The travel ban issued by President Donald Trump could bring an unintended consequence for U.S. citizens: the loss of medical care givers serving rural communities and poor neighborhoods. “Immigrants have always done what no one else wants to do – and this includes providing high-quality medical care for underserved patients,”  say OHSU Knight Cancer Institute physicians Nima Nabavizadeh, M.D., and Charles Thomas, Jr., M.D., in a commentary in JAMA Oncology.

The US president on Monday signed a revised executive order subjecting citizens of Iran, Libya, Syria, Somalia, Sudan and Yemen to a 90-day travel ban. It places a 120-day ban on new refugees. The order takes effect on March 16.

Amid ongoing physician shortages that disproportionately hurt rural and poor corners of the U.S., the Knight Cancer physicians say that J1 and H1B visa waivers have helped by bringing talented physicians to practice in these regions. “Undoubtedly, hundreds of currently practicing physicians and physicians in training within these visa waiver programs are directly affected by this immigration ban, and the attractiveness of these programs to future international candidates will likely decline,” they warn.

“Consequently, patients likely will disproportionately feel the ill-effects of these policies because their care will either have to take place at greater distances or be provided by competent but short-term locums tenens physicians.” Nabavizadeh is an assistant professor in the Department of Radiation Medicine, and Thomas is professor and chair of the department.

“The United States, in upholding this ban, stands to lose an important source of high-skilled labor, of health care, and of biomedical innovation.”

More than 7,000 physicians trained in countries targeted by the executive order are working in the US, according to a team of economists from Harvard and the Massachusetts Institute of Technology. They analyzed data from the online physician registry Doximity and created an interactive map showing the regional concentration of doctors from affected countries.

Those 7,000 physicians provide about 14 million patient visits per year, the economists found. And they make up a larger share of the workforce in several Rust Belt and Appalachian states, providing 1.2 million doctor’s appointments per year in Michigan, 880,000 million in Ohio, 700,000 in Pennsylvania, and 210,000 in West Virginia.

“The United States, in upholding this ban, stands to lose an important source of high-skilled labor, of health care, and of biomedical innovation,” the economists assert in a Health Affairs blog post.

Physicians have called attention to other unintended consequences. Suspension of the U.S. Refugee Admissions Program “has intensified the fear and anxiety of people who are fleeing terror, bombings, domestic abuse, and other types of persecution because of their religion, sexual orientation, or ethnic background,” a Harvard Medical School physician points out in a New England Journal of Medicine commentary. “Moreover, many U.S. clinicians have noted that their patients who are already here are refraining from seeking the medical care they need or using other vital public services for fear of being incarcerated and deported.”

Nabavizadeh and Thomas say that the executive order on immigrants and refugees brings echoes of regretful times in U.S. history. “Oncologists, in particular, and physicians, in general, occupy a special place in the U.S. social conscience, and given so, we must use this platform to advocate for the respect of people affected by these unusual, yet oft-repeated, set of circumstances,” they say. “These first few weeks of the new administration must not detract from one of the most primary motivations of being a physician, compassion.”

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Further reading:

Impact of US Immigration Ban on Oncologists and Patients by Nima Nabavizadeh and Charles R. Thomas Jr. JAMA Oncology (May 2017)

The Immigration Ban And The Physician Workforce by Matthew Basilico and Michael Stepner. Health Affairs Blog (March 6, 2017)

Protecting the Tired, the Poor, the Huddled Masses by Katherine Peeler. NEJM (March 9, 2017)

Trump’s Executive Order on Immigration — Detrimental Effects on Medical Training and Health Care by Ahmad Masri, M.D., and Mourad H. Senussi, NEJM (May 11, 2017)