Foreign Physicians May Not Be Hurt by Travel Ban Stay

Ken Terry

June 28, 2017

International medical graduates (IMGs) will probably be unaffected by the US Supreme Court's decision Monday to partially stay the lower court injunctions against President Trump's ban on travel from six Muslim-majority countries, leaders of medical education organizations told Medscape Medical News.

IMGs will still likely be able to travel here to accept residency positions that begin July 1, if they're not already in this country, said Atul Grover, MD, PhD, executive vice president of the Association of American Medical Colleges, and William Pinsky, MD, president and CEO of the Educational Commission for Foreign Medical Graduates.

In addition, Dr Pinsky said he expected IMGs to be able to come to the United States to take clinical skills exams that help qualify them for the residency match next year. They must take these exams in one of six centers in the United States.

Both experts, however, emphasized that they can't be sure of how the State Department will interpret the Supreme Court's language.

In deciding to take on the case against the travel ban, the high court granted the Trump administration's request for the stay, but with an important exception: immigrants from Iran, Libya, Somalia, Sudan, Syria, and Yemen who have connections to people or entities in the United States will continue to be allowed to enter the country during the 90-day period of the travel ban. On the basis of examples that the court gave in its ruling, opponents of the ban interpreted this to mean that it allows the entry of most people who wanted to come to the United States to "visit a relative, accept a job, attend a university, or deliver a speech," the New York Times reported.

IMGs who have matched to residencies should fall into this exception, Dr Grover said. Not only are they training in an educational institution, but they are also accepting job offers. So they definitely have a connection with a US entity that meets the Supreme Court's definition, in his view.

The same should be true, he added, of foreign individuals who have been admitted to US medical schools. "But if they're just applying to medical school here, there could be barriers, because they don't have an established relationship," he said.

Dr Grover hopes that the process will be the same for fellowship matches. "This [ruling] should mean that training for IMGs falls within that area of exemption. But that still depends on how they implement it."

Monica Signer, president and CEO of the National Resident Matching Program, told Medscape Medical News she is "hopeful that the exceptions noted in the US Supreme Court ruling, particularly the one for workers who accepted a bona fide offer of employment, will apply to matched applicants," including residents and fellows.

Fellows from the six countries who have matched for next year face the same danger as matching residents do from the travel ban if it is upheld, although they match with programs at different times. "Fellowship matches for more than 60 subspecialties have schedules that run throughout the year," Signer explained. "The earliest began in February 2017 and concluded in May. The latest begin in October and conclude in January 2018. All have training start dates close to July 1, 2018."

Extension of Ban

Under the original travel ban and its amended version, the travel ban would last for only 90 days while the State Department reviewed its vetting procedures. According to Dr Grover, the administration recently restarted the 90-day period by reissuing the executive order a couple of weeks ago. But with the Supreme Court not scheduled to take up the case until October at the earliest, the State Department might extend the ban beyond the end of September, he said.

Weighing that possibility, the government's interpretation of the court-ordered stay, and the eventual Supreme Court decision on the case itself, he said, "There's still a lot of trepidation and uncertainty within the [healthcare] community."

Dr Pinsky agreed that the Trump administration might extend the travel ban. More importantly, he pointed out, the Supreme Court decision on the constitutionality of the ban might come down during the recruiting/interviewing season for 2018 residency positions, which begins in September.

Dr Pinsky also repeated his recent warning that the availability of J-1 visas to IMGs — not just in the six countries affected by the travel ban but also in other nations — depends on the process that the State Department uses in granting those visas. Some doctors in Pakistan and India, for example, have been denied visas recently, he said.

"We're all in favor of having strong security, so that's not a question or a challenge," he noted. "It's how the processes are applied. We'd consider that IMGs coming to this country have a connection with an entity here if they're taking their exams to become eligible for the residency match. And if they're successful in the match, they'll have a job here in residency training. I'd like to think that the spirit of the Supreme Court decision will be carried out appropriately."

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