President Trump on Monday signed a new executive order that will ban the issuance of new visas for 90 days to individuals from six countries: Iran, Libya, Somalia, Sudan, Syria, and Yemen.
Secretary of State Rex Tillerson said that Trump with the order was "exercising his rightful authority to keep our people safe." Administration officials asserted the six named countries were either essentially safe havens for terrorist groups or state sponsors of terrorism.
Several groups have said they will file court challenges against the order.
The new order is different in several respects from one issued Jan. 27 that was later put on hold by the 9th U.S. Circuit Court of Appeals. It will not apply to anyone who is already in the United States legally or who has a valid visa, and it no longer will restrict travel from Iraq specifically.
The order still will suspend refugee entry from all countries for 120 days. And it still may affect many medical residency applicants.
Possible effects on medical residency applicants, hospitals
The order's effective date, March 16, is one day before Match Day, when applicants for medical residency in the United States find out whether and where they are placed in residency—a fact with significant implications for the ability of physicians potentially affected by the order to obtain visas.
Educational Commission for Foreign Medical Graduates (ECFMG) Assistant VP Elizabeth Ingraham explains to the Daily Briefing that to apply for the J-1 or H-1B visa, the two most common visa classifications used by foreign national physicians who wish to enter U.S. residency training, a "physician must have a contract for a U.S. residency position."
Since most U.S. residency positioned are obtained through the National Resident Matching Program, Ingraham says, "most physicians who obtain a 2017 residency position and need an appropriate visa status cannot begin to apply for one" until March 17 at the earliest, at which point the new order is scheduled to block the issuance of visas to individuals from the six countries.
The deadline for applicants and medical institutions to submit their final ranking lists for "the Match" was Feb. 22. ECFMG President and CEO William Pinsky told Straus Media last week that hospitals were likely to rank applicants from the countries named in the original travel ban lower than they would have otherwise.
Ninety days from March 16 would be June 14, 2017, just weeks before new residents are scheduled to begin work. The Department of Homeland Security says petitions for H-1Bs can be expedited for "emergency situations" or "humanitarian reasons," among other considerations. According to the Chicago Tribune, "A [spokesperson] for U.S. Citizenship and Immigration Services wasn't immediately able to comment Monday on whether the exceptions might apply to doctors."
The Association of American Medical Colleges (AAMC) President and CEO Darrell Kirch in a statement called on the administration to "at a minimum .... promptly apply waiver and other discretionary authorities to all affected health professionals, including those international medical graduates matching to residency training programs on March 17 who are required to begin training and treating patients on or around July 1, 2017."
Kirch added, "AAMC stands ready to work with the administration to eliminate barriers to entry and ensure continued eligibility to practice for carefully screened physicians and scientists entering and remaining in the [United States]. Failure to further clarify this order will not only have short-term negative implications, but will have a lasting impact on our nation’s patients, particularly those in rural and urban underserved areas."
AAMC in January said that about 260 people had applied for medical residency in the United States from the seven nations affected by the original order's 90-day ban. The organization is still calculating how many doctors could be directly affected by the new order, NBC News reports.
(Thrush, New York Times, 3/6; Nakamura/Zapotosky, Washington Post, 3/6; Meckler/Kendall, Wall Street Journal, 3/6; Syed, Straus Media, 3/1; NRMP Match calendar for applicants, accessed 3/6; NRMP Match calendar for institutions and programs, accessed 3/6; AAMC statement, 3/6; Petulla, NBC News, 3/7; DHS website, accessed 3/7; Schencker, Chicago Tribune, 3/6).
Changing dynamics between you and your patients
As payment models change, hospitals must evolve from solely serving legacy payers to serving a new and growing payer: their patients. Analyses from the Centers for Medicare and Medicaid Services (CMS) show consumer payments doubling in the last few years—jumping from 13% of provider revenue in 2013 to roughly 25% to 30% in 2015.
Join us to hear how patient access can have a dramatic impact on patient satisfaction, loyalty, and propensity-to-pay. We will dissect the complex and often frustrating journey of the patient through the revenue cycle and demonstrate how improved processes, structure, and technology can drive patient loyalty and improve collections.