision by US Citizenship and Immigration Services (USCIS). Part of the Department of Homeland Security, USCIS has announced that starting April 3, 2017, it will temporarily suspend "premium processing" for all H-1B visa petitions. This suspension, intended to work down the backlog of H-1B applications, could last up to 6 months, USCIS said.

Here's how this affects doctors from abroad: IMGs who participate in residency programs normally hold J-1 visas. When they graduate, they are required under the terms of those visas to return to their home countries for at least 2 years before they can seek readmission to the United States. They can be granted waivers if they agree to provide care in an underserved area for at least 3 years. But to do so, they must convert their J-1 visa to an H-1B visa.

Under the premium processing option, these physicians could pay an extra fee and get their H-1B visa application approved in a couple of weeks. But with that option suspended, it can take USCIS 3 to 6 months to approve an H-1B visa. So, if a physician graduates from a residency program on June 30 and has a job waiting for him or her in September, that physician may not be able to take it because she or he has not been able to obtain the required visa.

The H-1B visas are also a big issue for medical researchers, Dr Grover said. About half of the research workforce is foreign-born, he noted. "We have access to the best and brightest in these fields from anywhere in the world. If we don't take advantage of it, another country will."

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