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Physicians worry Trump’s immigration policies could worsen doctor shortages

Dr. Bahar Bastani poses for a portrait at Saint Louis University Hospital on March 2, 2017.
Carolina Hidalgo | St. Louis Public Radio
Dr. Bahar Bastani stands on the floor of a dialysis unit at Saint Louis University Hospital. Bastani, a kidney specialist, moved to the United States from Iran in 1984.

In 1984, Dr. Bahar Bastani knew he had to leave Iran.

During Iran's cultural revolution, religious leaders closed universities and threatened academics. Bastani, then a professor of medicine in Tehran, realized he had become “unhireable” in that political climate.

“I was religious, I was doing prayers, but I could not tolerate the hardship the government was putting on people,” said Bastani, now a kidney specialist who works at Saint Louis University Hospital.

But Bastani had a friend — a professor at the University of Pennsylvania who had visited Iran and was impressed with him as a young medical student. With his help, Bastani obtained a J-1 visa to come to the United States, secured a residency and repeated his medical training. Today, Bastani and other doctors worry that people in similar circumstances may not be allowed in the country, due to President Donald Trump's moves to restrict immigration.

More than 100 doctors in the St. Louis region are from the countries included in the president’s latest executive order, which temporarily suspends visas from being issued to citizens of Iran, Somalia, Sudan, Yemen, Libya and Syria, according to data compiled by the Immigrant Doctors Project.

While it scales back an earlier attempt that was blocked in court, and removes Iraq from the list of affected countries, the president’s actions are causing deep concern in the health care field, where one in four physicians was born abroad. Another measure suspends expedited processing of H1-B visas for high-skilled workers for six months.

From NPR: Trump's New Executive Order On Travel, Annotated

After federal courts blocked the president's initial order, which barred travelers and refugees from seven Muslim-majority countries for 90 days, Trump promised changes to the nation’s immigration policies.

“The current outdated system depresses wages for our poorest workers and puts great pressure on taxpayers," Trump said late last month to a joint session of Congress. "Nations around the world, like Canada, Australia and many others, have a merit-based immigration system.”

The line may suggest Trump would favor immigrant doctors. Though the new order provides for exceptions, it says that federal immigration authorities will not issue the visas that doctors from the six countries rely on to work or study in the United States, for 90 days beginning March 16.  Though current visa holders aren’t affected, hospital leaders worry that the new administration’s policies will worsen an existing doctor shortage, particularly in rural areas. 

“It appears that only the State Department can provide clarity on how future visa requests will be affected by the new order,” said Robert Mills, a spokesperson for the American Medical Association. 

The AMA released a statement Tuesday criticizing the new order, and highlighted concerns for visas used by patients seeking medical care in the states.  

"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," wrote AMA president, Dr. Andrew Gurman. "The new executive order leaves them in limbo and without an explicit waiver, those foreign physicians will be unable to provide care in the U.S. when training programs begin on July 1." 

Dr. Jerry Kruse, dean of the Southern Illinois University School of Medicine, said the Trump administration’s Friday announcement that it would suspend fast-track processing for H-1 B visas is his most immediate concern. The documents are held by 28 of the school's faculty physicians, and about 75 residents.

Dr. Jerry Kruse, Dean and Provost of the SIU School of Medicine.

Dr. Jerry Kruse, dean and provost of the SIU School of Medicine.
Credit provided by SIU School of Medicine
Dr. Jerry Kruse, dean and provost of the SIU School of Medicine.

H1-B visas cover people with “specialty occupations,” which include medical professionals. Kruse estimated that new hires at SIU will have to wait up to eight months to be cleared, instead of two weeks under the current processing times. They must renew the visas after three years.  

“This whole process has been pretty erratic and impulsive, and doesn’t breed the confidence that we need to move forward,” Kruse said.

Despite the narrowed scope of the new order, the swiftness and breadth of that initial ban — and Trump’s overall stance on immigration — has stoked fears that it will be more difficult to recruit foreign-born doctors.

The country already is facing a shortage of physicians, particularly in rural areas.

“There are 28,000 residency positions available per year, and we have 18,000 graduates of U.S. medical schools, so that’s a pretty good gap,” Kruse said.

The “gap” is filledin part by graduates foreign medical schools. Many are U.S. citizens who studied abroad, but others are citizens of other countries who come to the U.S. to complete their training.

Such students generally use a J-1 visa, which appears to be included in Trump’s latest executive order. Newly minted doctors in the country on the visas must leave the country for a couple years afterwards, unless they work in an underserved community. That could be an urban center, a veteran’s hospital or a rural area — all of which have historically struggled to attract U.S.-born applicants. 

Dr. Bahar Bastani, a nephrologist, speaks to his team at Saint Louis University Hospital on March 2, 2017.
Credit Carolina Hidalgo | St. Louis Public Radio
Bastani meets with his team at Saint Louis University Hospital. Several of his colleagues have used visas that are affected by the order. Dr. Nadeem Najam, second from left, worked as an internist in an underserved part of Milwaukee to meet requirements for a sponsored J-1 visa.

“These are the cream of the crop,” Bastani said. “They provide in the very city small cities … they go there to five years and some of them stay there, some of them come back to bigger city to complete their training.”

Today, Bastani helps prepare patients for kidney and pancreas transplants, and takes care of them afterwards. His wife, Dr. Farrokh Dehdashti, whom he met in medical school, followed him to the United States under a J-2 visa. She now works as a radiologist in the nuclear medicine division of Washington University.
On March 17, medical students will find out where they’ve been accepted for a residency to complete their training. Graduates who aren’t U.S. citizens will have to get a visa before they start working. In the current political climate, that may become more difficult.

On a personal level, Bastani said the confusion of the past months has kept some of the doctors he knows from traveling abroad to visit family members. Medical residents looking for jobs after their training are worried that hiring committees won’t take a chance on someone from one of the countries included in the order. 
“People with green cards, they’re afraid to move,” Bastani said. “And those with a visa, they should not leave the country.”

Follow Durrie on Twitter: @durrieB