By Robert McLean, MD, MACP
President, American College of Physicians
The American College of Physicians (ACP) is extremely concerned about the potential health impact of President Trump’s announcement that he intends to issue an Executive Order to suspend all immigration to the U.S. Such a broad-brush approach, especially if it limits the ability of physicians and other scientists to enter the U.S., could have significant negative consequences on public health and the mitigation and treatment of COVID-19 in the U.S.
It is not yet clear whether international medical graduates (IMGs) and other foreign born physicians would be included in such a ban. Should they be included, the new class of medical residents from other countries, scheduled to start their assignments at hospitals across the U.S. on July 1, would not be able to enter the U.S in time to start their residency assignments. These physicians, at the beginning of their careers, play a vital part of providing care in our health care system, and are especially needed now to treat thousands of patients battling COVID-19. In 2019, more than 4,200 non-U.S. citizen IMGs matched in U.S. residency programs. The reduced capacity in teaching hospitals that are unable to fill their residency positions with IMGs would have an effect well beyond the hospitals themselves, putting more demand on other community physicians and hospitals that are already at or beyond capacity. It would also severely disrupt medical education.
It is also unclear whether the Executive Order would prevent IMGs already in the U.S. from renewing their visas or being processed for permanent residency status. A large number of IMGs currently are serving on the frontlines of U.S. healthcare, both under J-1 and H1B training visas and in other forms. IMGs provide health care for underserved populations in the U.S. and are often more willing than their U.S. medical graduate counterparts to practice in remote, rural areas. Nearly 40 percent of internal medicine physicians in the U.S. are IMGs. Internal medicine physicians, including those who are IMGs, provide care to millions of patients with underlying chronic illnesses such as diabetes and heart disease, conditions that if not managed effectively by internists, could put patients at higher risk of death from COVID-19. Many are also on the frontlines of treating COVID-19 patients.
ACP has already urged the administration to expedite entrance of IMGs into the country and ensure that lawfully present IMGs are not negatively impacted by the COVID-19 pandemic.
In addition to physicians, there are other science and public health disciplines that are critical to addressing the COVID-19 epidemic and may have appropriate reasons to enter or remain in the U.S. to assist with essential public health activities including research and mitigation.
We urge the administration, at minimum, to ensure that physicians and others who are critical to the health and safety of our country are not included in a ban. We need to make sure that physicians and other health care professionals are able to come to the U.S; are able to stay if they are already here; and are able to renew their visas when necessary.
The virus is already in our country. Any measures being considered to help mitigate the impact of COVID-19, including immigration policy, need to be based on the best-available evidence about what would be an effective tool in slowing its spread and increasing health system capacity.
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide.