President Donald Trump's 90-day ban on immigrants from seven predominantly Muslim countries has some in the healthcare industry worried that it will make staffing at hospitals more difficult.
For starters, the timing presents a challenge. In March, medical students and graduates of foreign medical programs will learn if they've been matched with a residency program, allowing them to start their medical careers. The travel ban, if it holds for the full 90 days, would overlap with that annual process, which has caused concern among hospitals already facing staffing shortages.
"All the applicants have just completed their interviews, and they're just putting together their rank order list of the programs they want to go to," said Andrew Yacht, MD, chief academic officer at New York-based Northwell Health. "The deadline for that match is in three weeks. I don't know how many of those people are from the seven affected countries, but it's not nothing."
If any of those applicants are in their home country, chances are they won't be allowed into the United States to start practicing. Citizens of Syria, Iran, Iraq, Libya, Somalia, Sudan and Yemen are currently barred from entry into the country.
That has left program directors in a tight spot, said Yacht. Just as the potential residents rank the programs they'd like to work in through the matching system, program directors also rank which promising doctors-to-be they'd like to come work for them. Ranking someone from Libya, for example, may not mean that person can come work for the program, at least for the time being.
"That's a big workforce program," said Yacht. "That's a big challenge."
In other cases, residents are unable to complete their training. Yacht knows of at least one woman who had been training in the United States since June but was just sent back to her home country, unable to complete her first year of training due to the ban.
Yacht said program directors will have to determine what level of risk they're willing to take.
"Many of our hospitals in rural and even urban areas could not function without international medical graduates," he said. "There's naturally a great deal of trepidation about how they're going to serve the needs of their patients."
Charles Schleien, MD, executive director of Cohen Children's Medical Center and chair of pediatrics at Northwell, also expressed concern about Trump's immigration ban, saying it is likely to affect patients at his hospital, which is located in ethnically diverse Queens.
"Many of our patients and their families will be terribly affected by this ban in ways that are unimaginable," he said. "Clearly, breaking apart families, with parents and relatives unable to return to rejoin their children, will be heartbreaking for these families and have negative effects on the children we serve medically."
Similar sentiments were expressed in op-ed pieces, blogs and various news outlets throughout the country Monday morning. Ford Fox, a physician specializing in rehabilitation medicine, wrote for CNN that the immigration ban "is a blunt instrument that's already wreaking havoc" on healthcare. A Cleveland Clinic physician with a Sudanese passport was ejected by border agents at John F. Kennedy Airport on Saturday, directing her back to Saudi Arabia and causing uncertainty at the hospital.
"Anyone who doesn't work in healthcare 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," wrote Fox. "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."
Jennifer Adaeze Okwerekwu, a first-year resident at Cambridge Health Alliance in Boston, wrote an op-ed piece for STAT in which she said that there are doctor shortages in every speciality, which makes the ban especially worrisome.
"I come from a family of immigrant doctors, and I'm intimately familiar with the extra hoops foreign medical graduates need to jump through in order to train and practice in the United States," she wrote. "From securing research opportunities to doing additional rotations and observerships, international medical graduates often need to do more than the average American medical student just to get a foot in the door for a residency spot."
For decades, she said, the United States has relied on foreign medical graduates to fill an unmet need.
What happens from here, said Yacht, is anyone's guess.
"It's the unknown that's concerning," he said. "It's very fearful."