Travel Ban Is Revealing—but Does Not Threaten American Medicine

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By Jane Orient, MD

A 90-day ban on travel from seven countries has sparked tremendous outpourings of “worry” or outright opposition by some 33 medical organizations.

“The community is reeling over the order, fearing that it will have devastating repercussions for research and advances in science and medicine,” states an article in Modern Healthcare.

Certainly the order is disrupting the lives of individual physicians who have won coveted positions in American medical institutions and were not already in the U.S. when the order was issued. Also their employers have a gap in the work schedule to fill. War tears people’s lives apart, however innocent they may be. And countries that sponsor terrorism have effectively declared war on the U.S.

But is American medicine so fragile that it can’t survive a 90-day delay in the arrival of physicians, most of them trainees, from Iran, Iraq, Libya, Syria, Yemen, Somalia, and Sudan? After all, every year more than a thousand seniors in U.S. medical schools do not land a position in a post-graduate training program through the annual computerized “Match” of graduates with internships. After another chance through the Supplemental Offer and Acceptance Program, or SOAP, hundreds of seniors are still without a job. This means that they cannot get a license to practice in the U.S., however desperate rural communities or inner-city hospitals are to find a physician, and their four years of rigorous, costly post-college education are wasted. Yet James Madara, CEO of the American Medical Association (AMA), is worried about vacant residency slots, according to a Feb 3 article in MedScape by Robert Lowes.

Entry to medical school is highly competitive, so presumably all the students are well-qualified. Can it be that graduates from Sudan are better trained? Does the U.S. have so few young people capable of and interested in a medical career that we have to depend on a brain drain from countries that are themselves desperately short of physicians?

For all the emphasis on “cultural competence” in American medical schools, and onerous regulations regarding interpreters for non-English speakers, what about familiarity with American culture and ability to communicate effectively with American English speakers? Some foreign-born graduates are doubtless excellent, but many American patients do complain about a communication gap. So why do some big institutions seem to prefer foreigners? Could it be that they want cheap, and above all compliant labor? Physicians here on an employment-related visa dare not object to hospital policy.

Whatever the reasons for them, here are some facts about the American medical work force:

  • One-fourth of practicing physicians in this country are international medical graduates (IMGs), who are more likely to work in underserved areas, especially in primary care, according to Madara.
  • According to the Accreditation Council for Graduate Medical Education (ACGME), 10,000 IMGs licensed in the United States graduated from medical schools in the seven countries affected by the ban.
  • Immigrants account for 28% of U.S. physicians and surgeons, 40% of medical scientists in manufacturing research and development, and 15% of registered nurses, according to the Institute for Immigration Research at George Mason University. More than 60,000 of the 14 million workers in health-related fields were from the seven countries affected by the ban.

Is medicine, like agriculture, now filled with “jobs that Americans won’t do”? Actually, we have more than enough Americans who love medical work. But some of best doctors are being driven out by endless bureaucratic requirements, including costly “Maintenance of Certification™” programs that line the pockets of self-accredited “experts” but contribute nothing to patient care. They are being replaced (substituted for) by “mid-levels” with far less training. Then there are thousands of independent physicians having to retire or become employees because they can’t afford the regulatory requirements—soon to be greatly worsened by MACRA, the new Medicare payment system. Physician “burnout” is becoming so bad that we lose up to 400 physicians—the equivalent of a large medical school class—to suicide every year.

The U.S. should be a beacon to attract the best and brightest, and it should welcome those who want to become Americans. Unfortunately, the lives of Americans, as well as the opportunities of aspiring foreign-born doctors, are threatened by those who desire to kill Americans and destroy our culture. These must be screened out.

Meanwhile, the reaction of organized medical groups to the travel ban is spotlighting serious problems in American medicine.

 


 

Jane M. Orient, M.D.obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. She completed an internal medicine residency at Parkland Memorial Hospital and University of Arizona Affiliated Hospitals and then became an Instructor at the University of Arizona College of Medicine and a staff physician at the Tucson Veterans Administration Hospital. She has been in solo private practice since 1981 and has served as Executive Director of the Association of American Physicians and Surgeons (AAPS) since 1989.  Dr. Orient is the 2017 recipient of The Edward Annis award for medical leadership.

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  • Kore Zet

    Brava, Dr. Jane Orient hits every nail squarely in her article, above. I would add only this: the travel ban was always meant to be temporary, not permanent, as a way for the U.S. Government to adopt policies and procedures that would prove successful at identifying persons at high risk of committing terrorist acts in the USA. Prior to Obama, potential terrorists were identified using metrics similar to those used by Israeli airport screening personnel, who have had to defend against a more concentrated terrorist threat than we do, and for longer. These metrics involve certain patterns of behavior, dress, speech, spending, and personal documents, which are learned by each and every airport screening worker, with periodic challenges to the system by actors pretending to be secret terrorists. With the travel ban struck down early, perhaps the Israeli government can “loan” a dozen or so teams of seasoned screeners, to instruct our own airport personnel and demonstrate how to screen more effectively and efficiently. This will allow the vast majority of people entering the USA from high-risk regions, who are well-intentioned, peaceful and productive guests in our country, or bona fide refugees, to travel as required to or from their home countries.

  • S Wong

    Resident trainees (on visa) who rotate through the VA have access to veterans, reservists, and active duty Americans … hmmm

    • Patriotliz

      One of my colleagues worked at the VA part-time. He knew a Muslim VA doctor who gave him literature about Islam. Since my friend was going to throw it away, I told him I wanted to look it over.

      It includes pamphlets from: https://www.whyislam.org/ courtesy of ICNA. ICNA seeks to promote Islam and the Islamic way of life in the United States and is an offshoot of MSA.
      http://www.icna.org/

      Also he gave him this handy dandy booklet “Brief Illustrated Guide to Understanding Islam” which can be found here…
      http://www.islam-guide.com/
      It makes Islam seem so benign along w/ some very weird pseudo-science. Scary to think that our Vets have this guy as their physician.

      Nothing in that “Guide” discussed Islam’s Jihad against Western Civilization as presented by scientist Dr. Bill Warner:
      https://youtu.be/t_Qpy0mXg8Y

      • Kore Zet

        The best cover organizations in the USA for subversive activities will be discovered to be religions and houses of worship, due to First Amendment protections. A religion which is bent on overthrowing our constitutional government and replacing it with a theocracy is wise to conduct their revolutionary activities as a religion. Despite the growing secular and agnostic trends in the USA, the non-establishment clause is still considered sacrosanct. This is an area where the former communists in Russia enjoy a survival advantage over us; their belief in, and sympathy for, religion was attenuated by 70 years of KGB infiltration of the Russian Orthodox Church. They do not have a First Amendment to restrain the activities of their Internal Defense ministry.

  • Patriotliz

    No one should assume that a foreign Muslim doctor won’t be a Jihadist. We are certainly familiar w/ an American born Muslim doctor jihadist who was responsible for the Fort Hood massacre.
    http://www.telegraph.co.uk/news/uknews/1556553/45-Muslim-doctors-planned-US-terror-raids.html

    An immigrant Muslim doctor also does not have to do anything that would make headline news to take the lives of American patients:
    http://www.debbieschlussel.com/1307/when-your-doctor-is-a-muslim-medical-terrorism-comes-to-america/

    But of course, there are many superb, compassionate Americanized Muslim doctors who are well-integrated into American society/culture who are well-established and I would even seek them out for their expertise. Foreign born Muslim doctors who originated recently from Islamic theocracies which are hotbeds for terrorism, on the other hand, are a risk. Why do we need to take the risk if there are available US Medical graduates to fill the positions?

    • Kore Zet

      For years, Major Nidal Hasan, the Fort Hood mass-murderer, announced his intentions at every opportunity. His superior officers were afraid to report his extremist religious rants because Obama’s administration banned such normal precautions, designating them as a “phobia”. Well, darn straight everyone should exhibit such phobia (which is Greek for fear, not hatred, except insofar as fear and hatred are at some levels intertwined). When a psychiatrist with a sidearm tells you that his god has instructed him to disarticulate your cranium from your torso at approximately the level of C4-C5, it is best not to ponder too long if he is manifesting an axis I or II psychopathology. If there was any doubt left, Major Hasan would hand you his card, which described his professional occupation as “Jihadist”. My theory is that the only reason he got away with such behavior for so long was his specialty. If he had been anything but a psychiatrist, he would have been instantly recognized as abnormal, if not criminally insane, or perhaps just a bit too observant, as the case may be argued.

      • Patriotliz

        Not so sure about that. It was the military being PC and not being labeled w/ Islamophobia since Obama didn’t believe terrorism was due to Islam. I believe Hasan had on his card “SOA”— “Soldier of Allah.”

        • Kore Zet

          Synonyms. Same difference. So what’s your point?

          • Patriotliz

            He could have been a Dermatologist, an Allergist, etc. and still give a pass because of PC. Being a Psychiatrist wasn’t the reason why he was not considered a threat or “abnormal.”

          • Kore Zet

            You miss the point if you believe Nadal was not considered a threat by those who attended meetings with him, in which he spoke openly of his extremist beliefs. It was known that the Commander-In-Chief had made the Armed Forces safe for those of Hasan’s beliefs, and dangerous for anyone who questioned them. He was given a pass mainly because it was futile and dangerous to report his behavior and everyone knew it.

            As a second-order phenomenon, his specialty of psychiatry undoubtedly provided some cover, because psychiatrists are well known among physicians as the looniest specialty. In any typical room full of psychiatrists, Nadal would have a good chance of not exhibiting the most abnormal behaviors.

          • Kore Zet

            By the way, “PC” or political correctness, is a communist term, from the days of the 1920’s when power shifted back and forth between the radicals and the conservatives on the Politburo, when it was important for party members to know what views were considered “correct” by the party at every moment; to be misinformed could be fatal. Despite the current alliance between communists and a certain religion, that is an unnatural alliance which will fall apart immediately after the subjugation of traditional America. I believe the religion will prevail in the ensuing power struggle with the left because the religion is armed and experienced in urban warfare and in assassination (they coined the term).* The left will never know what hit them.** I feel particularly sorry for those whose abnormal lifestyles will never be tolerated by the religion. They will finally understand that at the present time they are not oppressed or persecuted, and to think they are they must have been raised in the most tolerant and freedom-loving nation in human history.

            * and **: See the shocking assassination of the Russian ambassador to Turkey, the original home of the Assassin sect.

          • Patriotliz

            Agree w/ 1st paragraph, not w/ your second or your original statement “My theory is that the only reason he got away with such behavior for so long was his specialty.” It’s not about covering for “abnormal” behaviors, i.e., psychiatric disease, it’s about sedition.

          • Kore Zet

            I will concede your point because to argue about second-order phenomena when sedition is afoot is maladaptive behavior.

      • tobyw

        Psychologically, phobia is an unreasoning fear. By making phobia interchangeable with fear and even hate, there is now no word for unreasoning fear, or a well reasoned fear.

        Sebastian Gorka, PhD has written an excellent book on the topic:

        “Sebastian Gorka’s trenchant new work, Defeating Jihad, employs a Cold War analogy to make blunt recommendations as to what is to be done about the existential threat of jihadism. Like George Kennan’s 1946 ‘Long Telegram’ analysis to the Truman administration of how to confront predatory communism, the foundation of Seb Gorka’s strategy to destroy the jihadists is containment. Containment, however, was not by itself sufficient to destroy the Soviets, and it won’t roll back and erase Al Qaeda and its kindred of Cain. Seb Gorka reminds us that there are three fundamental tactics that will hasten the defeat of the jihadists. First, speak candidly of the enemy. These are predators who preach a homicidal interpretation of Islam. Second, accept that the U.S. cannot do the fighting. The U.S. can only help those who defend themselves. Finally, educating ourselves about the enemy’s point of view requires patience and resources, and gathering fresh intelligence on the enemy requires even more patience and money. ‘Pay now or pay later.’ To continue Seb Gorka’s historical analogy of the Cold War to defeat the Soviets, at present we are at about 1949. The Berlin Crisis is behind us, and we have learned little about the nature of the enemy or about ourselves in conflict.” —John Batchelor, author and host of The John Batchelor Show

    • Kore Zet

      Now is the time to present your views and supporting evidence to DHS. Later may be too late.

  • Phillip

    al-Zawahiri, leader of al-Qaeda, is a surgeon. The travel ban is not wide enough, as he is from Egypt

  • wfmcfp

    I do not feel this 90 day ban is damaging. If this is all it takes to bring the house down, we ARE in trouble. This 90 day “travel ban” is not unlike other presidents (Clinton / Obama) put in place for short periods of time. This IS the executive branches duty…to consider our national security and act when necessary. This time period will pass quickly, after which 50,000 immigrants from these very countries will be allowed to “immigrate” to the US over the following 12 months,….but in a very orderly and well vetted fashion.

    • Kore Zet

      The Ninth Circuit panel of judges who failed to strike down the illegal stay, as well as the appellate judge who ordered the stay, should all be impeached and convicted of gross incompetence and inability to read or understand the straightforward statutes and Constitutional clauses which made the original Executive Order legal and unassailable, except as a party-line exercise in blind obedience to partisan interests.

  • tobyw

    Have you all checked whitehouse.gov for the first exec order? If you want to see executive orders, announcements, etc., this a good place to start.
    https://www.whitehouse.gov/blog

    https://www.whitehouse.gov/the-press-office/2017/01/2/executive-order-minimizing-economic-burden-patient-protection-and

    Executive Order on January 20, 2017
    Executive Order Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal

    Trump has our back.

    “Sec. 2. To the maximum extent permitted by law, the Secretary of Health and Human Services (Secretary) and the heads of all other executive departments and agencies (agencies) with authorities and responsibilities under the Act shall exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications.”

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