Now that the U.S. Supreme Court has upheld President Donald Trump’s Travel Ban in Trump v. Hawaii, it is important to think about some of the consequences the ban will have on various industries that rely on employing individuals from the affected countries: Iran, Libya, North Korea, Somalia, Syria, Venezuela, and Yemen. Healthcare is one of those.
The U.S. is already facing shortages of doctors, nurses, and home health aides – especially in more rural areas of the country. The Migration Policy Institute has reported that 30% of all physicians and surgeons are immigrants. Syria and Iran rank 6th and 10th, respectively, of the top 10 countries that “supply” these doctors.
The Association of American Medical Colleges (AAMC), joined by more than 30 other organizations, filed an amicus brief in Trump v. Hawaii supporting their shared view that “[i]nternational health professionals provide essential care in teaching hospitals and their communities, particularly for rural and underserved populations,” and that excluding them “compromises the health security of the nation.” Certain specialties are more heavily populated by foreign-born physicians: geriatric medicine (50%), nephrology (almost 50%), internal medicine (close to 40%), and psychiatry (30%). There is some agreement among those in the industry that these specialties are less attractive to U.S.-born medical students because these fields are less financially lucrative, particularly when the jobs are outside of urban centers. There has been recent particular focus on this trend in psychiatry.
Although the Travel Ban has waiver provisions that theoretically would allow qualified physicians with job offers to apply for and receive visas and enter the U.S., as pointed out by Justice Stephen Breyer in his dissent in Trump v. Hawaii, the waivers are hard to come by and issued unpredictably. Beyond that, Travel Ban 3.0 and its previous iterations have had a chilling effect. Physicians from the affected countries who want to come to the U.S. to pursue their clinical medical training and remain after completion of that training are concerned about whether they can really hope to have a future in the U.S. Questions include:
- Will they be able to enter and then travel freely?
- Will their families be able to join them?
- Will they be separated for long periods of time?
Related, hospitals and clinics are concerned about offering positions to these physicians for similar reasons. The National Resident Matching Program (the “Match”) is the national mechanism through which medical school graduates, whether from U.S. or foreign medical schools, who aspire to do their training in the U.S. rank their chosen graduate medical education programs at which to train. Through that process, medical school graduates ultimately match with training programs, which also rank their chosen or preferred candidates, and prepare to enroll as trainees in those programs. Employers are thus concerned that they could go through the annual Match, plan for the hiring of foreign medical graduates in their training programs, only to later be faced with a situation where those graduates cannot enter the U.S. to start working in their programs.
Of course, at any time, the Administration can remove countries from the Travel Ban list or add countries to that list, thus creating further uncertainty for employers and prospective immigrants.