One of the biggest challenges facing Veterans Affairs in carrying out its mission to provide high-quality medical care to our nation’s veterans is ensuring access to that care. A national physician shortage, particularly in rural areas and in primary care specialties, has made it difficult to provide easy access to care for all veterans. President Trump’s revised executive order banning immigration from six predominantly Muslim countries (Iran, Syria, Somalia, Yemen, Libya, and Sudan), which was struck down by another federal appeals court this week, would worsen the shortage of health care personnel in ways that would harm our veterans.
One objective measure of the extent of the VA physician shortage is the number of unfilled physician job postings. At the time of this writing, there were over 1,000 unfilled physician positions nationally in the Veterans Health Administration facilities across the country. Many of these unfilled positions are for primary care physicians (for example, internists in Greenville, N.C., and Oklahoma City, Okla.), and some are for medical specialists (an oncologist in Des Moines, Iowa; an interventional cardiologist in Shreveport, La.), surgeons (a general surgeon in Jackson, Miss.; a gynecologist in Martinsburg, W.Va.) and others (a psychiatrist in Parma, Ohio; a radiologist in Philadelphia, Pa).
When hiring to fill these vacant positions and increase access to care for veterans, VA prioritizes hiring veterans and US citizens. That more than 1,000 physician job vacancies exist despite those statutory preferences demonstrates that the need for physicians exceeds our domestic supply. To fill this gap within VA, we must rely on physicians from other countries to work in VA clinics and hospitals (which have repeatedly been shown to perform as well as or better than private sector hospitals).
Immigrant physicians are already an integral part of our health care system. An estimated 27 percent of all physicians currently practicing in the United States are foreign-born. According to a recent analysis by researchers at Harvard and the Massachusetts Institute of Technology, approximately 7,000 physicians in the United States are from the six countries targeted by the immigration ban. Of these, 250 work in the VA system and provide an estimated 500,000 patient visits for veterans each year.
The 2014 investigations into the deaths of veterans awaiting care at the VA Medical Center in Phoenix, Ariz., shed light on the harm that physician shortages can create. In 2016, due to persistent difficulty hiring enough physicians to care for veterans, VA amended its rules to allow certain advanced practice nurses to practice independently without physician oversight despite objections from physician groups like the American Medical Association. Adding more advanced practice nurses is an appropriate stopgap measure, but this policy change will not solve the physician shortage.
The Harvard/MIT data reveal that the states with the most VA physicians from countries targeted by the ban are Michigan, Illinois, Pennsylvania, Kansas, West Virginia, Tennessee, and Wisconsin. Especially in rural areas, these physicians may be the only ones available to care for veterans who receive medical care from VA. The proposed immigration ban would deny veterans in areas with a dearth of VA physicians the essential services they need.
The immigration ban does more than just block physicians from entering the United States. It sends a message to physicians from other Muslim-majority countries that, even though we need them, they are not welcome here. Beyond the six countries named in the executive order, many physicians from other Muslim-majority countries also serve our veterans. For example, VA employs 690 physicians from Pakistan according to the Harvard/MIT data.
Putting veterans first means we cannot jeopardize the already limited supply of physicians and other health professionals who care for them. The 250 immigrant VA physicians from the countries targeted by the ban pose no threat to us as a nation. On the contrary, they are working hard to save and improve the lives of our veterans by taking jobs that no American citizen was able or willing to take.
The stated purpose of the president’s executive order is to make our country safer. Yet the available data available suggest that the potential harm it would do to our veterans alone would outweigh any perceived national security benefit. Failing to care for our veterans, to whom we are indebted as a nation, is a blemish on our national conscience.
We urge the president to honor the lower courts’ ruling on this executive order. We owe too much to our veterans to gamble with their lives.
Rahul Ganatra, M.D., Matthew Chase, M.D., Lakshman Swamy, M.D., and Christopher Worsham, M.D., are internal medicine physicians and chief medical residents in the VA Boston Healthcare System, where they all provide care to veterans. The views expressed in this article are their own; they do not represent the U.S. Department of Veterans Affairs.