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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?

Deportation nation


The Trump administration on Tuesday moved one step closer to implementing the president’s plans to aggressively rid the country of undocumented immigrants and expand local police-based enforcement of border security operations.

In a fact sheet outlining the efforts, the Department of Homeland Security said that though their top priority is finding and removing undocumented immigrants with criminal histories, millions more may also be subject to immediate removal.

“With extremely limited exceptions, DHS will not exempt classes or categories of removal aliens from potential enforcement. All of those in violation of the immigration laws may be subject to enforcement proceedings, up to and including removal from the United States,” the fact sheet explains. “The guidance makes clear, however, that ICE should prioritize several categories of removable aliens who have committed crimes, beginning with those convicted of a criminal offense.”

The memo did not include instructions to halt the 2012 executive action called Deferred Action for Childhood Arrivals, or DACA, which has allowed about 750,000 undocumented immigrants who arrived in the United States as children to live and work in the country legally.

The guidelines also state that the Department of Homeland Security has authority to expedite the removal of undocumented immigrants who have been in the country illegally for at least two years, a departure from the Obama administration’s approach of concentrating mainly on newly arriving immigrants.

“To date, expedited removal has been exercised only for aliens encountered within 100 air miles of the border and 14 days of entry, and aliens who arrived in the United States by sea other than at a port of entry,” the agency states.

The action also seeks to expand a police-based immigration enforcement program known as 287(g), which allows local and state officers to perform immigration duties if they undergo the requisite training. The program fell out of favor under the Obama administration after Immigration and Customs Enforcement announced in 2012 that it wouldn’t renew contracts that were in place at the time.

“Empowering state and local law enforcement agencies to assist in the enforcement of federal immigration law is critical to an effective enforcement strategy, and CBP and ICE will work with interested and eligible jurisdictions,” the memo reads.

This is going to be a humanitarian catastrophe. It’s going to be devastating for a lot of industries – agriculture, construction, hospitality – all of which will be a drag on Texas’ economy. It will do further damage to our already dented international reputation. And it won’t do a damn thing to make us safer. I wonder what Jeff Sessions will do when churches start offering sanctuary to people who are being targeted. Oh, and it will be a big unfunded mandate on cities and counties, in the same way that the “sanctuary cities” bill in the State Senate will be, if local cops are being required to enforce immigration law. This is going to be very, very ugly. Political Animal, Daily Kos, the Current, and ThinkProgress have more.