ACP, AMA: Trump’s revised executive order on immigration still poses threats to health care

President Donald J. Trump’s revised executive order on immigration will allow existing visa holders from six designated, majority-Muslim countries to enter and reenter the United States; however, the new order still encourages discrimination against Muslims, hinders travel by physicians and others and exacerbates a public health crisis for refugees, according to a press release by the ACP.

In the revised order, Iraq was removed from the ban, as was the indefinite ban of Syrian refugees. Residents of Iran, Somalia, Sudan, Libya, Syria and Yemen will still not be able to secure visas for travel to the United States for a period of 90 days starting March 16 under the travel ban. In addition, the new order offers travel allowances to legal, permanent residents of the United States, those with existing visas or those who have previously been granted asylum or refugee status. The order is intended to address concerns with an executive order issued Jan. 27 that was met with widespread protests and was suspended in federal court.

“ACP acknowledges the changes to the executive order but we feel overall it is still harmful to the practice of medicine and medical education in our country,” Nitin S. Damle, MD, MS, MACP, president of ACP, said in the release. “ACP has grave concerns about the implications of the executive order on medical education, access to health care services, public health and families.”

The ACP emphasized that even though the revised order will benefit some travelers, some of the most vulnerable are still at “an unacceptably increased health risk.”

The executive order suspends the U.S. refugee program from all nations for 120 days and lowers the cap on refugees admitted into the United States to 50,000 for the next fiscal year, down from the cap at 110,000 allowed by the Obama administration. Both of these actions put those who are denied at a substantial risk for injury, death, persecution and deprivation, according to the ACP.

The organization expressed concern that the order will disrupt the flow of medical education by restricting entry of physicians and medical students from the affected countries and therefore, cause patients to lose access to their doctors.

“We are extremely concerned that the 90-day ban on travelers from the six designated countries will not allow time for medical residents from those countries to obtain a visa in time for their start date,” Damle said. “Each medical resident treats thousands of patients over the course of a year. It is critical that the administration acknowledge the negative impact that this ban will have on medical education and allow an exception for these medical residents.”

The ACP previously expressed concerns on Trump’s executive order on immigration and offered recommendations to ease impact of Trump’s travel ban.

The AMA also voiced apprehension about the revised version of the executive order; specifically, the components that would apply to the physician training program and the expertise that the United States shares with the countries affected by the travel ban. 

“Hundreds of physicians from six countries are subject to the revised executive order and have applied to U.S. training programs and requested visa sponsorship. The new executive order leaves them in limbo and without an explicit waiver, these foreign physicians will be unable to provide care in the U.S. when training programs begin on July 1." Andrew W. Gurman, MD, president of AMA, said in a statement.

“The AMA is also concerned that the revised executive order will continue to affect the exchange of medical knowledge between the U.S. and the six impacted countries by barring foreign experts from traveling to medical and scientific conferences in the U.S.,” Gurman said.

Prior to the release of Trump’s revised executive order, William W. Pinsky, MD, of the Educational Commission for Foreign Medical Graduates in Philadelphia, wrote a commentary published in Annals of Internal Medicine outlining how international medical graduates are essential to the quality of health care delivery in the United States.

“The future supply of physicians in the United States will not be adequate to meet the country's health care needs,” he wrote. “Internationally educated physicians currently account for approximately one fourth of the practicing physician workforce and will continue to play a critical role in the delivery of health care services.”

“Any disruption to this flow of international medical graduates will have a negative effect on patient care,” he added.

Pinsky noted that while there have been calls for the United States to cease depending on economically underdeveloped countries to enhance its medical workforce and to train its own physicians, the path to self-sufficiency is unclear and therefore, international medical graduates are required to fill the practice gaps left in underserved areas and in certain specialties that are not filled by graduates from the United States.

“The future composition of the U.S. physician workforce clearly will depend on [international medical graduates],” he concluded. “Because access to health care depends on an adequate supply of high-quality practitioners, preserving the ability of [international medical graduates] to compete for training positions in the United States is extremely important.” – by Alaina Tedesco

References:

Pinsky WW. Ann Intern Med. 2017;doi:10.7326/M17-0505.

https://www.acponline.org/acp-newsroom/revised-immigration-executive-order

https://www.ama-assn.org/new-immigration-travel-order-leaves-hundreds-physicians-limbo

Disclosure: Pinsky reports no relevant financial disclosures.