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mack in the middle of President Trump’s 90-day suspension on immigration from seven majority-Muslim countries is a date sure to be marked on medical students’ calendars: March 17. Match Day.

That’s when thousands of students at medical schools in the United States and around the world find out if and where they’ve “matched” for a residency program, where they will begin to practice as doctors for the first time and further develop their skills.

But Trump’s executive order on immigration, issued on national security grounds, has thrown the process into disarray. Some physicians-in-training have been left wondering if they will be allowed into the country to start their programs, while hospitals are weighing whether to risk reserving coveted spots for students who might not be able to fill them. Medical students and residency programs have to submit rankings of their preferences by Feb. 22.

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“It’s just causing havoc,” said Dr. Atul Grover, the executive vice president of the Association of American Medical Colleges. “Right now, you’ve got potentially hundreds of people that are actively pursuing a residency in the United States. This order gets executed, and now they’re unclear on what it means for their status and whether they would be allowed to come.”

Most of the uncertainty right now is focused on the students who are from one of the seven countries subject to Trump’s order — Iraq, Iran, Syria, Libya, Yemen, Sudan, and Somalia — and remain abroad.

Mona Signer, the president of the National Resident Matching Program, said medical organizations are trying to learn more about the effects of Trump’s executive order but that residency program directors “will be reluctant” to rank applicants from these countries.

On Wednesday, the American Medical Association asked the Trump administration to clarify its policy so that patients would not lose access to care and that doctors and students trained abroad wouldn’t be barred from coming to the United States, noting that foreign doctors often fill primary care positions and work in poor areas.

“The executive order places into question those [international medical graduates, or IMGs] who have applied for or who have been granted visas to come to the United States to train and provide care in underserved communities,” AMA CEO Dr. James Madara wrote to Secretary of Homeland Security John Kelly. “Guidance is urgently needed from the Administration to ensure the upcoming residency matching program in March 2017 does not leave training slots vacant and that all qualified IMG applicants can participate.”

Many overseas students have spent years — and thousands of dollars — trying to secure a US residency, burnishing their resumes and trying to qualify for a visa.

“If they wanted to go to residency in Iran, they could start right away, but most of these people have spent at least three or four years doing research, and doing … board exams,” said Dr. Mehdi Farokhnia, a postdoctoral fellow at a National Institutes of Health lab, who plans on applying for psychiatry residencies in the next few years.

Farokhnia was born in Colorado but went to medical school in Iran and said he has heard concerns from friends there. Exams required for US residencies aren’t offered in Iran, so students need to travel to Dubai or Turkey to take them, he said. It’s not cheap: Farokhnia said that the test alone can cost $3,000.

The Educational Commission for Foreign Medical Graduates, which certifies people who complete medical school abroad to practice in the United States, said it has heard from students and residents worried about how the executive order affects them, and that, “at this time, we still are assessing the impacts of this executive order.”

In 2016, more than 3,700 non-US citizens who studied medicine abroad matched into US residency programs, according to the American College of Physicians. Overall, about 1 in 4 physicians in the United States was born abroad.

Grover said the AAMC has identified more than 1,000 non-US citizens applying for residency programs who are from one of the seven countries or who have listed contact or family addresses there. Many of them have visas or green cards and are already in the United States, but Grover said he and others are not sure how those people will be affected by the immigration policy, or what will happen after 90 days.

“The thing that’s still a problem, with the way the administration keeps changing the rules, is you don’t know what’s going to happen next year,” Grover said. “Is the Trump administration going to say, ‘You have to make these residents leave?’”

Dr. Sanaz Attaripour, a native of Iran who is in her last year of a neurology residency at Drexel University, said people in Iran have been trying to come up with other plans since the policy was announced. Attaripour started a Facebook group for Iranians pursuing residencies while she was applying for her own, and members there have been trying to make sense of the ban.

“What I am hearing is all sad news,” she said. “I haven’t heard of a single spark of hope.”

Attaripour said she has already lined up a fellowship with the NIH after she completes her residency, but she is worried that Trump’s hiring freeze or future visa problems could unsettle her plans. But she added that since Trump announced the immigration policy, Americans have grown even more welcoming: When she was at a 7-Eleven in her neighborhood recently, the clerk gave her two free cupcakes.

“People know we are just like people of other nationalities,” she said. “We are just normal people.”

The immigration order could also affect students training to become osteopathic doctors, who find out where they match on Monday. The American Osteopathic Association said it hasn’t heard from any students or programs yet with concerns, but that it is offering legal assistance to students and osteopathic doctors from the seven countries if needed.

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For some physicians-in-training, worries extend beyond this Match Day.

“Next year, when it comes to selecting their residents, the program directors might say, ‘Remember last year, what happened with the Iranians?’” said Dr. Elmira Hassanzadeh, an Iranian radiology resident at the University of Illinois at Chicago, who has a green card. “What will happen is that in the coming years, fewer and fewer Iranians will get into residency programs [and] less and less Iranians will be recruited into research labs. It will systematically discriminate against us in health care and research science.”

Dr. Ahmed Ahmed, an Egyptian who came to the United States six years ago after completing medical school there, is waiting to see whether he matched at a psychiatry residency program. Egypt is not one of the countries subject to Trump’s policy, but Ahmed, who lives in Minnesota, is concerned the ban could be broadened to more countries and to sweep up people like him who have green cards.

“Our turn is going to come,” Ahmed said.

Plus, he said, he is speaking out against the policy on principle.

“I’m not standing just because I’m a Muslim or because I’m from Egypt, but because the policy is against the Constitution,” he said. “If I don’t stand with the LGBT community, if I don’t stand with Mexicans, if I don’t stand with Jews … something big is happening, and we need to be united.”

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  • Years ago when I was applying to residency I found that many programs would not consider Visa holders (both H1-B and J-1). “Too many problems” is what many program directors would say, even if they didn’t explicitly state it on their application. While the Trump Executive Order may have increased that sentiment among programs, it’s hardly new. I think this article is a bit hyperbolic in that regard.

    And let’s get real for a moment. The IMGs applying for these residency spots are doing it mostly because of greed. They could easily get a residency in their home country (many have already completed a foreign residency). They just know that they have a chance to make more money as a physician in the US than in Iran, or wherever. Nobody is acknowledging that. But it’s true. #dirtylittlesecret

  • I find it very amusing the ignoramus quotes from morons

    Having friends, family and colleagues who are in the medical field, nothing gets me more laughing at the ignorant responses. In the medical field, the US gets the best doctors in the world from pcps to surgeons.

    Not every doctor who wears a white jacket is a good doctor. U want the best to save your ass. Just because the doctors are born here….it doesn’t mean that u will survive on the operating table.

    Death is what u will get. By the way….the US competes with Canada, UK, AUSTRALIA to get the best.

    Think about it. Look at the medical research on drugs, diseases and care.

    U want the most highly talented no matter where they are from.

    Its funny….having been around these doctors….just because they are born here doesn’t ….doesn’t mean they are actually even good or even care weather u live or die.

    I remember one donor who dropped 20 million on a top research doctor at Childrens during the recession. She dropped the cash and the hospital got a new research wing just because of the doctor.

  • There is not going to be a problem. The US has thousands of doctors that are hear already and prepared to take these jobs. A lot of programs prefer foreign nationals because they work harder and require less training.

    I did not vote for Trump, i actually signed up for have him impeached. But this one is a no brainier. Citizens like myself that owe trillions in student loans to the government should get training before foreign graduates as long as they passed the board exams.

    We educate people from other nations to help those other nations. But if people all stay here we are not helping them it continues a “brain drain”. We have to look further out at all the ramifications of our actions. I don’t think that we are doing that right now.

    • “A lot of programs prefer foreign nationals because they work harder.” You’re saying that like it’s a bad thing. If I’m a program director trying to create the strongest program, I’m going to take the best candidates who will work hard and deliver the best patient care.

      I’m a 4th year US allopathic student, and I know I’m not “entitled” to a spot over an IMG. One is not more deserving of a spot because they’re an American who managed to pass their boards. One is not more deserving of a spot because they went to school here. One is not more deserving of a spot because they’re in “trillions” of debt (ghastly hyperbole you used btw.) A person is not more deserving of a spot because they plan on treating a particular population after finishing residency (American vs otherwise.)

      The person who is more deserving of a spot is the best all-around candidate, taking into account scores, research, volunteer endeavors, and personal characteristics.

      As soon as we stop this attitude of entitlement and stop seeing the training of some IMGs who are more qualified than some mediocre US seniors, the state of patient care in this country will improve. Because we are attracting the best doctors, not necessarily the most American.

  • “First they came for the Socialists, and I did not speak out—
    Because I was not a Socialist.
    Then they came for the Trade Unionists, and I did not speak out—
    Because I was not a Trade Unionist.
    Then they came for the Jews, and I did not speak out—
    Because I was not a Jew.
    Then they came for me—and there was no one left to speak for me”
    Pastor Martin Niemöller (1892–1984)

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