t’s debatable whether the U.S. Supreme Court’s 5-4 decision to uphold President Trump’s policy to prevent people from five Muslim-majority countries from entering the United States will protect national security. But it is certain to be a setback for the health of Americans.
The travel ban now restricts certain visa classifications for citizens of Iran, Libya, Somalia, Syria, and Yemen, as well as those from North Korea and Venezuelan government officials. While it applies broadly to individuals in all fields of study and professional practice, it has a disproportionate impact on the field of medicine. Millions of Americans, particularly those in underserved communities, depend on foreign doctors, thousands of whom hail from countries affected by the restrictions.
Today, roughly 1 in 4 physicians practicing in the United States is an international medical graduate. Such physicians, who get their medical education in countries outside the U.S., make up an even greater share of the primary-care physician workforce — about 40 percent.
International medical graduates also tend to practice in poor and underserved communities in the United States, where the physician shortage is most acute. In places where fewer than 10 percent of residents have college degrees, approximately 30 percent of doctors are international medical graduates. In regions with per-capita income below $15,000 a year, internationally educated doctors account for more than 42 percent of physicians.
Many parts of the United States are already experiencing a shortage of physicians, and that’s expected to get worse. By 2030, our nation could be short 121,000 physicians. The shortage in primary care, the front line of our nation’s health care system, could reach 49,000 by the end of the next decade. With a catastrophic doctor shortage on the horizon, the United States can’t afford to turn away qualified physicians.
Consider a few accounts from people in underserved communities who know firsthand how essential international medical graduates are.
About 1,500 international medical graduates currently practice medicine in Iowa. Dr. Steve Craig, executive director of the Des Moines Area Medical Education Consortium and an assistant dean at the University of Iowa Carver College of Medicine, told me: “We recruit international medical graduates to our training programs because it’s hard to attract other physicians to train in such small communities and because they often stay in these communities and practice after their training.”
Dr. Archana Chatterjee, chair of the department of pediatrics at the University of South Dakota Sanford School of Medicine, is one of only two pediatric infectious disease specialists in the entire state. Both are international medical graduates. “There is a large volume of work here that is being done by these doctors,” she said.
In Georgia, Dr. Michelle Nuss, who serves as campus dean for the Augusta University/University of Georgia Medical Partnership, said that “international medical graduates are a lifeline for our programs. Not only do they bring diversity, but they deliver high-quality patient care and are some of the best residents I’ve worked with.”
Simply put, foreign-born physicians help keep native-born Americans healthy. Yet the Trump administration, in its attempt to enhance national security, has unknowingly implemented policies that may prevent much-needed doctors from training and practicing in communities across the United States.
The Immigrant Doctors Project estimates that approximately 7,000 physicians from Syria, Iran, Somalia, Sudan, Libya, and Yemen now live and work in the U.S. They staff 14 million doctor appointments for Americans each year. About 2.3 million of those occur in areas currently experiencing a doctor shortage.
The visa restrictions may be stopping talented foreign physicians from even applying for residencies in the United States. In 2017, the number of Iranian, Libyan, Somali, Sudanese, and Syrian applicants who applied for certification from the Educational Commission for Foreign Medical Graduates, which is required for international medical graduates who want to train and practice in the U.S., declined nearly 18 percent. This year, the number of residency applications from these five countries plus Yemen dropped 27 percent.
Doctors from Muslim-majority countries aren’t the only ones affected by the travel restrictions. These and other recent changes in U.S. immigration policy have created an environment of uncertainty and anxiety for residency applicants from all countries. The number of non-U.S.-citizen international medical graduates who have applied for residencies in U.S. hospitals has declined in the past two years, in part because they perceive our country to be an unwelcoming environment.
Dr. Majid Aized, an international medical graduate from Pakistan who completed surgical residency and fellowship programs in the United States, knows this all too well. “I know more than a few medical graduates from my country who spent months waiting for a visa. Some were late to their U.S. training programs,” he said.
We cannot afford to deter talented foreign-born doctors from caring for American patients. Our nation already has too few doctors to meet our population’s needs. So the travel restrictions aren’t protecting our nation — they’re putting American lives at risk.
William W. Pinsky, M.D., is the president and CEO of the Educational Commission for Foreign Medical Graduates and board chair of the Foundation for Advancement of International Medical Education and Research.