The White House’s travel ban encompassing seven majority-Muslim countries is a blunt instrument that’s already wreaking havoc and the impact is already being disproportionately felt in American health care. The administration emphasizes it’s preventing only a “small percentage” of global travelers from entering or leaving the country, but our hospitals rely on a steady influx of international physicians to keep running.
Throughout my medical career I’ve benefited from working alongside medical graduates from around the world. I’ve enjoyed professional relationships with Russians, Saudis, Canadians, Israelis, Iranians and Italians in the halls of medical centers in Alabama, Ohio, Missouri, Massachusetts and Georgia. Thanks to our conversations between cases I’ve learned about different medical systems and different approaches to managing the same conditions, and I’ve enjoyed their camaraderie.
Today I work at one of the top rehabilitation hospitals in the country, and on our wards I’ve recently had the pleasure of overseeing a resident physician from Iran who’s doing her rehabilitation specialty training through Emory University School of Medicine. She holds an H-1B visa, the kind our government grants to the highly skilled workers our economy needs.
Under President Trump’s new order, even after the interventions of two federal courts, if she left the country for any reason, such as going to visit family, she might be locked out from returning. Her colleagues, including myself, trust her to care for patients at the country’s eighth ranked rehabilitation hospital, but our government doesn’t trust her enough to let her travel.
Other doctors made the mistake of being out of the country the same week Donald Trump started flexing his newfound powers. Border agents ejected a Cleveland Clinic physician who arrived at John F. Kennedy Airport on Saturday, directing her back to Saudi Arabia (she holds a Sudanese passport). On Sunday the clinic took a bold stand against the White House’s disruptive new policy, saying it had caused uncertainty for its employees and that the clinic is “fully committed and actively working toward the safe return of any of our employees who have been affected by this action.”
Anyone who doesn’t work in health care may be surprised to learn just how much American medicine, ranging from the Cleveland Clinic to your own local hospital, relies on physicians from abroad. International medical graduates represent an essential influx of talent that supplements our own domestic medical school trainees, who are in too short supply to treat everyone who needs care in our communities.
Our training hospitals posted job listings for 27,860 new medical graduates last year alone, but American medical schools only put out 18,668 graduates. International physicians percolate throughout the entire medical system. To highlight just one particularly intense specialty, fully 30% of American transplant surgeons started their careers in foreign medical schools. Even with our current influx of international physicians as well as steadily growing domestic medical school spots, the Association of American Medical Colleges estimates that we’ll be short by up to 94,700 doctors by 2025.
The President’s decision is as ill-timed as it was sudden. The initial 90-day order encompasses Match Day, the already anxiety-inducing third Friday in March when medical school graduates officially commit to their clinical training programs. Unless the administration or the courts quickly fix the mess President Trump just created, many American hospitals could face staffing crises come July when new residents are slated to start working.
The international doctors who come to our shores represent some of the best ambassadors for their native countries, but they all have their own reasons for choosing to build medical careers in America. In doing so many are looking to leave behind more authoritarian regimes.
When it comes to the impact on our health care system, some countries may appreciate President Trump’s new medical blockade. As the Iranian-born resident working with me pointed out, her home government will be happy to see its educated citizens and scientists stay right where they are. “If [Trump] wants to fight with the Iranian government in this way, it doesn’t work at all.”
It doesn’t seem to matter what element of American medicine this President touches; on issues ranging from vaccines to health insurance to simply keeping our hospitals staffed, Trump has a way of downgrading his patient to life support.
We have a phrase for this kind of unfortunate person in medicine, and it doesn’t matter whether you graduated from med school in Iran or Alabama, you know it: a black cloud. If your black cloud persists, you might need to think about an alternate career. With his cloud’s darkness spreading fast, it’s past time Trump step away from the health care policy arena.