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CLEVELAND — President Trump’s temporary immigration ban could quickly undermine American health care, which relies heavily on foreign-born labor — including many workers from the Middle East — to fill critical gaps in care, industry specialists say.

As many as 25 percent of physicians practicing in the US were born in another country. Rural clinics and public safety-net hospitals, in particular, rely on foreign medical school graduates to take care of isolated and vulnerable populations. They often serve as primary care doctors, filling a vital need as more American-born MDs gravitate toward high-paying specialties.


And it’s not just foreign doctors who are needed: A STAT review of visa requests found that employers seek to bring in thousands of occupational and physical therapists, dentists, pharmacists, and other health professionals each year. In 2014, the last year for which data is available, more than 15,ooo foreign health care workers, nearly half of them physicians and surgeons, received H-1B visas, which are designed to bring skilled labor into the US.

The data don’t indicate how many foreign health care professionals come from the seven predominantly Muslim nations targeted by Trump’s executive order, but health care executives say the Middle East is a crucial pipeline.

“I had trouble sleeping last night, to tell you the truth,” said J.B. Silvers, a trustee of The MetroHealth System here in Cleveland and a professor of health care finance at Case Western Reserve University.


“If you go to almost any hospital, a community hospital or a teaching hospital, you will find a very substantial number of people from the Middle East,” he said. “This is just mind-blowing.”

The travel ban is meant as a temporary measure, in place for 90 days. But Trump has pledged to institute “extreme vetting” to more tightly control immigration from those nations after the ban is lifted. He has also talked about making major changes to the H-1B visa program that lets hospitals bring in so many foreign workers.

The uncertainty is creating a sense of crisis in some hospitals — especially those that have seen some of their workers ensnared by the order, held in airports or sent back overseas when trying to return to the US from trips abroad. Hospitals are also scrambling to figure out how to help foreign patients who had been scheduled to come to the US for surgery in the coming weeks.  

“Everyone is sort of in a state of paralysis,” said Dr. Alexi Nazem, an internist at NewYork-Presbyterian and founder of Nomad Health, an online physician staffing firm. “We don’t know how to interpret the order that was issued on Friday or what the long-term version of it is going to be.”

Nazem was born in the US, but some of his relatives are Iranian immigrants now working in health care in the United States. “These are hardworking doctors providing care to Americans,” he said. “They have done absolutely nothing wrong and love this country, and now they may be kicked out of it. That’s a travesty for them personally, but also for the people who depend on them.”

A Cleveland Clinic doctor was prevented from reentering the US on Saturday because she was carrying a passport from Sudan, one of the seven nations affected by Trump’s order. She was flown to Saudi Arabia, and the clinic said it is trying to secure her safe return.

Foreigners’ role in US health care has steadily grown. The foreign-born share of health care workers jumped as high as 30 percent in the 1990s, up from 5 percent in the 1960s, according to a 2014 study from Georgetown University’s Center on Education and the Workforce.

Health care now has the largest percentage of foreign-born and foreign-trained workers of any industry in the country, the study found.

The visa applications underscore that reality: The Cleveland Clinic last year certified applications to bring in just under 200 foreign workers, mostly doctors and clinical associates. Other major employers seeking to bring in health care workers include Emory University, the Mayo Clinic, and William Beaumont Hospital in Michigan.

Federal legislation has encouraged the trend. For example, the Nursing Relief for Disadvantaged Areas Act of 1999 created a special visa classification to encourage more foreign-born nurses to come to the US to deliver care in rural communities.

Trump’s order also stands to undermine hospital IT staffs that rely heavily on foreign talent to develop software and digital health products, and to manage reams of sensitive internal data. Many leaders in the health IT field criticized Trump’s order, including athenahealth chief executive Jonathan Bush, who posted several scathing tweets.  

The travel ban could also disrupt training programs at hospitals and medical schools and undermine patient care.

“We have huge concerns about this,” said Dr. Bruce Siegel, chief executive of America’s Essential Hospitals, which represents safety-net providers across the US. “In many of our underserved communities, people from overseas are the backbone of the health care workforce.”

Siegel said the percentage of foreign-trained doctors tops 25 percent in states such as New York and New Jersey.

“It’s early to tell, but this could have implications for decades to come,” Siegel said. “We could be shutting down a big part of the physician pipeline. … We’re going to lose people in areas we need the most. Often, the American grads get into specialty residencies, while international residents meet the needs of primary care.”

Even with the supply of foreign-born workers, providers are stretched thin by the demands of an aging population and the high percentage of Americans struggling with chronic diseases. Before Trump’s order, many industry leaders had been pushing to bring in more workers, arguing for the elimination of barriers such as complex accreditation requirements.

Beyond the impact on hospitals, Nazem, the founder of Nomad Health, said the executive order stands to undercut the broader principle that America is a melting pot whose success is built on its willingness to welcome talented workers, regardless of their backgrounds.

“I would hate to see us lose our position as a leader in the world of science and medicine because we are unwilling to accept the best and brightest due to an irrational fear,” he said. “I know a lot of the people affected by this ban, and I can tell you with absolute certainty that they are decent people who America would be proud to have.”  

Kate Sheridan contributed reporting.

  • Here is an idea…Open more seats at US Medical and other Healthcare Profession University Programs instead of allowing citizens of foreign countries to have our jobs. Thousands of qualfied US applicants are denied admission to these programs under the guise that high standards must be met, yet graduates from “colleges” in shopping plazas in Manilla are given a much easier and much less academically demanding path than we are…A U.S. trained Physical Therapist must earn a Doctor of PT which has a tuition cost alone of around $90,000 to $115,000 and is an intensely competitive application process after a Bachelors is earned. Citizens from Phillipines, Ireland, Brazil, Netherlands do not need to earn a Doctor of PT and are not regulated by the US Physical Therapy Education Board (CAPTE) to work in the U.S., their path is actually much easier, academically speaking. They under go a vague review of their education coursework to determine if it is comprable to a US program. Seems like a loose process to me. Foreign PT’s have been found to have found to have comitted widespread cheating at testing centers and only 22% of foreign educated PT grads pass the PT National Exam compred to >98.5% of U.S trained PT’s but they come over and take jobs from Americans that were not given the same opportunities to practice in the U.S as a citizen of the Phillipines. The Philipines, which has very few Physical Therapy providers and very low employment prospects for PT’s has over 100 Physical Therapy Bachelor Programs whose primary goal is to send graduates to work in the U.S. Notice I said “Bachelor” programs. Not Doctor of PT programs as is required of a US citizen, never the less, they come and scoop up our high paying jobs that are mostly funded by the US taxpayer via Medicare. Open up more opportunites and seats for American’s at Universities to become healthcare professionals!!!

  • Currently there is an over supply of pharmacists in the US. Many graduates cannot find jobs. There is NO need to bring in pharmacists with H1B visas, yet pharmacy owners game the system because they can pay some Canadian, Indian, Chinese pharmacist much less. I find many foreign born non-citizen pharmacists to be poorly trained and very difficult to understand. Darrell Issa’s bill is a step in the right direction to stop the abuse.

  • Uhh no. In fact, we have an abundance of U.S. citizen MD’s. Every year, over 4,000 U.S. citizen doctors are blocked from residency positions by foreign doctors (usually from India and the Middle East) who come over on H-1B visas. These young American doctors have passed all their licensing examinations, but are unable to practice medicine because they are unable to land a residency position. No preference is given to citizens in applying. As a result, we have thousands of unemployed doctors. Tightening H-1B visas will directly benefit these Americans. With the cost of medical education in this country, it’s high time we start taking care of our own.

    Read this article about American doctors who are screwed over by the current system.

    • If you read the article thoroughly you would have found that 94% of US med students found placement in the first round, others were scooped up in a secondary selection and many of the unloaded students had poor exam grades.

  • Actual data for perspective on healthcare workers from the 7 countries affected by President Trump’s ban:

    – 12,440,670 total U.S. healthcare workers (
    – 781,235 U.S. residents from 7 affected countries, 11% employed in healthcare (
    – Math 1: 781,235 * 11% = 85,935 U.S. healthcare workers from 7 affected countries
    – Math 2: 85,935 / 12,440,670 = 0.7% of total U.S. healthcare workers from 7 affected countries

    Not a huge problem.

  • Just how many healthcare professionals do you think are coming from Iraq, Syria, Iran, Libya, Somalia, Sudan and Yemen? These seven countries were designated countries of concern by the Obama administration. Halting immigration from these countries for three months until we can figure out how to prevent “bad guys” from getting in is entirely reasonable.

    • How many terrorist attacks have been carried out in the US by people from Iraq, Syria, Iran, Libya, Somalia, Sudan and Yemen?

      Compared to say home grown terrorists, or terrorists from countries Trump hasn’t placed restrictions on?

      You’re making excuses for harmful, ill-considered, counter-productive measures that are reducing the goodwill of the United States throughout the Muslim world and far beyond. You really think that’ll make you safer? You’re sadly mistaken.

      And to answer your question, a significant number of healthcare professionals come from Iraq, Syria, Iran, Libya, Somalia, Sudan and Yemen.

    • I think you need to look up what a straw man argument is, Ken.

      She asked a question, I answered it.

      If it’s about your security, aren’t you concerned at the number of countries restrictions haven’t been placed on? The origin countries of all previous terrorists on US soil, including 9/11 terrorists, have not been restricted. I’d be extremely worried if I was you, but thankfully I’m not that paranoid or insecure.

      This ban is damaging goodwill towards the US around that world. That is what will make you less safe, not your border policy.

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