hospitals, Resident candidates contend with immigration uncertainty

By Razi Syed

As program directors at New York City hospitals narrowed their list of candidates for each residency program or fellowship, they had an additional factor to consider for 2017: will certain foreign applicants be able to enter the country this summer to start their training?

President Donald Trump’s January executive order temporarily banning foreign nationals from seven Muslim-majority countries has complicated residency matches for international medical students and U.S. hospitals. While it was stayed in early February by a federal judge, the administration has suggested they hope to rewrite another executive order with the same end results as the initial order.

The countries included in the executive order are Iraq, Syria, Iran, Sudan, Libya, Somalia and Yemen.

There are 1,049 applicants from the affected countries for this year, said Dr. William Pinsky, president and CEO of the Educational Commission for Foreign Medical Graduates. The ECFMG vets foreign medical graduates before they can apply for residency in the United States and ensures they possess degrees from accredited institutions.

Since many residency spots, especially for primary care, are unfilled by U.S. medical graduates, foreign students often take up the slack and in many cases go on to be physicians in underserved areas, Pinsky said. Nationally, around 25 percent of all physicians are foreign medical graduates.

As the Feb. 22 deadline for ranking applicants occurred at a time while the immigration situation was still in flux, Pinsky expects applicants from the seven affected countries will probably be ranked lower than they might otherwise have been.

“I think in one way or another it will affect the match — undoubtedly, it will,” Pinsky said. “The concern among the program directors is if the there’s a risk that they won’t be able to come into the country to fulfill their obligation.”

Most residency programs and fellowships start on July 1.

Residency programs are scheduled very tightly with little flexibility to reschedule residents in the event that a candidate is unable to join with the crop of residents, said Dr. Ethan Fried, internal medicine program director at Lenox Hill Hospital on the Upper East Side.

“Every position needs to be filled,” Fried said. “When one person is missing, that puts a tremendous burden on the program. If a program matches someone and if that person can’t show up, that program will go thought a lot of stress. And that devalue the training for everyone else.”

Fried said he believes the applicant rankings were likely affected by the order.

“I am quite sure that programs have taken the travel ban into account since they know they need to have a full complement,” he said.

Fried pointed out that because of the strict regulations in place for medical residencies and fellowships, programs often have their hands tied in the event that a resident is unable to join on time.

“When a resident signs with with a program, that is considered a contract,” Fried said. “If a program does not receive its complement of residents, we cannot simply hire someone else. We have to go back to the [National Resident Matching Program] and seek a waiver of that contract.”

“The acquisition of these jobs is very tightly controlled and we don’t have the flexibility to just hire someone else, and nor should we, frankly, because we want the system to have some integrity,” he added. “We want a match that can’t be overturned on a whim.”

Foreign graduates generally arrive on J-1 visas, which require the visa holder to return home after their residency. However, the Conrad 30 program allows each state to sponsor up to 30 international graduates annually for a waiver if they can secure a position at a facility in an underserved rural or urban area.

“The United states is a net importer of physicians,” Pinsky said. “We rely on international physicians to meet our medical access.”

In addition to this year’s applicants, the 318 current residents from the seven countries on J-1 visas are also affected as they may not be able to visit family back home for fear of not being allowed back in the country upon their return, Pinsky said.

“There’s no indication of whether these visas will be revoked,” he said. “They could have families, spouses, in other countries — many families have been disrupted because of this.”

Susan Grossman, an internal medicine program director with NYC Health + Hospitals, said, “It’s obvious that we should make our decision based on who is the best candidate, not what country is the person coming from. I ranked my candidates solely based on who would make the best resident, which included several from the seven countries.”

Grossman said she acknowledged the uncertainty but was optimistic that residents would be able to start on July 1.

Pinsky said the blanket immigration ban in the executive order is misguided.

“We clearly understand the need for security in the country,” he said. “But we believe the screening and vetting we do does keep the country safe and adds to the security of the country by contributing to a strong health care workforce.”