Doctors, hospitals scrambling after Trump's travel ban

Several doctors have not been allowed to return to the United States

President Trump's recent executive order blocking many individuals from seven countries from entering the United States has directly affected doctors and researchers—and left hospitals as well as hundreds of medical residency applicants from the affected countries in limbo.

About the executive order

The order, signed by Trump on Friday afternoon:

  • Blocks individuals from Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen from entering the United States for 90 days, with exceptions for naturalized U.S. citizens;
  • Suspends refugee entry from all countries for 120 days;
  • Suspends Syrian refugee resettlement indefinitely; and
  • Cuts in half the total number of refugees permitted to enter in 2017 and calls for prioritizing those who are "religious minorities" in their respective countries for the remaining slots.

Trump said the order is intended to "kee[p] our country safe" and reduce terrorism.

A federal judge on Saturday issued a temporary stay on a portion of the order, ruling that refugees or visa holders held at U.S. airports under the policy could not be deported. Litigation is still ongoing.

On Sunday, Department of Homeland Security (DHS) Secretary John Kelly in a statement said that in applying the order, he deemed "the entry of lawful permanent residents"—green card holders—"to be in the national interest." A DHS official told CNN that green card holders would be allowed back in the United States if they don't have links to terrorism or an extensive criminal history.

Uncertainty for hospitals

The executive order has created uncertainty for hospitals and applicants for medical residencies.

Johns Hopkins Medicine told STAT News it had identified at least 11 patients from the seven nations affected by the order's 90-day ban who were scheduled to travel to America over the next 90 days for medical care, many of whom are very ill. Hopkins is contacting patients to see if their care can be postposed; if not it may send Hopkins staff abroad to treat them or see if a health system outside the United States could care for them.

Cleveland Clinic, for its part, told STAT News it had identified nine patients who had been set to come to the United States for treatment from the affected nations.

Meanwhile, according to the Association of American Medical Colleges (AAMC), about 260 people have applied for medical residency in the United States from the seven nations affected by the order's 90-day ban. This year, Match Day—when applicants find out whether and where they are placed in residency—falls on March 17, and some students are concerned that uncertainty surrounding the order may affect their standing, STAT News reports.

A Sudanese doctor told STAT News, "What I'm worried about is how this can affect the rank order lists, because this news, when it came, it came at a critical time for us."

AAMC EVP Atul Grover told the Daily Briefing that his organization will be working with its attorneys and the White House to try to get answers before hospitals and students must submit their final ranking lists in late February that will determine residency matches.  

Areas of uncertainty include how courts may rule on the order, whether the Trump administration might create exemptions for medical students, whether more countries might be added to the ban, whether the 90-day ban may be extended, and what will happen to individuals who must get their visas renewed.

The Los Angeles Times on Friday reported that an official at a major teaching hospital in Ohio had already ordered administrators to cancel offers of residency for medical students from particular countries in anticipation of the executive order. "We are literally going to look at 'Country of origin' and remove the applicant based on [that]," the official said.

Grover told the Daily Briefing that he would tell teaching hospitals not to take immediate action. "I would say, 'Let's see what happens,'" he said. "We've got about a month to figure this out, so that's what we're trying to do so, desperately."

According to Politico's "Pulse," the White House did not respond to a request for comment on the executive order's effects on health care workers.

Grover noted that if the 260 applicants are not allowed to come to the United States for residency, the executive order may further exacerbate a physician shortage. The average resident treats about 3,000 patients, he said, so those 260 applicants could treat up to 780,000 patients if they are allowed to matriculate.

AAMC in a statement issued Monday said, "We are deeply concerned that the ... executive order will disrupt education and research and have a damaging long-term impact on patients and health care."

Doctors, researchers stuck abroad

Meanwhile, those who have been detained—or stranded outside the United States—under the order include doctors and medical researchers.

Suha Abushamma is in the first year of an internal medicine resident program at Cleveland Clinic and holds an H-1B visa for employees in "specialty occupations." Abushamma holds a Sudanese passport and was detained in a New York airport on Saturday after arriving from a trip to Saudi Arabia.    

Abushamma said Customs and Border Protection agents gave her the option of withdrawing her visa and leaving America voluntarily or being forcibly deported, which would have barred her entry from the United States for a minimum of five years. After her requests for a delay were refused, Abushamma was put on a plane back to Saudi Arabia.

Abushamma in a statement released by the Clinic said she was safe with her family in Saudi Arabia and is "deeply committed to my medical career and to helping patients at Cleveland Clinic." The health system in a statement said, "We deeply care about all of our employees and are fully committed to the safe return of those who have been affected by this action."

100K doctors short? Report says the physician shortage may get much worse

Another doctor affected by the order is Kamal Fadlalla, a second-year internal medicine resident at Interfaith Medical Center in Brooklyn. Fadlalla, who holds an H-1B visa, was not allowed to board a flight on Saturday from his home country of Sudan back to the United States.

Fadlalla said his residency program and union are attempting to "figure out what they can do." He added, "My colleagues are going to be affected. My hospital is going to be affected. And for sure, my patients are going to be affected."

Interfaith Medical Center CEO LaRay Brown said, "Individuals like Dr. Fadlalla are not the folks that I presume the president and others are wanting to keep the United States safe from."

Medical researchers reportedly affected by the executive order include:

  • Samira Asgari, an Iranian who was set to move from Switzerland to the United States for a post-doctoral fellowship at Harvard Medical School working under a Brigham and Women's Hospital rheumatologist to research tuberculosis. Asgari, who was granted a J-1 visa and had quit her job in Switzerland, was not allowed to board her connecting flight to the United States;
  • Kaveh Daneshvar, who is completing a post-doctoral fellowship at Harvard Medical School and Massachusetts General Hospital, who had planned to speak at a molecular biology conference next month in Canada but is reconsidering those plans amid fears he would not be allowed back in the United States, Nature reports; and
  • Seyed Saravi, who was set to begin a cardiovascular pharmacology fellowship at Harvard but has now had his visa suspended, Vox reports.

Other reaction

The American College of Physicians' Bob Doherty told Politico's "Pulse" that "there is palpable alarm among our members that many more physicians and medical students will be trapped in similar circumstances if the [executive order] is not permanently rescinded, blocked by the courts, or reversed by Congress." He added, "It will also hinder the free exchange of information and travel among doctors around the world."

The Islamic Medical Association of North America (IMANA) in a statement provided to the Daily Briefing said it is "concerned about the adverse impact of President Trump's executive order on the health care profession in the United States."

Asif Malik, an anesthesiologist and IMANA's president, said, "Hospitals and residency training programs should continue to support their medical staff and physicians-in-training, increase diversity training, and offer counsel for their employees who may be affected and/or stressed because of the executive orders. The United States has a shortage of health care professionals and even a small number of attrition would directly impact patients, who deserve the highest quality of care."

(Merica, CNN, 1/29; Stack, New York Times, 1/29; Cleveland Clinic statement, 1/29; Heisig, Cleveland.com, 1/29; Ornstein, ProPublica, 1/29 [1]; Ornstein, ProPublica, 1/29 [2]; Belluz, Vox, 1/29; Yong, The Atlantic, 1/29; Morello/Reardon, Nature, 1/29; Gans, Boston Globe, 1/29; Crimaldi et al., Boston Globe, 1/28; Japsen, Forbes, 1/29; Adaeze Okwerekwu, STAT News, 1/29; Bengali et al., Los Angeles Times, 1/27; Diamond, "Pulse," Politico, 1/30; Scott/Thielking, STAT News, 11/30; AAMC statement, 1/30).

Navigating the first 100 days of the Trump administration for health policy

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On November 8, 2016, Donald Trump defeated Hillary Clinton in an unexpected upset to become the 45th president of the United States. Health care reform has since quickly risen to the top of the GOP's policy agenda—and heath care executives are grappling with a new sense of uncertainty.

While many unknowns will remain across the next few months and potentially even years, the first 100 days of the Trump administration will provide significant insight into the direction of reform efforts. Read our briefing to learn what five key issues you should watch.

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