Ahmed Alsayed typed emails to more than a dozen hospitals after President Donald Trump announced his travel ban.
Alsayed urged them to still consider him for their residency programs despite the fact that he’s from Sudan, one of seven Muslim-majority countries mentioned in Trump’s executive order temporarily banning citizens of those countries from entering the U.S.
"I was really excited all my interviews went well and I could start ranking programs and hopefully match for next year," said Alsayed, who’s been living in Chicago for two years on a visa, taking exams and applying for residencies in hopes of working as a doctor here. "Then came this executive order and everything became so confusing, so stressful."
Though courts have suspended the ban for now, the continuing uncertainty surrounding its ultimate fate has international medical school graduates and teaching hospitals on edge as they prepare for one of their biggest days of the year — Match Day on March 17. It’s the day when medical school graduates and students find out at which hospitals they’ll do their residencies — putting into practice what they learned in medical school and honing their skills as doctors.
Aspiring residents like Alsayed wonder if they’ll be turned away from hospitals that don’t want to deal with the potential hassle of hiring physicians who would be subject to a travel ban. And hospitals worry whether the residents they choose will be barred from working in the U.S., leaving them short-handed to care for patients and, over time, making a shortage of doctors in the U.S. more acute.
Trump recently defended the travel ban calling it "very important for the country" and saying "we have to have security in our country."
But hospitals in Illinois and across the nation rely heavily on doctors from abroad.
Last year, about 14 percent of residents who matched through the main matching program — more than 3,700 people — were non-U.S. citizens who graduated from medical schools outside the U.S, according to the National Resident Matching Program. This year, more than 42,000 people are expected to apply for 32,000 residency spots across the country, in all.
Ahmed Alsayed Abel Uribe / Chicago Tribune Ahmed Alsayed, 22, of Sudan, helps a friend study for a medical school test on Feb. 7, 2017, at their apartment in Chicago’s Buena Park neighborhood. Alsayed, a medical school graduate, is worried about how the now-suspended travel ban may affect his chances of matching to a residency program. Ahmed Alsayed, 22, of Sudan, helps a friend study for a medical school test on Feb. 7, 2017, at their apartment in Chicago’s Buena Park neighborhood. Alsayed, a medical school graduate, is worried about how the now-suspended travel ban may affect his chances of matching to a residency program. (Abel Uribe / Chicago Tribune)
It would be "disastrous for not only medical education but bad for patient care" if hospitals can’t get the residents they choose because of the travel ban, said Dr. Fred Zar, program director of the internal medicine residency at the University of Illinois at Chicago College of Medicine.
"If we lose that part of the workforce because we can’t get enough people in our residency programs because these countries are banned, the ability to take care of the volumes of patients we care for (is) diminished," Zar said. "It’s got very deep-running ramifications for health care."
Zar’s particular program doesn’t have many residents from other countries, but others certainly do, he said.
The American Medical Association has asked the Trump administration for guidance on Trump’s order to ensure it doesn’t keep out qualified med school grads or leave hospitals with unfilled training spots.
Hospitals’ reliance on residents from other countries varies based on the institution and the specialty. Residency programs in popular specialties at top tier hospitals might not have as many doctors from other countries because so many American medical school grads want to work in them, and Americans might be easier to interview and hire, said Mark Smith, president of Merritt Hawkins, a placement firm specializing in physicians. But less prominent hospitals and less popular specialties might rely more on foreign doctors.
Those hospitals could suffer — including financially — if a ban keeps their top choices for residents from entering the U.S. If a resident is selected for a spot at a hospital and then can’t follow through because of a ban, some hospitals will still likely be able to fill the spot with a bit of scrambling, but others may not.
"The resident plays a critical role in not just the care-providing of a hospital but also the financial viability of a hospital," Smith said. Residents make an average of $56,500 a year, according to a 2016 Medscape report, but they work up to 80 hours a week. "They’re the cheapest labor you have."
Hospitals could hedge their bets by simply avoiding those international residents. The National Resident Matching Program is "concerned" that hospitals might not rank those applicants, said Mona Signer, program president and CEO.
The program recently released a statement urging medical educators to support international medical graduate students and "make the best decisions they can under current circumstances."
"The affected applicants have worked hard for many years to achieve their goal of becoming physicians, and they should not be denied that opportunity because of a blanket policy that does not consider the individual," according to the statement. "Similarly, U.S. training programs should be able to select applicants based on their excellent character and qualifications, without regard to nationality."
Rush University Medical Center has already decided not to take applicants’ nationality into account as it ranks its top choices for residents this year, said Dr. Richard Abrams, associate dean of graduate medical education at Rush.
It’s possible that approach could leave Rush with last-minute vacancies. Abrams estimates about 10 percent of Rush’s residents attended medical school in other countries and about 10 of its current residents and fellows are from the seven countries in question.
2 stranded overseas by Trump travel ban allowed to return to Chicago Jason Meisner
Federal authorities worked swiftly Wednesday to resolve two lawsuits filed by Chicago residents who said they were unlawfully stranded overseas due to President Donald Trump’s controversial executive order restricting travel from seven majority-Muslim countries.
One suit was filed by Dr. Amer Al…
Federal authorities worked swiftly Wednesday to resolve two lawsuits filed by Chicago residents who said they were unlawfully stranded overseas due to President Donald Trump’s controversial executive order restricting travel from seven majority-Muslim countries.
One suit was filed by Dr. Amer Al…
(Jason Meisner)
Still, if Rush accepts residents that ultimately aren’t able to make it to the U.S. in time to begin their residencies because of the ban, Rush would hope to hold their spots until they can travel to the U.S., he said.
"After the executive order went out, we made it very, very clear and I made it very clear to all our program directors here and our trainees here that we were going to do nothing differently," Abrams said. "I’ve been here 30 years and this is our family, and the people who come here, they’re part of our family."
He just hopes those residents feel the same way.
Some doctors and health care leaders fear even the prospect of a ban could scare young foreign doctors away from the U.S. for years to come.
Alsayed, the aspiring resident now living in Chicago, said his brother, a student in his final year of medical school in Sudan, had planned to follow his lead and come to the U.S. for his residency. Now, his brother isn’t sure if he wants to come here, Alsayed said.
Abrams said that one of his medical residents from the Philippines recently asked him what would happen if he traveled home and wasn’t allowed back in the U.S. because of a ban. Abrams told him Rush would hold his spot until he could return. Doctors are concerned about what that kind of fear might mean for the growing U.S. doctor shortage.
The Association of American Medical Colleges projects that the U.S. will have a shortage of between 46,100 and 90,400 doctors by 2025. Doctors from other countries can help ease that gap, said Dr. Atul Grover, executive vice president of the association.
Crystal Lake doctor with American, Iranian citizenship held for questioning at O’Hare Katherine Rosenberg-Douglas
Even if Dr. Amir Heydari had been held longer at O’Hare International Airport on his way home to Crystal Lake from Iran on Sunday, he knew he’d be OK.
He’s a bariatric surgeon with a large network of colleagues, patients and friends; he’s married to an American woman and together they’re the parents…
Even if Dr. Amir Heydari had been held longer at O’Hare International Airport on his way home to Crystal Lake from Iran on Sunday, he knew he’d be OK.
He’s a bariatric surgeon with a large network of colleagues, patients and friends; he’s married to an American woman and together they’re the parents…
(Katherine Rosenberg-Douglas)
About 29 percent of Illinois’ licensed practicing doctors graduated from medical schools outside the U.S., and the majority of them were likely born outside the U.S. That includes 779 doctors from the seven countries affected by the ban: Iran, Syria, Iraq, Sudan, Libya, Yemen and Somalia, according to the Federation of State Medical Boards.
"We need them as part of the physician workforce in this country because we’re never going to be able to keep up and expand our medical school enrollment fast enough, given the growing and aging population," Grover said.
Alsayed said he wouldn’t be surprised if future doctors are leery of applying for residencies in the U.S.
But he won’t be deterred.
He knew he wanted to be a doctor from a young age, growing up the son of a science teacher mom and dad who worked with community programs. He was taught to help people.
He hopes residency programs appreciate his resolve.
"Honestly, I’ve worked so hard for this that I’ll try my best to find a legal way to stay here," Alsayed said. "Training here is like nowhere else. Being the person that I am, I’m always wanting to be the best. I haven’t thought of any other place other than here for my training, and I’m not giving up on that."
lschencker@chicagotribune.com
Twitter @lschencker
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