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Travel Ban Is Revealing—but Does Not Threaten American Medicine

A 90-day ban on travel from seven countries has sparked tremendous outpourings of worry or outright opposition by some 33 medical organizations.

“The community is reeling over the order, fearing that it will have devastating repercussions for research and advances in science and medicine,” states an article in Modern Healthcare.

Certainly the order is disrupting the lives of individual physicians who have won coveted positions in American medical institutions and were not already in the U.S. when the order was issued. Also their employers have a gap in the work schedule to fill. War tears people’s lives apart, however innocent they may be. And countries that sponsor terrorism have effectively declared war on the U.S.

But is American medicine so fragile that it can’t survive a 90-day delay in the arrival of physicians, most of them trainees, from Iran, Iraq, Libya, Syria, Yemen, Somalia, and Sudan? After all, every year more than a thousand seniors in U.S. medical schools do not land a position in a post-graduate training program through the annual computerized “Match” of graduates with internships.

After another chance through the Supplemental Offer and Acceptance Program, or SOAP, hundreds of seniors are still without a job. This means that they cannot get a license to practice in the U.S., however desperate rural communities or inner-city hospitals are to find a physician, and their four years of rigorous, costly post-college education are wasted. Yet James Madara, CEO of the American Medical Association (AMA), is worried about vacant residency slots, according to a Feb 3 article in MedScape by Robert Lowes.

Entry to medical school is highly competitive, so presumably all the students are well-qualified. Can it be that graduates from Sudan are better trained? Does the U.S. have so few young people capable of and interested in a medical career that we have to depend on a brain drain from countries that are themselves desperately short of physicians?

For all the emphasis on “cultural competence” in American medical schools, and onerous regulations regarding interpreters for non-English speakers, what about familiarity with American culture and ability to communicate effectively with American English speakers? Some foreign-born graduates are doubtless excellent, but many American patients do complain about a communication gap. So why do some big institutions seem to prefer foreigners? Could it be that they want cheap, and above all compliant labor? Physicians here on an employment-related visa dare not object to hospital policy.

Whatever the reasons for them, here are some facts about the American medical work force:

One-fourth of practicing physicians in this country are international medical graduates (IMGs), who are more likely to work in underserved areas, especially in primary care, according to Madara. According to the Accreditation Council for Graduate Medical Education (ACGME), 10,000 IMGs licensed in the United States graduated from medical schools in the seven countries affected by the ban.Immigrants account for 28% of U.S. physicians and surgeons, 40% of medical scientists in manufacturing research and development, and 15% of registered nurses, according to the Institute for Immigration Research at George Mason University. More than 60,000 of the 14 million workers in health-related fields were from the seven countries affected by the ban.

Is medicine, like agriculture, now filled with “jobs that Americans won’t do”? Actually, we have more than enough Americans who love medical work. But some of best doctors are being driven out by endless bureaucratic requirements, including costly “Maintenance of Certification™” programs that line the pockets of self-accredited “experts” but contribute nothing to patient care. They are being replaced (substituted for) by “mid-levels” with far less training. Then there are thousands of independent physicians having to retire or become employees because they can’t afford the regulatory requirements—soon to be greatly worsened by MACRA, the new Medicare payment system. Physician “burnout” is becoming so bad that we lose up to 400 physicians—the equivalent of a large medical school class—to suicide every year.

The U.S. should be a beacon to attract the best and brightest, and it should welcome those who want to become Americans. Unfortunately, the lives of Americans, as well as the opportunities of aspiring foreign-born doctors, are threatened by those who desire to kill Americans and destroy our culture. These must be screened out.

Meanwhile, the reaction of organized medical groups to the travel ban is spotlighting serious problems in American medicine.

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Bich NgocPerryRobert BowmanNiran Al-Agbajamesepurcell Recent comment authors
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Bich Ngoc
Member

Many comments below take large exception to this blog post. My take it that it raises some interesting issues…..for example the hundreds of medical students who don’t “match”…..and comparing them to the international students who take slots. I don’t know the answer, but it seems a worthy discussion point…..and the exodus of talent from third world countries (vs. a more libertarian argument that people should be free to migrate) is a topic also worthy of discussion and debate. Thank you THCB for publishing.

Robert Bowman
Member

Basic Health Access recovery requires spurious studies and statements to be challenged. The following indicate distributions and primary care contributions of different medical school origin graduates. Only Allopathic private US medical schools have worse distribution than International graduates when considering locations over decades rather than a few years after graduation. Only origins in certain nations contribute to distribution and to primary care. If the AMA and others really focused on health access, why did they allow the 5th Pathway to be terminated – one of the best routes to Spanish speaking physicians and graduates among the most likely to distribute.… Read more »

Niran Al-Agba
Member

Dr. Orient – I have watched the AAPS for a long time as I tend to agree on their stances regarding over-regulation in medicine and the burden placed on physicians like me — who loves my patients, works hard to make their lives better, and yet still could have an insolvent business despite my best efforts. I am with you for the second half of your piece as you echo my sentiment well. However, the first half of your piece has nothing to do with the second. I am well aware of the difficulty American medical students have matching and… Read more »

jamesepurcell
Member

This post and the prior asking our President to apologize are difficult to respond to given that both reflect moralistic outrage of varying degrees–always a challenge to reply to. I can, hazily, recall 1968-71, when I served in the military and in Viet Nam. When I came back home, I was vilified as were the people I served with. The rhetoric and its overwhelming moralistic bludgeoning were similar to what we are hearing today. I can recall how I cringed when people asked “were you in Viet Nam,” or in a group asked if there were Viet Nam vets amongst… Read more »

Ross Koppel
Member
Ross Koppel

There is so much wrong with this article. Doctors are not killing themselves because of the need to re-certify their skills., I agree the professional associations rake in the money for this…but this is not the government….this reflects rules by fellow physicians. Most of this piece is just blind rage against any regulation (except against abortion). Doctors are unhappy because of the terrible EHR software they struggle with daily, because they must fight with insurance companies, and because of the insane payment system we have here absent a rational payment system. Similarly, if foreign doctors are taking the worst jobs… Read more »

Margalit Gur-Arie
Member

Everybody sitting down? Good. A glass of water could help too…. Here we go… Why do articles like this one come into existence? Why did it take a coin toss to decide whether to publish or not to publish? Oh, sure, you can take issue with pretty much every sentence, but something in the whole is infuriating precisely because it cannot easily be dismissed: the travel ban has nothing to do with medicine in America. It just doesn’t. You may think that the travel ban is ill-conceived, idiotic, evil, discriminatory, unconstitutional, fascist, whatever floats your boat….. but that does not… Read more »

Allan
Member
Allan

Margalit, once again I enjoyed the thrust of your argument and have much agreement. Who you voted for doesn’t change the excellent points you make. You were a strong supporter of Sanders who was beaten by Clinton. I think Sanders had at least as much support as Clinton in the Democratic party, but apparently many in the Democratic leadership didn’t recognize how important some of his issues were. If they did I believe Clinton would be President today. Outrage Trumped Clinton and Trump Trumped outrage.

Peter
Member
Peter

“Yes, a few doctors were caught in the ban (probably some engineers, teachers, waiters, drivers, etc. as well). Yes, the human stories of the physicians were unfortunate, but were they worse than the stories of waiters, drivers or full-time moms? Or are we implying that physician misfortunes are somehow more important than, say, a taxi driver’s travails? See where I can take this? I won’t though.” This is a health care blog, if you want to discuss the other careers affected then go to the taxi blog, or engineer blog, etc. By extension this ban affects the whole country. No,… Read more »

Margalit Gur-Arie
Member

It’s not about this blog. It’s about national headlines. I have not seen any national headlines running story after story with breathless updates about individual cabbies or about the ruin of the taxi industry, complete with charts, and color graphics..

Peter
Member
Peter

“Why do we blow a gasket now?” You’re right, more voters should have recognized a despot before they voted. Gaskets are being blown because because this act is the insidious tip of what this administration is capable of. This act gives license to the acts that will follow. This weekend two muslim Canadian women were questioned at the border about their religion and if they liked Trump. They were detained for 5 hours and had their cell phones investigated. The agents found several harmless religious videos that I doubt they understood and ultimately the women were denied entry to visit… Read more »

Margalit Gur-Arie
Member

Peter, the travel ban was stupid. The implementation of the travel ban was a master class in incompetence. The courts struck it down. There is no tip and no iceberg. It’s how government was set up to work, and it worked. People got caught at the borders before the travel ban, and will get caught after the travel ban, for all sorts of idiotic reasons (I missed a flight from Canada a few years ago because I was traveling with a colleague who had a green card and they detained him and humiliated him for hours). That’s not why we… Read more »

Peter
Member
Peter

“There is no tip and no iceberg.”

Wait for it, it’s only been 25 days.

“It’s how government was set up to work,”

No, it’s how this government is set up to work.

Paul @ Pivot ConsultingLLC
Member

Many comments below take large exception to this blog post. My take it that it raises some interesting issues…..for example the hundreds of medical students who don’t “match”…..and comparing them to the international students who take slots. I don’t know the answer, but it seems a worthy discussion point…..and the exodus of talent from third world countries (vs. a more libertarian argument that people should be free to migrate) is a topic also worthy of discussion and debate. Thank you THCB for publishing.

kpedmonds
Member

This extremist, politicized post is riddled with spin and comes from the leader of a fringe physician group with deeply objectionable positions. It has no place on this website. “The AAPS statement of principles declares that it is “evil” and “immoral” for physicians to participate in Medicare and Medicaid, and its journal is a repository for quackery. Its website features claims that tobacco taxes harm public health and electronic medical records are a form of “data control” like that employed by the East German secret police. An article on the AAPS website speculated that Barack Obama may have won the… Read more »

Peter
Member
Peter

“every year more than a thousand seniors in U.S. medical schools do not land a position in a post-graduate training program” “But 8,640 did not — a number that includes international applicants” “we lose up to 400 physicians—the equivalent of a large medical school class—to suicide every year.” “Although it is impossible to estimate with accuracy because of inaccurate cause of death reporting and coding” “the lives of Americans, as well as the opportunities of aspiring foreign-born doctors, are threatened by those who desire to kill Americans and destroy our culture. These must be screened out.” Yes, screened out in… Read more »

Steve2
Member
Steve2

“are threatened by those who desire to kill Americans and destroy our culture. These must be screened out.”

Agreed. So let’s ban people from the countries where killers really come from, like KSA, Egypt and Pakistan.

Allan
Member
Allan

Steve, That may or may not be a good idea even if sarcasm was involved. I can’t say since apparently the seven countries were on the temporary ban list because there is no way at the present to check the history of immigrants from those seven nations.

However, thinking about things in a completely different fashion, the US has first world healthcare and these countries under discussion don’t. Why are we so satisfied to brain drain trained physicians from these nations where trained medical personal are in short supply and the needs for these doctors are so much greater?

Peter
Member
Peter

“because there is no way at the present to check the history of immigrants from those seven nations.”

So the U.S. was just flipping a coin?

Wrong as usual Allan.

http://www.vox.com/policy-and-politics/2017/2/2/14452090/refugee-vetting-difficult

Allan
Member
Allan

There has been so much infrastructure destruction that the normal ability of governments to communicate with one another prevents our government from verifying needed information in those 7 countries where false passports are used by many.

Peter, there was no flip of a coin by Trump or Obama in recognizing that problem. It appears that your responses are based upon what wall you are presently banging your head against. All I seem to hear from you is insult after insult with accusations all lacking fact or any understanding of what you are talking about.

Steve2
Member
Steve2

“Why are we so satisfied to brain drain trained physicians from these nations where trained medical personal are in short supply and the needs for these doctors are so much greater?” I think it is a good question. I dont know if we are morally correct to be doing this. As a physician I think I almost have too many conflicting interests to have a valid opinion (and I am pretty opinionated). It would likely benefit me financially to keep these people out of our country. OTOH, it would also benefit, probably those people in those other countries. Weigh that… Read more »

Allan
Member
Allan

Steve, I liked your answer. Honest and willing to question both sides of the equation. I always think about this question much like you do and consider the morality. People are dying all over the world and we have so much yet we complain and are terribly self centered. I soothe my feelings knowing that our capitalist system here has helped to bring so many lives out of dismal poverty all over the world.