Azi Torkamani is eight months pregnant and working 12-hour shifts at St. Josephs Hospital in Syracuse, New York. She’s a resident physician in family medicine1. Some days she has so many patients she doesn’t have time to stop and eat lunch; she eats as she walks from floor to floor treating patients. On Monday, as she took rounds in the family medicine clinic, she was distracted by a nagging worry: How am I going to manage once the baby is born?
This was not the normal worry of a first time mother. Torkamani is Iranianand, in an instant, President Trumps new immigration ban upended her familys future. Downstream effects of the ban are hitting the entire healthcare system, from doctors like Torkamani to nurses and all the way to patients.
It wasn’t supposed to be like this. Torkamani has a green card to work permanently in the US, and her mother had obtained a visa to come from Iran to care of her grandson for a year. But Torkamani’s mother was en route from Tehran to America when the president signed the executive order banning travel into the US by anyone from Iran and six other predominantly Muslim countries. As she satawaiting takeoff on a flight from Turkey to Dulles, officials boarded the plane and removed her. After 15 hours in custody, they sent her back to Tehran.
“I was depending on my Mom,” Torkamani said Monday, on the phone in the hospital. “Now I don’t know what I’ll do.” With Torkamani’s 80-hour work weeks and frequent overnight shifts, she’ll need full-time care when the baby is borncare that will be very hard to pay for on a resident’s salary. Without help, she may not be able to complete her residency, which lasts another two years.
“I can’t go back to Iran,” Torkamani says. “I can’t quit now. I had to take all medical board exams. I [spent] so much money to [qualify to] get into this medical residency. I can’t just quit and say goodbye.”
Torkamani is not alone. By one estimate, a quarter of all doctors in the US were not born in this country. Across the healthcare industry, from medical students to doctors to pharmacists to orderlies, lives were changed in an instant last Friday. Some, like Torkamani, because they were separated from family. Others because they were prevented from even doing their work.
The Doctor Deficit
According to the Association of American Medical Colleges, 260 doctors from the banned nations—Iraq, Iran, Libya, Somalia, Syria, Sudan, Yemen—applied for residencies like Torkamani’s this year. The AAMC believes these doctors may not be able to practice in the US because of the timing of the order. That trend will likely continue, says immigration expert Elizabeth Cohen of Syracuse University, who is alarmed by the leaked draft of another looming executive order that would change the H-1B visa program and potentially bar much-needed nurses and high-skilled healthcare experts from entering the country.
As was widely reported over the weekend, Iranian-born Samira Asgari was on a flight to the US to start work at the Harvard-affiliated Brigham and Women’s Hospital researching tuberculosis treatments when the president signed his executive order. She was forced to return to Switzerland. Seyed Soheil Saeedi Saravi was about to join a cardiology research group at the same hospital when his visa was suspended Saturday. Cleveland Clinic doctor Suha Abushamma, an H-1B visa holder originally from Sudan, was forced back to Saudi Arabia, where she had been visiting family, on Saturday. Boston University reported that two students in its School of Public Health were barred from returning to the US to study. The list goes on.
And it’s not just those who work in healthcare who are affected: Patients travel all over the world to be treated in American hospitals. Abdollah Mostafavi flew to San Francisco from Iran on Friday for a hip replacement surgery, but was detained at the airport, his daughter told the LA Times. Mostafavi, though, is a legal permanent resident of the US with a green card. After six hours in a room with other Iranian nationals, authorities released him.
The impact of the order isn’t limited to patients from the countries it lists. The AAMC estimates that those 260 resident doctors who may now not be able to practice in the US would each have seen 3,000 patients a year: 780,000 in total. That’s an especially large cut to confront as the new administration and Republican Congress plan to dismantle the Affordable Care Act, which will result in millions losing health insurance. The effects could be bleak: fewer people actively seeking out preventative and nonemergency care; more people showing up to emergency rooms for high-cost and higher-risk treatment. Not to mention, the AAMC1 projects the US will face a shortage of 90,000 doctors by 2025.
The country already suffers from a massive nursing shortage, which would be worsened if the president signs the order changing the H-1B visa program. “Since the 1940s we’ve been not only recruiting nurses from other countries but actually in some cases getting people into training abroad and then bringing them to America,” says Cohen. “This H-1B shift could really reduce the population of highly skilled doctors and nurses.”
Hospitals and medical schools are scrambling to figure out how to support those affected in their communities. George Q. Daley, dean of Harvard’s medical school, sent a letter to all staff on Sunday expressing outrage over the executive order. “The impact of this executive order on faculty, students, and staff has the potential to resonate far into the future, and to alter how we work with colleagues around the globe and how we care for international patients,” he wrote. He noted that Harvards Global Support Services were reaching out to all students to give them advice. Boston University President Robert Brown said Monday that BU was in contact with all 118 members of its community from those nations, and that the school would be offering guidance and holding forums for the international community.
The president of Partners HealthCare, which manages Brigham and Women’s Hospital among many others, wrote to staff on Monday. “Partners has been in close communication with both Governor Baker and Attorney General Maura Healey,” the statement said, “who are working together to pursue short term remedies via the court system. The longer term outcome is obviously impossible to predict at this early stage.” Brigham doctors in white coats joined a protest against the ban on Saturday. Like so many hospitals, it depends on international workers, and workers specifically from the nations banned by the new order.
Much is still unclear. One of the dangers of racing to implement a vaguely-worded order without preparation is that people on the ground don’t quite know how to handle or interpret it. That can lead to abuses and mistakes. This, too, has had direct health consequences. At JFK on Friday, a woman with diabetes was detained without access to medication for hours. Turkish authorities forced Torkamani’s mother out of her wheelchair in order to move her to a holding area before they sent her home to Iran. They made her drag two large suitcases when she could barely walk. “They treated my mom like a criminal,” says Torkamani. “She told me, ‘I got numb in all my hands and legs and I couldn’t talk. I was about to faint.’” Torkamani’s due date is in 10 days. When she thinks about meeting her first-born child, she, too, is speechless with fear.
Correction 9:38pm ET on 2/1/2017: An earlier version of this story incorrectly abbreviated the Association of American Medical Colleges. Additionally, Torkamani’s last name was misspelled. Her residency type as well as one quote have been altered to match the speaker’s intentions.