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Travel Ban Could Further Harm Underserved Patient Populations

Analysis  |  By John Commins  
   February 08, 2017

More than one-in-five healthcare professionals in the United States is foreign-born. The trickle-down effect of a federal travel ban may discourage some providers from practicing their badly needed skills here.

In the 1930s, sociologist Robert K. Merton popularized an idea that's become known as the Law of Unintended Consequences, which has come to mean outcomes that are not intended or foreseen by a purposeful action.

A recent example of the law is the 90-day travel ban imposed on Jan. 27 by President Donald Trump. The ban extends to people in seven majority-Muslim countries: Iran, Iraq, Libya, Somalia, Sudan, Syria and Yemen.

The controversial order has been blocked by a federal judge in Seattle, but the Trump administration is appealing that ruling and requesting an expedited hearing before the U.S. 9th Circuit Court of Appeals.

President Trump has said the temporary ban is needed to ensure that vetting processes for people from those countries are adequate before visa are issued for entry into the United States. Critics say that adequate vetting is already in place and that the ban specifically discriminates against Muslims.

Observers in the healthcare sector fear that one unintended consequences of this ban will harm healthcare delivery in the United States, particularly in underserved areas, both rural and urban.

"More than 22% of all healthcare workers are immigrants, and 28% of those workers are physicians and surgeons," says Jeanne Batalova, senior analyst at the Washington, DC-based Migration Policy Institute.

Batalova says that doctors from the seven countries under the travel ban account for 7% of all immigrant doctors in the United States. "That is a substantial number," she says. "There is a significant over-representation of doctors from these seven countries among immigrant doctors and surgeons."

Batalova says the ripple effects could extend further than the seven countries specified in the ban.

"A lot of groups understood this ban as anti-immigrant more broadly and definitely an anti-Muslim ban," she says.

"The interpretation of what the ban means and how it is going to be implemented will vary a lot, and it will vary over time, because when the ban was initially announced a much broader group was included, including legal permanent residents who were denied access to get on the plane. People who are currently in the pipeline to obtain a green card, they are banned from the admissions."

'Some May Choose Not to Come Here'
"Also, we've seen from some reports that the customs and border patrol officers in different areas interpreted the executive orders somewhat differently," Batalova says.

"In some airports they were saying this group is not affected, but in another airport the same group could be denied access. At the moment it is too early to tell because the executive order did not have very detailed rules that would serve as guidance for consistent policy and application."

Rasheed Ahmed, executive director of the Islamic Medical Association of North America says the travel ban has created uncertainty and angst and sends a message that is less than welcoming.

"Given this situation, some might not be allowed in, and some may choose not to come here. They don't want to have this uncertainty for themselves or their families," Ahmed says. "They may choose to go to some other countries in the Middle East or Europe. They may say this is not worth it."

"Those who are in the United States may worry about leaving," he says. "Those who are outside the United States for some reason may not be able to come in, and the potential healthcare experts we need in this country may have second thoughts about their future in the United States."

Physician Shortage Persists
That fear was shared by Association of American Medical Colleges President and CEO Darrell G. Kirch, MD, who said his member schools are "deeply concerned that the Jan. 27 executive order will disrupt education and research and have a damaging long-term impact on patients and healthcare."

"The United States is facing a serious shortage of physicians. International graduates play an important role in U.S. healthcare, representing roughly 25% of the workforce," he says, adding that existing "pathways that include student, exchange-visitor, and employment visas provide a balanced solution that improves healthcare access across the country through programs like the National Interest Waiver and the Conrad 30 J-1 Visa Waiver."

In the last 10 years the Conrad 30 J-1 Visa Waiver by itself has brought nearly 10,000 physicians into rural and urban underserved communities.

"Impeding these U.S. immigration pathways jeopardizes critical access to high-quality physician care for our nation's most vulnerable populations," Kirch says.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


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