President Donald Trump's executive order on immigration, which sparked protests abroad and in the U.S., is also raising fears about the impact on international medical students vying for training programs at U.S. hospitals, as well as young doctors in training from affected countries who are already working here.
Medical residency assignments will be announced in six weeks. The Association of American Medical Colleges, which represents medical schools and teaching hospitals, has identified 260 applicants who could be affected.
In a statement Monday, the AAMC asserted the nation's need for foreign physicians to address the growing doctor shortage and maintain the U.S. as a "global leader" in medical innovation. The organization urged the Trump administration to "carefully consider the health care needs of the nation."
Atul Grover, executive vice president at the AAMC, said the immigration policy's effect on international medical graduates remains uncertain. Although the ban potentially affects a fraction of the nearly 31,000 people who are placed in residencies, he said he worries the executive order will cause disruption for the students and people whom they could help.
"These are doctors. They could be exceptional practitioners and I don't know if you want to stop them from coming here and serving their patients," Grover said.
Clarence H. Braddock III, a professor and vice dean at UCLA's medical school, acknowledged concerns about the prospects for some international students following the Trump administration's order and said that it could discourage residency programs from offering positions to some candidates.
Trump signed an executive order Friday imposing a 90-day ban on travelers entering the U.S. from seven countries: Iran, Iraq, Libya, Somalia, Sudan, Syria and Yemen. The initiative also suspended refugees from entering the country for 120 days and indefinitely from Syria.
One Sudanese applicant, who asked not to be named for fear of impacting his residency placement, said the news was a shock.
"It's very devastating," he said. "Because you [are] born in an unfortunate situation, you have to pay the price for that."
The 26-year-old grew up in a middle class home in Sudan and graduated with awards from the University of Khartoum in 2014. He said he studied for two years for the U.S. Medical Licensing Examination, a series of four tests required for international medical graduates to secure a spot in a residency program. He traveled twice to the U.S. and twice to Dubai to take the exams. He estimates the cost of travel, study materials and exam registrations totaled upwards of $20,000.
Young doctors from these nations who have already secured a coveted U.S. training slot and are working in U.S. hospitals are worried about their futures. As a first-year internal medicine resident in South Dakota, Radowan Elnair, 27, who is also from Sudan, had heard rumors of a major legislative change coming, but didn't believe it would happen.
"It all happened so suddenly," he said.
Elnair has been in touch with his immigration lawyer to learn how the ban affects his legal status. He needs to extend his visa but is waiting until more details of the executive order are released. His attorney recommended against traveling overseas, so he has cancelled plans to visit his family in Sudan this year.
Elnair also is concerned about whether he can even complete his training in internal medicine. "No one knows what's gonna be next," he said.
The ban began at a critical point for medical students. The residency announcements set for March 17 mark the end of a long application process for thousands of domestic and international medical graduates. Students submit a list of their preferred residencies to the National Resident Matching Program. Hospitals review applicants and submit a list of their preferred candidates. The program uses computer technology to assign students to residencies.
Mona Signer, the president and CEO of the matching program, said in an email that her organization is still planning to move forward with the original date, but "no one knows the long-term effect of the Executive Order." She also said it's likely the immigration change will make program directors reluctant to rank international students among their preferred candidates for residencies.
On Wednesday, Dr. James L. Madara, the CEO of the American Medical Association, sent a letter to the administration saying his organization is "concerned that this executive order is negatively impacting patient access to care and creating unintended consequences for our nation's health care system." He specifically raised fears that the restrictions could affect medical students applying for residencies and international doctors seeking to practice in the U.S. "Guidance is urgently needed from the Administration to ensure the upcoming residency matching program in March 2017 does not leave training slots vacant and that all qualified IMG applicants can participate," Madara said.
The Educational Commission for Foreign Medical Graduates, which is responsible for assessing international medical graduates' qualifications for U.S. residencies, said Friday it was also "evaluating the potential impacts."
International medical graduates already face an uphill battle to secure a residency, said Carl Shusterman, an immigration attorney in Los Angeles. Medicare funding for residencies have been capped since the 1990s, curtailing the growth of programs and increasing competition among applicants.
According to Grover, international medical graduates have about a 50-percent chance of securing a residency in the U.S. "There's way more people applying to more residency positions than there are available," Grover said.
The majority of medical residents enter the country using a J-1 visa, which is relatively easy to acquire but requires holders to leave after they complete their training.
Many of them, however, stay in the country after their residencies through the Conrad 30 program, which places doctors in medically underserved areas, said Shusterman.
Phil Miller, vice president of communications for the physician recruiting company Merritt Hawkins, said these physicians help fill the gaps in American medicine that domestic doctors alone cannot do.
"We are, I think, benefiting from their presence here," Miller said. "They're saving a lot of lives."
Dr. Catherine Lucey, professor of internal medicine and vice dean for education at the University of California, San Francisco, noted that many international graduates that stay in this country end up choosing specialties that are facing shortages, such as primary care, and practicing in places in dire need of doctors, including many rural communities. "We have benefitted a lot as a profession from the hard work and contributions of international graduates in the U.S. health care workforce," Lucey said. "As educators, we are concerned about the health care workforce that serves our most vulnerable patients."
She said her facility is not directly impacted by Trump's executive order because the medical school graduating class doesn't include students who are from the affected countries and its residency program generally recruits students from U.S. medical schools.
Foreign doctors provide a vital lifeline for health care in the United States. About a quarter of doctors in the country were born abroad. And according to the AAMC, the United States faces a shortage of up to 94,700 physicians by 2025.
But for the medical graduates seeking to enter the country for their residencies, Shusterman said they have few legal options at their disposal. The American Civil Liberties Union filed a lawsuit against the ban. Individual doctors could file their own lawsuits, Shusterman said, but a resolution is unlikely to occur before they are to begin their residencies.
Senior Correspondent Emily Bazar contributed to this article.