February 7, 2017
The Honorable John F. Kelly
U.S. Department of Homeland Security
Washington, DC 20528
Dear Secretary Kelly:
The undersigned organizations are greatly concerned that the executive order signed by President Trump on January 27, 2017 will result in discrimination against foreign-born persons from certain predominantly Muslim countries. We are particularly concerned that by restricting entry of physicians and medical students from seven designated Muslim majority countries, the order will undermine medical education and result in patients losing access to their doctors. We are also greatly concerned that the 120 day ban on accepting refugees, and the indefinite ban on Syrian refugees, will contribute to an ongoing public health crisis for those affected, needlessly subjecting them to violence, injury, illness, deprivation and even death. While we are pleased that the courts have temporarily halted implementation of the executive order, the underlying issues of concern about the harm caused by the executive order remain.
The restrictions in the executive order will hinder the free exchange of information and travel among medical students, residents and physicians around the world and result in Americans having poorer access to care. In 2016, 3,769 non-U.S. citizen international medical graduates (IMGs) obtained first-year residency positions. More than half of internal medicine residency positions were filled by IMGs. Approximately 25% of the nation’s physicians are IMGs and provide a disproportionate share of the care to Americans in underserved communities that have a shortage of U.S. born and trained physicians. They also add necessary diversity and cultural competency to our healthcare workforce. If the executive order prevents IMGs from being able to come to the U.S. this could potentially affect the care for thousands of patients.
Our organizations are also especially concerned about refugees with dire medical conditions who had been approved for visas to enter the U.S. but since the executive order, have been unable to enter the country to receive much needed medical care.
While we urge that the executive order be rescinded and replaced with non-discriminatory policies that support families, public health, and medical education, and are pleased that the courts have temporarily halted implementation, there are steps that DHS can take immediately to selectively ease travel restrictions that impact medical education, access to health care services, and public health for individuals who otherwise meet the criteria for immigration, including those from the seven countries identified in the executive order. Specifically, we urge the Department of Homeland Security to:
1. Reinstate the Visa Interview Waiver Program. Suspension of the program “risks creating substantial backlogs in the processing of new and renewal visas for trainees from any foreign country — delays that create substantial problems for residency programs with trainees on visas and that could interfere with the residency match process this year.” [http://www.nejm.org/doi/full/10.1056/nejmp1701339]
2. Remove restrictions on entering the U.S. for physicians from the seven designated countries who have been approved for J-1 or H-1B visas and students from those countries with F-1 visas who have been accepted to U.S. medical schools.
3. Develop and implement a plan to allow physicians from the seven designated countries to obtain travel visas to travel to the U.S. for medical conferences and other medical and research-related engagements.
4. Make it a priority to implement a process to admit refugees, without further delay, who had already been vetted and approved for entry prior to the executive order and who are in need of urgent medical care. We note that even with such revisions, the executive order will still inappropriately bar immigrants and refugees based on discriminatory criteria (religion and country of origin) including family members of physicians and medical students in the U.S.
Our organizations are committed to non-discrimination against physicians, medical students and others in immigration policies and offer our assistance in developing policies that support access to health care services, public health, and medical education while balancing the nation’s security needs. Until or unless the executive order is completely rescinded or permanently blocked, it is essential that DHS move forward to ensure that restrictions on physicians and medical students are not reimposed, and that priority is given to refugees with medical conditions needing treatment.
Alliance for Academic Internal Medicine
American College of Chest Physicians
American College of Physicians
American Society for Gastrointestinal Endoscopy
American Society of Hematology
American Society of Nephrology
American Thoracic Society
Infectious Diseases Society of America
Renal Physicians Association
Society for Adolescent Health and Medicine
Society of Critical Care Medicine
Society of General Internal Medicine