Trump Immigration Order Under Health Industry Scope

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By Mary Anne Pazanowski

President Donald Trump’s Jan. 27 executive order restricting entry to the U.S. for foreign nationals from seven predominantly Muslim countries is being scrutinized for potential health-care industry impacts.

The order generated significant fear and uncertainty its first weekend in effect and, although few people expect the health-care industry to be greatly affected, the reverberations of the order already have been felt in this sector. At least one medical professional was barred from entering the U.S. shortly after the order took effect.

In the future, foreign nationals from the affected countries who serve as members of hospital and health system medical staffs, medical school faculty and research fellows at facilities around the country could be affected, as could doctor-training programs that admit foreign medical graduates.

No one is certain yet, and the “order is time-limited in many important respects,” Anne Murphy, an experienced health-care attorney in Chicago who previously served as general counsel at Rush University Medical Center, told Bloomberg BNA.

The order suspended all refugee admissions for 120 days and blocked citizens of Iran, Iraq, Libya, Somalia, Sudan, Syria and Yemen from entering the country for 90 days.

It is important to remember that government officials are enforcing the order as currently written, but the White House could refine or clarify the order in the near future to address any unintended consequences, Murphy said.

Confusion Abounds

The executive order “has caused a great deal of uncertainty and has impacted some of our employees who are traveling overseas,” the Cleveland Clinic said in a prepared statement. One of its medical interns, Suha Abushamma, was on her way back to Cleveland after vacationing in Saudi Arabia when she was forced to return to the Middle East.

Abushamma said in the press release that she is safe and with her family. She is a citizen of Sudan, one of countries affected by the order.

The Cleveland Clinic said it is “fully committed to the safe return of those who have been affected by this action.”

Academic Medical Centers Affected?

The executive order may affect academic medical centers (AMCs) disproportionately.

“A significant number of clinical faculty, research faculty and attending physicians at AMCs are citizens of foreign countries,” and a portion of those professionals are citizens of Middle Eastern countries affected by the executive order, Murphy said.

Additionally, “a significant number of physicians in post-graduate training are citizens of foreign countries, including Middle Eastern countries,” she said. “In some cases, these physicians are highly regarded and sought-after candidates for specialized residency training or fellowship programs in surgery or research.”

And, although the order likely will affect only a few medical professionals, there could be a “broader chilling effect on the influx of these individuals to fill United States positions in AMCs.”

“Uncertainty regarding the possibility of future expansion or extension of the order could have a significant impact on the willingness of foreign citizens to apply for faculty or staff positions at AMCs,” she added.

“Foreign citizens already on staff at U.S. academic medical centers may experience anxiety around continuing to stay in the United States,” Murphy continued. The executive order “may enhance broader discomfort about whether the United States will continue to be a welcoming culture for them and their families going forward,” she said.

Graduate Medical Education

Graduate medical education also could be affected significantly, at least in the short term.

“Foreign citizens might experience practical difficulties participating in the upcoming [residency] match program and, in a broader way, might be less comfortable applying for United States-based residency or post-graduate training positions due to uncertainty as to the interpretation of the current order and the potential for expanded restrictions in the future,” Murphy said.

Organizations that evaluate foreign medical graduates’ credentials and qualifications to study in the U.S. also are watching the order.

The Educational Commission for Foreign Medical Graduates estimates that international medical graduates make up one-quarter of the U.S. physician workforce. The ECFMG certifies foreign medical graduates before they enter graduate medical education programs in the U.S. Certification by the organization also is required for physicians taking licensing examinations to practice medicine here, according to the ECFMG’s website.

The ECFMG is “evaluating the potential impacts” of the executive order on international medical students and graduates applying for ECFMG certification, the organization said in a Jan. 28 statement. The group said it “is communicating actively with other U.S. organizations involved with the education and training of physicians,” including the Accreditation Council for Graduate Medical Education (ACGME).

The ACGME is an independent, not-for-profit, physician-led organization that sets and monitors professional educational standards for physicians. The ACGME said it is studying “the specific dimensions of the policies announced, and the implications for our current residents and potential future residents.”

“In the meantime,” the organization asked members of the graduate medical education community to “pay particular attention to the well-being of our current residents who are from other countries, and understand the anxiety that may develop, regardless of their country of origin.”

“Those with family outside the United States may be particularly concerned. These physicians may require heightened support, and more overt efforts to demonstrate that support,” the ACGME said in a letter from CEO Thomas J. Nasca.

Association of American Medical Colleges President and CEO Darrell G. Kirch said Jan. 30 the “AAMC strives to ensure medical education and training is accessible for students and physicians from all backgrounds.”

The group is “deeply concerned that the Jan. 27 executive order will disrupt education and research and have a damaging long-term impact on patients and health care,” Kirch said. “International graduates play an important role in U.S. health care, representing roughly 25 percent of the workforce.”

“Current immigration pathways—including student, exchange-visitor, and employment visas—provide a balanced solution that improves health-care access across the country,” Kirch said. “Impeding these U.S. immigration pathways jeopardizes critical access to high-quality physician care for our nation’s most vulnerable populations.”

To contact the reporter on this story: Mary Anne Pazanowski in Washington at

To contact the editor responsible for this story: Peyton M. Sturges at

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