By Casey Ross & Max Blau
President Trump’s temporary immigration ban could quickly undermine American health care, which relies heavily on foreign-born labor — including many workers from the Middle East — to fill critical gaps in care, industry specialists say.
As many as 25 percent of physicians practicing in the US were born in another country. Rural clinics and public safety-net hospitals, in particular, rely on foreign medical school graduates to take care of isolated and vulnerable populations. They often serve as primary care doctors, filling a vital need as more American-born MDs gravitate toward high-paying specialties.
And it’s not just foreign doctors who are needed: A review of visa requests found that employers seek to bring in thousands of occupational and physical therapists, dentists, pharmacists, and other health professionals each year. In 2014, the last year for which data is available, more than 15,000 foreign health care workers, nearly half of them physicians and surgeons, received H-1B visas, which are designed to bring skilled labor into the US.
The data don’t indicate how many foreign health care professionals come from the seven predominantly Muslim nations targeted by Trump’s executive order, but health care executives say the Middle East is a crucial pipeline.
“I had trouble sleeping last night, to tell you the truth,” said J.B. Silvers, a trustee of The MetroHealth System here in Cleveland and a professor of health care finance at Case Western Reserve University.
“If you go to almost any hospital, a community hospital or a teaching hospital, you will find a very substantial number of people from the Middle East,” he said. “This is just mind-blowing.”
The travel ban is meant as a temporary measure, in place for 90 days. But Trump has pledged to institute “extreme vetting” to more tightly control immigration from those nations after the ban is lifted. He has also talked about making major changes to the H-1B visa program that lets hospitals bring in so many foreign workers.
The uncertainty is creating a sense of crisis in some hospitals — especially those that have seen some of their workers ensnared by the order, held in airports or sent back overseas when trying to return to the US from trips abroad. Hospitals are also scrambling to figure out how to help foreign patients who had been scheduled to come to the US for surgery in the coming weeks.
“Everyone is sort of in a state of paralysis,” said Dr. Alexi Nazem, an internist at NewYork-Presbyterian. “We don’t know how to interpret the order that was issued on Friday or what the long-term version of it is going to be.”
Nazem was born in the US, but some of his relatives are Iranian immigrants now working in health care in the United States. “These are hardworking doctors providing care to Americans,” he said. “They have done absolutely nothing wrong and love this country, and now they may be kicked out of it. That’s a travesty for them personally, but also for the people who depend on them.”
A Cleveland Clinic doctor was prevented from reentering the US on Saturday because she was carrying a passport from Sudan, one of the seven nations affected by Trump’s order. She was flown to Saudi Arabia, and the clinic said it is trying to secure her safe return.
Foreigners’ role in US health care has steadily grown. The foreign-born share of health care workers jumped as high as 30 percent in the 1990s, up from 5 percent in the 1960s, according to a 2014 study from Georgetown University’s Center on Education and the Workforce.
Health care now has the largest percentage of foreign-born and foreign-trained workers of any industry in the country, the study found.
The visa applications underscore that reality: The Cleveland Clinic last year certified applications to bring in just under 200 foreign workers, mostly doctors and clinical associates. Other major employers seeking to bring in health care workers include Emory University, the Mayo Clinic, and William Beaumont Hospital in Michigan.
Federal legislation has encouraged the trend. For example, the Nursing Relief for Disadvantaged Areas Act of 1999 created a special visa classification to encourage more foreign-born nurses to come to the US to deliver care in rural communities.
Trump’s order also stands to undermine hospital IT staffs that rely heavily on foreign talent to develop software and digital health products and to manage reams of sensitive internal data. Many leaders in the health IT field criticized Trump’s order, including athenahealth chief executive Jonathan Bush, who posted several scathing tweets.
The travel ban could also disrupt training programs at hospitals and medical schools and undermine patient care.
“We have huge concerns about this,” said Dr. Bruce Siegel, chief executive of America’s Essential Hospitals, which represents safety-net providers across the US. “In many of our underserved communities, people from overseas are the backbone of the health care workforce.”
Siegel said the percentage of foreign-trained doctors tops 25 percent in states such as New York and New Jersey.
“It’s early to tell, but this could have implications for decades to come,” Siegel said. “We could be shutting down a big part of the physician pipeline. … We’re going to lose people in areas we need the most. Often, the American grads get into specialty residencies, while international residents meet the needs of primary care.”
Even with the supply of foreign-born workers, providers are stretched thin by the demands of an aging population and the high percentage of Americans struggling with chronic diseases. Before Trump’s order, many industry leaders had been pushing to bring in more workers, arguing for the elimination of barriers such as complex accreditation requirements.
Beyond the impact on hospitals, Nazem said the executive order stands to undercut the broader principle that America is a melting pot whose success is built on its willingness to welcome talented workers, regardless of their backgrounds.
“I would hate to see us lose our position as a leader in the world of science and medicine because we are unwilling to accept the best and brightest due to an irrational fear,” he said. “I know a lot of the people affected by this ban, and I can tell you with absolute certainty that they are decent people who America would be proud to have.”