Hospitals feel pressure to reject students over Trump policy
Hospitals are under intense pressure to reject qualified international medical students applying for residencies in the United States because of fears that President Trump’s immigration policies may bar the students from entering the country, educators and hospital administrators say.
As many as 1,000 medical school graduates may be unfairly penalized because of their country of origin, medical school officials say. Massachusetts could be hit particularly hard because the state is home to some of the world’s leading teaching hospitals as well as smaller community hospitals that typically depend on a large pool of foreign medical talent.
The concern over Trump’s policies — particularly his restriction on travel from seven majority Muslim countries — has added an unusual amount of anxiety to the upcoming “Match Day,’’ when medical students learn which hospital has accepted them to a residency program.
“We don’t know how programs are going to react, and it’s part of why everybody is very stressed and very on edge right now,” said Kelly Thibert, president of the American Medical Student Association.
Many doctors vehemently oppose the executive order but say that, as a matter of practicality, they need to ensure that anyone they hire as a medical resident is ready to work on July 1, to provide crucial patient care.
As a result, hospital administrators, who on Wednesday must submit lists of the medical students they would most like to hire, have been tempted to rank students from those seven countries lower than their credentials would merit.
“Based on one’s interpretation of American values and ideals, it’s a discriminatory practice,” said Dr. William W. Pinsky, chief executive of the Educational Commission for Foreign Medical Graduates, a nonprofit responsible for vetting international medical students. “But, frankly, it’s very pragmatic from a program director’s perspective and their concern about patient care.”
Dr. Darrell G. Kirch, chief executive of the Association of American Medical Colleges, said “hospitals are being given an impossible choice” between hiring the best candidates, regardless of nationality, and ensuring they have residents ready to care for patients in July.
“This has served our country so well,” he said of the system used to funnel foreign medical graduates into the United States, “and it’s a tragedy that it’s being disrupted by uncertainty.”
“I know national security is a priority, but I think health security — having the best physicians possible — is also part of our security as a nation,” Kirch said.
There are more than 10,000 licensed physicians in the United States who graduated from medical schools in the seven countries listed in Trump’s executive order, according to the Accreditation Council for Graduate Medical Education. Many work in poor rural and urban areas, under a federal program that lets foreign doctors remain in the country if they provide care in underserved communities.
Overall, nearly 1 in 5 physicians in the United States is foreign born, an influx that has helped the nation cope with a doctor shortage, according to the Association of American Medical Colleges.
Trump’s immigration order was suspended by a federal court, and he has said he will propose a new policy this week. His administration has not given any indication that it intends to carve out a waiver for medical students as part of the new policy.
Doctors said Trump’s initial order, issued Jan. 27, has already cast a shadow over the highly competitive system used to vet 20,000 foreign medical students based on test scores, interviews, and recommendation letters.
Under the system, hospitals submit lists of their preferred candidates, and medical students submit lists of the hospitals where they want to work. Both have until Wednesday to finalize their preferences.
Then a nonprofit group, The National Resident Matching Program, uses an algorithm to pair the two groups, and announces the results on “Match Day,” March 17. Residents typically work for thee years in a hospital, logging 75 to 80 hours a week, often on the overnight shift.
Medical residents from abroad will need to quickly obtain visas to enter the country, adding to the pressure on hospitals to discount them during the application process.
Dr. Jatin M. Vyas, who directs the internal medicine residency program at Massachusetts General Hospital, said he received 3,700 applications for 45 residency positions this year. About 250 medical graduates were interviewed, and his final list of candidates, he said, includes one doctor from Iran and one from Iraq — two countries named in Trump’s executive order.
“We are in a position where we’re willing to take the risk right now,” he said. “We are simply looking for the best talent.”
But the order is not only affecting students from the seven countries, Vyas said.
Medical school students from India, Pakistan, and Canada have been e-mailing him, he said, to urge him not to rank them lower because they are not coming from Trump’s list of targeted countries.
“What that has told me is there a lot of students who are very worried that they may not be able to train” in the United States, Vyas said.
Dr. Michael F. Collins, chancellor of the University of Massachusetts Medical School, said he is hoping that hospitals do not penalize qualified foreign medical graduates, given how much they contribute to the country.
“It seems a shame to me that students who have completed their studies and done their work and are attractive applicants would not be listed because of an uncertainty cast by the executive order,” he said. “And it would seem a shame to me that the next Nobel Prize winner wouldn’t be offered a spot because of this order.”