The writer is fortunate to have the time to read several news feeds including the American Nursing Association’s (ANA) “Smartbrief” and Medscape’s various updates. In both of these, analysis of recent political action demonstrates the gravity of the repercussions from poor policy making.
Donald Trump issued an executive order recently, banning immigration from 7 countries with largely Muslim populations and suspending the Visa Interview Waiver Program. According to a recent article in the New England Journal of Medicine, this is causing not only chaos, fear and uncertainty, it is undermining medical education and patient care (Ault, 2017).
Physicians have expressed widespread opposition to the ban, stating that it threatens the very foundation of American medicine – the free exchange of ideas, experience, and perspectives. But it affects them on more than just a philosophical level. On an individual level, fear is palpable among patient and physicians, who are unsure of their immigration status. A shortage of primary care and internal medicine residents is also a likely result. More than 50% of the internal medicine residency slots are filled by international medical graduates. These Residents care for America’s veterans in VA facilities, and any number of underserved populations. Some international medical students were not allowed to board their flights back to the US when the ban was issued. Others are in the process of obtaining a Visa. A large number of residents and medical students originate from Muslim-majority countries, and their inability to enter the country would deeply impact primary care for these vulnerable populations (Ault, 2017).
The numbers are there. Medical school graduates from Iran, Iraq, Syria and Sudan accounted for 753 applications for Internal Medicine residencies in 2013, and 40% of these were matched into a program (got a job as a Resident in the US). In addition, 1879 doctors in the US were here with J-1 Visas in 2015. J-1 Visas require that these doctors return home for 2 years after finishing their training, unless they take jobs in medically underserved areas (Ault, 2017). The impact on primary care and vulnerable populations is clear.
The writer can attest to this. Her daughter is a first-year Resident in an Internal Medicine. Previously, she studied medicine in downtown Detroit at WSU. In both cases, she has worked at VA facilities, and with underserved and vulnerable populations. Should this country be unable to fill its Internal Medicine Residency slots, veterans and minorities will suffer.
The medical community has come together to advocate for allowing qualified international medical graduates to enter the United States, regardless of country of origin. Residency programs’ selection committees are already reacting to the ban, altering their rankings of applicants based on country of origin – essentially discriminating against qualified young physicians on the basis of race and religion (Ault, 2017). This is not only ethically repugnant, it diminishes the quality of medical care for all. As nurses, we must advocate for quality care for all of our patients, and stand with physicians against this ill-advised policy.
Ault, A. (2017, February 2). Trump immigration order causing chaos for medical centers: NEJM [Blog post]. Retrieved from http://www.medscape.com/viewarticle/875302?src=WNL_specrep_170207_MSCPEDIT&uac=175171HR&impID=1285650&faf=1#vp_2