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The travel ban and the rural doctor shortage

Just another unintended consequence.

In Texas and across the country, foreign-trained doctors like the Iranian-born [Dr. Hossein] Yazdani fill a critical need in rural communities, which often struggle to attract physicians born and trained in the U.S. That reality has been highlighted in the weeks since President Donald Trump signed an executive order temporarily banning travel from several predominantly Muslim countries.

A revised version of the order issued Monday was intended to keep terrorists from entering the country, but it also threatens to block international medical graduates, who help fill a growing physician shortage.

Yazdani is a classic example. He came to Houston for a prestigious fellowship at Texas Heart Institute. When he completed the training in 1997, he was given two choices: Return to Iran, or apply for a J-1 visa waiver, which allows international doctors to stay in the U.S. in exchange for working as primary care physicians in medically underserved areas.

Yazdani went to work in Anahuac.

“I had to stay three years to meet my requirement,” he said during a recent interview at his clinic. “But after that, I was interested to stay here in the community. A lot of doctors are in the big city. But there are poor people here who I like to help.”

In Chambers County, where he practices, nearly 80 percent of residents voted for Trump. A few blocks from his tiny clinic, a huge “Trump-Pence” campaign sign is painted on the side of a barn.

But inside his office, he said, politics rarely comes up.

“Patients come to see me, and I help them. That is all,” he said. “Patients don’t ask where I come from.”

Physicians who attended medical school in the six countries affected by Trump’s new order – Iran, Syria, Libya, Yemen, Sudan and Somalia – provide 14 million appointments to American patients each year, according to an analysis by Harvard and Massachusetts Institute of Technology economists. That includes more than 2.3 million office visits in areas with doctor shortages.


The problem is bigger in Texas, [Travis Singleton, senior vice president of Merritt Hawkins, a Dallas-based medical recruiting firm] said, where an additional 13,000 doctors are needed just to bring the state in line with the national average of physicians-per-resident. Thirty-five of Texas’ 254 counties have no doctors at all. About 150 counties have no general surgeons, psychiatrists or gynecologists.

International doctors are helping fill the gap: A third of Texas’ doctors were born abroad, including more than 1,000 from one of the six countries named in Trump’s order, according to a Houston Chronicle analysis of Texas Medical Board licensing data.

The rural doctor shortage, in Texas and elsewhere, is nothing new. It was cited as a reason for passing the 2003 tort “reform” proposition, which doesn’t make any more sense now than it did then and which obviously hasn’t had much effect. My guess is that if it was pointed out to the Trump-voting people of Anahuac who have been patients of Dr. Yazani that they might never have had his services had a travel ban like Trump’s been in existence before, that they’d react the same was as those people in Illinois who didn’t understand why one of their longtime and well-liked local residents had been targeted for deportation. But he’s one of the good ones! That’s not what I voted for! Well, it is what you voted for, and the Trump administration doesn’t distinguish between “good” immigrants and “bad hombres”. Maybe check the fine print next time. In the meantime, will any Republican elected official who represents a rural county that may never have a doctor again speak up about this?

See you later, alligator

We all know how much Hurricane Ike has affected and continues to affect people and property. I at least had no idea how devastating it had been to the state’s alligator population.

The throaty bellow of adult male alligators, a combination mating call/territorial warning and a signature sound of vibrant coastal wetlands, has been all but absent from marshes along Texas’ upper coast this year.

The gators are gone. Marshes that a year ago held, quite literally, tens of thousands of alligators have, for the past eight months, been all but devoid of the signature wetlands reptile.

Hurricane Ike, which shoved a wall of saltwater as much as 18 feet deep as far as 15 or more miles inland along the upper coast this past September, profoundly impacted the marshes and the hundreds of thousands of alligators that lived there.

The storm hit dead-center of the state’s most extensive alligator habitat and highest alligator populations. The four-county area of Chambers, Galveston, Jefferson and Orange in the southeast corner of Texas held an estimated quarter-million alligators ahead of Ike.

The storm’s lingering effects continued killing gators for months. Just how many were lost to the storm remains in question.

“Right now, it’s still too early to say,” said Port Arthur-based biologist Amos Cooper, who heads Texas Parks and Wildlife Department’s alligator programs. “We know we had some mortality of alligators. But whether they were just displaced and will move back as the habitat recovers is something we won’t know for a while.”

The good news is that the folks who keep an eye on this are optimistic that the gator population will bounce back next year. That’s what happened in Louisiana after Hurricane Katrina, so there’s no reason it can’t happen here. We hope, anyway.