Trump’s Immigration Order Quickly Hits Home for Some Foreign-Born Physicians

On Saturday, a day after President Donald Trump signed an executive order restricting access to the United States for residents from several Muslim-majority countries, Muhamad Alhaj Moustafa, MD, waited anxiously at Dulles International Airport outside of Washington, DC, for his wife’s flight from Qatar to land. Both born in Syria, Alhaj Moustafa and his wife, Nabila Alhaffar, were eager to be reunited after a multiweek trip. Instead, Alhaffar found herself on a plane back to Qatar after a stressful encounter with authorities at the airport.

“I really feel lonely. I feel hopeless,” Alhaj Moustafa told TCTMD. He worries it may be months before he sees his wife again, because he can’t risk leaving the country. The order is “really destructive to my family right now,” he said.

With the stated purpose of protecting the United States from foreign terrorists, the executive order suspends entry of people from seven countries—Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen—for 90 days, blocks admission of all refugees for 120 days, and prevents Syrian refugees from coming indefinitely.

The action sparked weekend-long protests as people from the affected countries were detained in airports by authorities tasked with implementation. Several US judges ruled that parts of the order should not be enforced, but Reuters reports that some officials disregarded those decisions.

Alhaj Moustafa, who is training at MedStar Washington Hospital Center (Washington, DC) on a J-1 visa, had an up close view of the confusion as he awaited word about his wife, who held a J-2 visa given to spouses of J-1 visa holders. Alhaffar was visiting with family when word began to spread about the possibility of a restrictive executive order. Alhaj Moustafa booked a flight for her to return as soon as possible, but President Trump signed the order while she was in the air.

After officials revoked her visa and took her marriage certificate, a tearful Alhaffar was forced to return to Qatar. She required oxygen for the first part of the trip because she was short of breath. Alhaj Moustafa said that he still has not gotten the marriage certificate back.

Cardiologists, like other physicians, have been quick to recognize the concerns of their peers. TCTMD spoke with several leaders in the field about what the immigration order means for education, research, and patient care.

Contributions of Foreign-Born Physicians in the United States

In the United States, roughly 25% of physicians come from another country. Physicians who are already stressed due to their medical responsibilities will have an added layer of anxiety due to family concerns, which may affect how they function on a day-to-day basis.

There have also been reports of doctors who were traveling overseas and have not been allowed back, raising the possibility that hospitals will be scrambling to cover shifts. A well-publicized case involves Suha Abushamma, MD, an internal medicine resident at the Cleveland Clinic who was placed on a flight back to Saudi Arabia after being denied entry in New York. She holds a Sudanese passport.

There are also concerns, as reported by STAT, that patients traveling to the United States to receive care may not be allowed to enter, even if they’ve already secured visas.

One of Alhaj Moustafa’s friends at MedStar Washington Medical Center, M. Chadi Alraies, MD, an interventional cardiology fellow, suggested, too, that ongoing education within the medical community may suffer.

Alraies, who was born in Syria, said he obtained a green card to enable travel into and out of the United States without a problem. He has not had any issues with international travel in the last few years, but the executive order has caused him to cancel his travel plans for EuroPCR, which will be held in Paris in May, and to decide against attending the European Society of Cardiology Congress in Barcelona, Spain, in August.

“Professionally, this is affecting my growth and affecting my presence in interventional cardiology outside the United States,” Alraies told TCTMD.

Martha Gulati, MD (University of Arizona College of Medicine, Phoenix), decried the potential negative impact these restrictions can have on medical education in an email to TCTMD. “I think this will affect our meetings,” she said, noting that people from around the world are scheduled to attend the American College of Cardiology (ACC) meeting this March in Washington, DC.

“We want everyone to come to share ideas, to cross borders (literally and figuratively), to advance our mission, and to advance research and care of everyone,” she said. “That is what scientists and physicians do. But people will decide not to come if they think they won't be let in. They also may not come just because it isn't worth the hassle or they don't agree with the policies.”

Along that line of thought, William Zoghbi, MD (Houston Methodist DeBakey Heart & Vascular Center, TX), told TCTMD that the immigration order “is creating an unwelcome feeling towards the US in the science world.”

Gulati also questions whether training programs will be able to fill vacancies created if people from outside the country decide not to come, a concern shared by Sunil Rao, MD (Duke University, Durham, NC).

“Given the extensive number of immigrants and descendants of immigrants who are cardiologists or are in cardiology training programs nationwide, [the order] is having a significant negative effect on American medicine and will continue to do so,” Rao told TCTMD in an email.

Chandan Devireddy, MD (Emory University, Atlanta, GA), who told TCTMD that he knows of many people who have been directly or indirectly affected by the order, said he believes “healthcare is ground zero for the immigration ban's impact,” citing the dependence of both urban and rural hospitals on foreign medical graduates for a large percentage of their workforce.

“Many have commented that this ban is only a ‘minor inconvenience’ or that these physicians should ‘take care of people in their own country,’” he said. “These are sad statements that reflect a misunderstanding of healthcare worker shortages in this country. [T]hese individuals are often the best and brightest of the world who were attracted to the freedom and open exchange of ideas that the USA has always promised, until now.”

He noted that physicians often stay out of political debates. “This action, however, hits all of us and our patients, whether we realize it or not,” Devireddy said. “Thus, I feel physicians, who may never have felt comfortable expressing their views, need to express their concerns now.”

Support for Diversity in Medicine and Beyond

Professional societies and universities have largely responded to the executive order with statements that express concern about the potential impact on public global health and affirm their dedication to the promotion of diversity and international cooperation.

Darrel Kirch, MD, president and CEO of the Association of American Medical Colleges, for example, said in a statement that “the nation’s medical schools and teaching hospitals are dedicated to promoting a diverse and culturally competent health and biomedical workforce that supports improvements in healthcare, breakthroughs in medical research, and, ultimately, improved and equitable health for all patients. We are deeply concerned that the January 27 executive order will disrupt education and research and have a damaging long-term impact on patients and healthcare.”

Kirch also pointed out the important role that international graduates play in the US healthcare workforce, saying that impeding existing immigration pathways “jeopardizes critical access to high-quality physician care for our nation’s most vulnerable populations.”

Speaking to how the issue affects cardiology in particular, ACC President Richard Chazal, MD, said in a statement that “if we are to realize a future where cardiovascular disease is no longer the #1 killer of men and women worldwide, we must ensure that our system of scientific exchange allows for healthcare professionals to learn from each other regardless of their nationality.”

He continued: “Policies that bring the immigration status of those already here into question, while also limiting the ability of others to legally train in the US going forward, will only serve to exacerbate the already existing cardiovascular workforce shortage, especially in rural America. Such policies also threaten the care continuum of patients who rely on these providers for their medical care.”

Nitin Damle, MD, president of the American College of Physicians, argued that the order is “resulting in discrimination based on religion against physicians and medical students from the designated countries who are getting their training, and caring for patients, in the United States. . . . If the executive order is not permanently rescinded, blocked by the courts, or reversed by Congress, it will hinder the free exchange of information and travel among doctors around the world.”

Numerous universities and academic medical centers issued similar messages of concern and calls for inclusion. Yale University, Johns Hopkins University, University of Pennsylvania, University of Arizona, and others have advised students and faculty from affected countries to defer any international travel until the situation can be clarified.

In a particularly strongly worded statement, Lee Bollinger, president of Columbia University, called the executive order “discriminatory, damaging to America’s leadership in higher education, and contrary to our nation’s core values and founding principles.” Bollinger said it is critical for the university to not take a position on ideological or political issues, but added that the institution should object when policies conflict with its values, as in this case.

“It is important to remind ourselves that the United States has not, except in episodes of national shame, excluded individuals from elsewhere in the world because of their religious or political beliefs,” Bollinger said. “We have learned that generalized fears of threats to our security do not justify exceptions to our founding ideals. There are many powerful and self-evident reasons not to abandon these core values, but among them is the fact that invidious discrimination often adds fuel to deeply harmful stereotypes and hostility affecting our own citizens.”

TCTMD reporters Caitlin E. Cox, Yael L. Maxwell, L.A. McKeown, and Michael O’Riordan contributed to this story.