For some medical students, getting a yes or no Friday was more important than finding the right life partner.
Friday was "Match Day," the annual day when medical students find out which U.S. medical institution has accepted them for a residency program. It is a competition, of sorts: 32,000 training slots are available for 42,000 applicants, according to this year's data.
A residency, three to five years of practical experience and training in a student's chosen medical specialty, is the next step after medical school, which in the United States generally means four years of postgraduate university studies.
Of those 42,000 applicants vying for residencies, all but about 6,000 are foreign nationals. And that is where their aspirations could collide with President Donald Trump's latest executive order regulating immigration to the United States.
'Extensive upheaval'
The National Residency Match Program (NRMP), a nonprofit group that organizes the matches between students and hospitals, said the new immigration order has had a substantial impact on its program. In its current revised form, the order bans citizens from six Muslim-majority countries from traveling to the U.S., at least temporarily.
"The consequences of the [January 27] executive order are far-reaching for match applicants, and the upheaval it is causing is extensive," NRMP's chair, Dr. Maria Savoia, and CEO Mona Signer said in a joint statement.
"The affected applicants have worked hard for many years to achieve their goal of becoming physicians," the two medical-education experts said, "and they should not be denied that opportunity because of a blanket policy that does not consider the individual."
U.S. courts have issued a restraining order preventing enforcement of the travel ban, pending further legal arguments, but NRMP says it is concerned that some immigrants or foreign medical students with valid visas will nevertheless be delayed or rejected at U.S. borders.
Holidays at home are not care-free
In addition, foreign medical students who travel to their home countries during holidays or breaks in their university studies fear they may not be able to return in time to take up their new residencies in the U.S. Such medical programs typically begin each year on July 1.
"U.S. training programs should be able to select applicants based on their excellent character and qualifications, without regard to nationality. Both applicants and programs benefit from an orderly process for entry into graduate medical education," said Signer, who is a public health specialist, and Savoia. "The executive order disrupts that process very considerably."
Hospitals and other medical institutions that offer residencies worry that foreign students they choose for the multiyear training programs will be unable to begin their studies on schedule, Signer said.
Medical residencies are sometimes known as internships, or first-year post-graduate studies, because they occur during a fledgling doctor's first year of practical training alongside or under direct supervision of a fully qualified physician in one of 21 recognized medical specialties.
Is US becoming less welcoming?
Those who administer medical residency programs do not directly choose the candidates they would like to attract. Instead they rank applicants in order of preference. Under those conditions, Signer said, "It seems likely that residency program directors will be reluctant to rank J-1 visa applicants because they may not be able to enter the country to begin training."
The U.S. State Department's J-1 visa program offers foreign nationals an opportunity to come to the United States "to teach, study, conduct research, demonstrate special skills or receive on-the-job training for periods ranging from a few weeks to several years," according to Cultural Vistas, a nonprofit American group that has been organizing international exchange programs since 1963.
The perception that the United States is becoming less welcoming to foreign nationals in the medical professions appears to be having an effect.
Fewer non-U.S. citizen "international medical school graduates," or IMGs, submitted program choices for this year: 7,284 in 2017 vs. 7,460 in 2016. However, NRMP said more of these candidates (52.4 percent) were matched with institutions - the highest match rate since 2005.
Foreign physicians benefit all Americans
About 1,800 IMGs already enrolled in accredited residency and fellowship programs in the U.S. are impacted by the travel ban, according to Dr. Thomas J. Nasca, CEO of the Accreditation Council for Graduate Medical Education.
"These physicians are providing much needed medical care to a conservatively estimated 900,000 patients in urban, suburban and rural communities across the country annually. They are a valued and welcomed group of colleagues,” he wrote in a statement.
“Many communities, including rural and low-income areas, often have problems attracting physicians to meet their health care needs. To address these gaps in care, IMGs often fill these openings. These physicians are licensed by the same stringent requirements applied to U.S. medical school graduates,” the chief executive officer of the American Medical Association, Dr. James Madara, wrote last month.
"The medical education community must support all international medical graduates and their families during these difficult times," NRMP's statement said.
