New Travel Ban Ruling Ripples Through Medical Community

Marcia Frellick

December 05, 2017

The US Supreme Court on Monday allowed President Trump's latest ban on travel to the United States from six Muslim-majority countries ― Chad, Iran, Libya, Somalia, Syria, and Yemen ― to stand, at least for now.

It's not the final word on the ban ― the high court urged lower courts to move through their outstanding cases quickly. But it granted the administration's request to overturn two injunctions brought by lower courts that partially blocked the ban. Justices Ruth Bader Ginsburg and Sonia Sotomayor dissented, saying they would have denied the administration's request.

The ruling signaled a shift in the judicial path of the bans, and the medical community weighed in from several fronts.

The Association of American Medical Colleges (AAMC) told Medscape Medical News in an emailed statement, "Highly skilled professionals from other countries are critical to healthcare and biomedical research in the United States. We are greatly concerned that allowing the nationality-based exclusions in the September 24 proclamation to take full effect, even temporarily, will jeopardize patient care, medical discoveries, and public health."

The AAMC submitted an amicus brief to the Supreme Court in September and has released several statements regarding the president's executive orders and proclamations on immigration.

Anupam B. Jena, MD, PhD, Ruth L. Newhouse Associate Professor at Harvard Medical School in Boston, Massachusetts, has studied the effects of a previous version of the ban that included a seventh country (Iraq) and Sudan instead of Chad.

His research showed that about 8000 doctors had trained in those countries (about 5% of all foreign physicians and 1% of all physicians).

Dr Jena told Medscape Medical News the travel ban will have the greatest effect on internal medicine and subspecialties.

His research team used data from Doximity, which tracks, among other information, where physicians underwent training and where they are located.

The data showed that foreign-trained physicians make up large portions of specialties with the largest need.

"For example, 27.6 percent of all psychiatrists and 26.4 percent of physicians specializing in internal medicine graduated from foreign medical schools, compared with just 12.4 percent of doctors practicing radiology and 9.8 percent of those in the surgical subspecialties," the article states.

In October, Dr Jena coauthored an article published in the Annals of Internal Medicine that showed that the impact of all foreign medical graduates goes way beyond foreign graduates' ability to provide care.

They used Doximity to assess how many publications and clinical trials and National Institutes of Health (NIH) grants involved international medical graduates (IMGs).

They found that medical students who were trained abroad made up 18% of all professors in the United States; authored 18% of all publications in PubMed; received 12.5% of all NIH grants; and ran 18.5% of all clinical trials in the United States.

Recruiter Says Ban Could Have Wider Chilling Effect

Phil Miller, vice president of communications for the physician recruiting firm Merritt Hawkins, told Medscape Medical News the immediate impact on the workforce will be "marginal."

"Probably less than 150 residents would come from those countries in 2018," he said. His analysis takes into account a match rate for international students that historically has been about 50%. "In the overall context of physician supply, that's fairly small," he said, although he noted that each doctor has an effect on quality of care and a financial effect on their community.

The bigger impact, considering the growing physician shortage, may come from the message it sends to all foreign graduates, he says.

"They might see that the Trump administration is trying to raise the degree of difficulty for entering the US on work-related visas. Couple that with general anti-immigrant sentiment, and you have physicians from India and Pakistan ― the two nations that provide the most IMGs ― and China, Philippines, and other major providers, and they may get the sense that they're not welcome."

Match Preferences Start Next Month

The ruling comes just more than a month before January 15, when residency applicants and programs can begin to enter their rank order lists. Applicants must finalize the lists by February 21.

Mona Singer, president and chief executive officer of the National Resident Matching Program, told Medscape Medical News the organization is reviewing the impact of the travel ban on citizens from the named countries along with the Educational Commission for Foreign Medical Graduates, which sponsors the J-visas needed by international medical graduates who want to enter United States graduate medical education programs.

As Medscape Medical News reported earlier this year, the White House clarified in February that a previous version of the ban did not apply to holders of green cards.

According to the Associated Press, the 9th US Circuit Court of Appeals, based in San Francisco, California, and the 4th US Circuit Court of Appeals, based in Richmond, Virginia, will hold arguments on the ban this week. The Supreme Court is expected to fully review the proposed ban, but no date for that review has been set.

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