Dr. Amin Rabiei knew he wanted to work in medicine from an early age. When he was growing up in Iran, he watched his dad experience seizures and his mom struggle to help. Rabiei went on to medical school in Iran, then practiced at a rural clinic there, all the while working toward an important career point that culminates Friday: getting matched to a medical residency training program in the United States.
"I decided to come here to have better opportunities for research and clinical education," says Rabiei, who is already in Philadelphia on a research visa doing postdoctoral research at Thomas Jefferson University. His ultimate aim? "Hopefully to share this information and these skills for the people who need this in the undeveloped countries."
Rabiei hopes to train in neurology with a focus on epilepsy. For international medical graduates like Rabiei, becoming eligible for residency training in the U.S. is a rigorous process that can take years of planning, financing and work. In general, landing one of these coveted spots, a requirement for anyone aspiring to train and practice medicine in the U.S., is already competitive; about 32,000 slots are available to an applicant pool of 42,000. Last year, about half the applicants from outside the U.S. were successful in getting a match.
But now, as Rabiei braces for Friday, when these decisions will be finalized, he and others worry that the recent White House executive orders on immigration have further diminished their chances of getting a match.
"It becomes like double stress," Rabiei says.
"It is a valid concern," says Dr. William Pinsky, president of the Educational Commission for Foreign Medical Graduates. And that valid concern continues, even though the most recent executive order on travel was blocked nationwide, at least temporarily, Wednesday afternoon.
Here's why: Pinsky says President Trump's executive orders have created new unknowns in the visa process for foreign medical graduates — and the ambiguity puts the residency programs, as well as the applicants, in a bind. Though the training programs rank applicants according to their merits and qualifications, the matching system hinges on these young doctors being available and ready to start caring for patients in July. Many residency programs can't risk having an empty seat because of visa processing delays.
"Program directors have to weigh various factors of applicants, from their medical knowledge, ability to communicate, their observed level of empathy, their leadership capabilities — and their ability to be available when July 1 comes," Pinsky says.
He estimates that roughly 300 to 400 applicants this year from the countries covered by the White House executive orders would now need to apply for a visa — or change or renew the one they have — to train in the U.S.
"I have talked to a few program directors that were probably going to rank individuals from these countries lower on their preference order than they would have otherwise," Pinsky says.
About 1,800 people from these countries are already in medical residencies in the United States.
Further complicating this year's "match week," most residency programs ranked their preferences of applicants on Feb. 22 — in between the issuing of the first and second executive orders on travel restrictions. Those match decisions are to be released Friday, March 17.
"The timing and uncertainty of the executive order could not have come at a worse time," Pinsky says.
The first White House executive order restricting travel came out in January and applied to seven Muslim majority countries: Iran, Iraq, Libya, Somalia, Sudan, Syria and Yemen. The more recent version, announced in early March, removed Iraq from the list. It bans new visas from the remaining six countries for 90 days, but also includes some exceptions that allow U.S. entry — such as for lawful permanent residents of the U.S. and those with other valid documents.
The Educational Commission for Foreign Medical Graduates, which is based in Philadelphia, is responsible for certifying all international graduates who wish to apply for residency and practice medicine in the U.S. This involves administering qualifying exams and overseeing other background checks. ECFMG is also closely involved in the visa process, as a main sponsor of J-1 clinical visas for international graduates — the most common type of visa granted for training and practicing medicine in the United States. A smaller number of institutions may directly sponsor residents through an H-1B visa.
"If someone has a visa, as I understand, even though they're from one of these six countries, it's not an issue," Pinsky says.
Even so, it's still unclear who is eligible to get a visa or how long it will take. His organization is awaiting clarification from the federal government on that process and whether, as before, the process can be expedited in order to be completed by the start of a medical residency.
"I think our bigger institutions, like Penn and CHOP [Children's Hospital of Philadelphia], have very much said, 'Just on principle we're going to rank these people if we think these are the best people,' " Grover says.
"You know, if I'm Penn and I've got an internal medicine class of like 45 residents, maybe I can take more of a chance. If one resident doesn't come maybe I can figure it out." (Indeed, a spokesperson from Penn tells Shots they don't think the executive order will impact the institution's ability to train residents who match there.)
But waiting for somebody's visa to come through can be a greater risk for smaller programs, Grover says. "You can't afford to lose 10 or 25 percent of your class. It'd be a big gamble for them."
Dr. Robert Wimmer heads a small pediatric residency program at Einstein Medical Center in North Philadelphia, and says about half the residents there are medical graduates from another country. The program can't afford to accept someone in their new class of 10 if there's a chance they might not be able to start in July because of visa issues.
"It's unfortunate," Wimmer says. "Many work their tails off to get to the U.S. We might be losing a lot of talent."
While the United States has long been known as an epicenter for top medical research and care, Pinsky worries that reputation and the whole system could suffer if an uncertain immigration climate discourages young doctors from trying to train and practice in the United States.
"There could be an issue of access to health care as well as a quality situation," he says.
Rabiei says he and his Iranian peers are trying to stay positive.
They feel encouraged by the support they've received from colleagues and their universities.
"When you try so hard to get to your dream, and all of a sudden you feel that there are some issues — unexpected problems — it's a really bad feeling," he says.
Rabei won't know until Friday exactly where he'll be a medical resident, but he was thrilled to learn Monday that he has been offered a position by at least one institution. He knows other Iranians who were not so lucky.
STEVE INSKEEP, HOST:
Thousands of aspiring doctors learn news of their future on Friday. That's the day they're told where they'll be doing their medical residencies. Match Day is the end of a nerve-wracking process. President Trump's efforts to ban travel from six countries complicated the process even though it's, again, been stopped in court. Here's Elana Gordon from member station WHYY.
ELANA GORDON, BYLINE: About 40,000 students apply for medical residency in the U.S. each year for just about 30,000 slots. And for international medical graduates, it's even more competitive. Only about half typically get matched. For the roughly 1,000 applicants from countries that were included in President Trump's executive order on immigration, the pressure is even worse.
AMIN RABIEI: Yeah. It becomes, like, double the stress.
GORDON: Amin Rabiei went to medical school in Iran and has been working in Philadelphia on a research visa at Thomas Jefferson University. He got interested in medicine as a kid growing up in Iran. His dad had seizures, and his mom struggled to take care of him.
RABIEI: So I decided to come here to have, like, better opportunity for, like, research and clinical educations to hopefully share this information and these skills for the people who need this in the undeveloped countries.
GORDON: He's hoping to become a neurologist. But he worries he'll be even less likely to get matched and then get the right visa because of uncertainties from Trump's executive order.
RABIEI: When you try so much hard to get to your dream and all by sudden, you feel that there is unexpected problem, it's really a bad feeling.
WILLIAM PINSKY: It is a valid concern.
GORDON: Dr. William Pinsky is president of the agency that certifies all international medical graduates seeking residency in the U.S. It also sponsors visas for a majority of them. He says the timing of the first executive order was terrible for the residency match process.
PINSKY: Because that all came out, you know, right before the program directors turned their lists in.
GORDON: He's hopeful those who already have visas will be able to get their situation worked out. But residencies start in July, and there's still a lot of questions about who can get visas and how long it'll take. As a result...
PINSKY: I surmise - and have talked to a few program directors - that were probably going to rank individuals from these countries lower on their preference order than they would have otherwise.
GORDON: This unclear landscape makes Dr. Robert Wimmer of Einstein Medical Center uneasy. He heads a small pediatric residency program in a low-income neighborhood in Philadelphia that relies heavily on foreign medical graduates. He says they can't afford to accept someone in their new class of just 10 who might not be able to start come July because of these issues.
ROBERT WIMMER: We're just not willing to take any risk. It creates a hole for us in our program and what we're able to do here in North Philadelphia.
GORDON: And there might be long-term health impacts in the U.S. Pinsky says international doctors often provide care in areas that other doctors might not want to.
PINSKY: We potentially could be losing qualified people. And there won't be numbers to fill in the positions, so there could be an issue of access to health care.
GORDON: As for Amin Rabiei, he was thrilled to find out Monday that he has been matched somewhere. He'll find out where Friday. But he knows of others from Iran that weren't so lucky. For NPR News, I'm Elan Gordon in Philadelphia.
(SOUNDBITE OF TOE'S "BOYO")
INSKEEP: This story is part of a partnership with NPR, WHYY's health show "The Pulse" and Kaiser Health News. Transcript provided by NPR, Copyright NPR.