Trump’s Ban Heightens Anxiety

The spring season brings excitement, decisions, and stress for senior medical students in the form of the Match, the nationwide system that matches newly-minted doctors with residency programs. Those applying to U.S. programs from medical schools outside the country must also contend with an even more byzantine process: the American immigration system.

“It was a very convoluted and cumbersome process for me; even at that time [in the 1990s] it was extremely difficult,” said Dr. Lavjay Butani,the Section Chief for Pediatric Nephrology and Professor of Medicine at UC Davis.

Butani, who emigrated from India to the US for residency in 1992,described his immigration process as nearly as stressful as his demanding residency work at the Mayo Clinic.

“It was year-to-year in knowing if [my visa] was going to be renewed, and if not, you know, you have a house and family, and you’d have to give that up. Basically uproot yourself,”Butani explained.

The Trump Administration’s aggressive stance against immigration has only heightened this anxiety.

Although there is currently a court-ordered stay on the Administration’s week-one order banning immigration from seven majority-Muslim countries, international medical students studying at U.S. institutions and eager to match to U.S. residencies are still worried.

They’re not the only ones. International medical graduates, or IMG’s, currently comprise over one quarter of the American physician workforce and more than a third of primary care roles, often in underserved areas with little heath care access. Strict immigration laws could mean that community hospitals and clinics, already straining to find physicians, may experience serious staffing problems in the future.

Additionally, residency programs have spoken out on the value they see in recruiting IMG’s. An article in the New England Journal of Medicine authored by seven chairs of academic medical programs, including UCSF, Harvard and the University of Michigan stated that “…international medical graduates fill access gaps in underserved communities, including rural and Native American communities, as well as caring for American veterans in the Veterans Health Administration system.”

The article also describes the high quality of care provided by IMGs who, due to the competitiveness of US residencies, are often at the top of their medical school class.

A recent observational study in the BMJ (formerly the British Medical Journal) further supports the positive contribution of IMGs. Using Medicare data, the study found a statistically significant decrease in mortality for patients treated by IMGs.

Despite the important role highly trained foreign graduates play buttressing the healthcare system, U.S. immigration policies concerning these individuals are complicated.

Most IMGs come to the United States on a visa known as a J1 to complete residency. In order to stay in the country after the J1 timespan is up, they must apply for a waiver through a specific track. One of the most popular of these tracks is working in a Federally Qualified Health Center (FQHC) in an underserved area.

In Dr. Butani’s experience, these were difficult positions to get.

“These [FQHC] placements are hard to find, and I think that when I was looking, they were increasing the term from 2 to 3 years, and you’d have to work for 4 years in some places” explained Butani. “I certainly tried that, and I could not get a position, and it was very hard.”

Butani opted for an alternative track, the research route, and obtained his J1 waiver through demonstrating exceptional scientific skill.

He then applied for a variety of visas over a 25-year period, including an O visa (“Alien of Extraordinary Ability”), an H1b (for foreign workers in “specialty occupations”), and a Legal Permanent Resident card (green card). Most of these visas involved a yearly re-application process with stringent paperwork deadlines, expensive fees, and no guarantee of success. Butani learned to live with uncertainty.

Asked about how he and other IMG’s feel about the new administration’s attempted ban, Butani said that he’d seen no evidence to support the order.

“Most of us think that it’s very political, not based on fact, and ridiculous, and I share that view,” Butani said.

Dr. Lavjay Butani became a citizen of the United States in 2016, 24 years after starting his residency.