Hi Miriam,
Good points all here. Also, given that college is so damned expensive here, who
the heck can afford to pay for both under-graduate school and then medical
school?
And, it is harder and harder these day to get a doctor with whom you can have a
personal relationship.
I had the same doctor for almost 30 years and we did indeed have that kind of
raport. I have had two doctors since and I like them very well but they both
have retired and I'm once again looking for a new one. Also, so often when you
go to the doctor, you don't get to spend very much time with them.
Medical services should not be monetized as we do here. But then again, more
and more of life is getting monetized here. Sometimes I get the feeling that,
one day, even the air I breathe will be monetized.
Just one more reason to believe that we live in a decaying society.
Time for a drink!
Bob
-----Original Message-----
From: blind-democracy-bounce@xxxxxxxxxxxxx
[mailto:blind-democracy-bounce@xxxxxxxxxxxxx] On Behalf Of Miriam Vieni
Sent: Sunday, August 20, 2017 10:10 PM
To: blind-democracy@xxxxxxxxxxxxx
Subject: [blind-democracy] Hospitals in Trump Country Suffer as Muslim Doctors
Denied Visas to U.S.
Aside from the point that this article makes, we need to think about why we are
not graduating enough American doctors to fill our needs. It has to do with the
AMA's policy of making the supply of doctors scarce so that they can earn
higher incomes. It has to do with the fact that in the US, Medicine has become
a purely for profit institution and not a service to sick people. This pretense
that we have personal relationships with physicians who know us is ridiculous.
We have Corporate Medicine with doctors, hospitals, insurance companies, and
government officials fighting over who will get paid what.
Miriam
© First Look Media. All rights reservedTerms of use In this picture taken on
Wednesday, March 27, 2013, a Pakistani female doctor examines a patient at the
Dow Medical Institute for Health in Karachi, Pakistan. In a country better
known for honor killings of women and low literacy rates for girls, Pakistan’s
medical schools are a reflection of how women’s roles are evolving. Women now
make up the vast majority of students studying medicine, a gradual change
that’s come about after a quota favoring male admittance into medical school
was lifted in 1991. (AP Photo/Fareed Khan)
Photo: Fareed Khan/AP
Hospitals in Trump Country Suffer as Muslim Doctors Denied Visas to U.S.
Maryam Saleh
August 17 2017, 11:16 a.m.
Every March, doctors across the United States and the world eagerly await
“Match Day” — the day they find out what residency, internship, or fellowship
program they’ve been matched with. By that point, residency candidates have
completed medical school and passed a series of rigorous qualifying exams. For
those who are not American — about a quarter of all doctors in the U.S. are
foreign-born — there’s one additional step: securing a J-1 visa, a nonimmigrant
exchange visa conditioned on an individual’s return to their home country for
at least two years at the conclusion of the program.
In the weeks following the March 17 match, dozens of Pakistani physicians had
their J-1 applications denied in Islamabad and Karachi, said Shahzad Iqbal, a
Pakistani-American physician in New York.
Jan Pederson has spent the last 30 years of her legal career representing
foreign-born physicians coming to the U.S. for residency or fellowship
programs. It’s an unheralded but essential line of work, because without
foreign doctors, the U.S. healthcare system would simply collapse, with the
pain felt most acutely in rural areas. U.S. medical schools don’t produce
anywhere near enough graduates to meet the needs of the country, particularly
in places where people are reluctant to move to.
Like any legal practice, Pederson’s hasn’t always been smooth. Every so often,
a client’s visa application is denied. It happens. In the years following the
Sept. 11 terror attacks, doctors from countries, such as Iran and Syria, saw
their applications get stuck in administrative processing until U.S. officials
could affirmatively say the physicians posed no national security threat, she
said.
But this spring, weeks after President Donald Trump issued a revised version of
an executive order restricting immigration from six Muslim-majority countries,
Pederson saw the same thing Iqbal did — what she called an “epidemic of
Pakistani visa denials.”
Advocates say there is no way to separate the attempted Pakistani physician ban
from the so-called Muslim ban and other Trump administration immigration
policies.
“I think it’s a confluence of factors” that caused the visa denials, Pederson
said. “It would be hard to escape the conclusion” that there is a correlation
between the visa denials and the president’s anti-immigration rhetoric and
policies.
“This year, we had about 34 J-1 refusals that were reported to us. This is kind
of a historic number,” said Iqbal, who chairs the Committee on Young
Physicians, which is a part of the Association of Physicians of Pakistani
Descent of North America. APPNA only knows about denials that rejected
applicants reported to them, so it may be just the tip of the iceberg. Many
reapplied, starting from scratch, and were successful, but started their
programs late.
APPNA has lobbied on behalf of Pakistani doctors hoping to train in the United
States since 2003, Iqbal said. Heightened post-9/11 security measures meant
that many visa applications were held up in administrative processing, but “it
never happened before that there was a mass number of denials,” he said.
“Before, there were security clearances, and people were placed in security
clearance for six months to two years.”
For the last five years, APPNA received reports of, at most, one or two
physicians whose visa applications were denied, and usually it was because of
an issue with an applicant’s immigration history.
This is concerning, Iqbal said, since Pakistan is one of the top suppliers of
foreign doctors to the U.S. In 2015, 12,125 doctors of Pakistani descent were
practicing medicine in the U.S., second only to India’s 46,137 doctors,
according to the U.S. Organization for Economic Cooperation and Development.
“They take care of the sickest of the sick and the poorest of the poor.”
Of the 2,766 international medical graduates who received J-1 visas for the
first time for the 2017-2018 training year, 257 were from Pakistan, according
to the Educational Commission for Foreign Medical Graduates, which oversees
international medical graduates in the U.S. workforce. Among the 34 doctors who
reported visa denials to APPNA this year, 30 of them were ultimately granted
visas after reapplying multiple times or had their applications sent into
administrative processing, Iqbal said. Two doctors’ visas remain denied, and
another two lost their spots in residency programs, which started on July 1 in
Massachusetts and New York, and are therefore no longer eligible for visas.
(Iqbal said the program directors at those hospitals gave APPNA a verbal
promise that the physicians’ seats would be saved for next year, but he
declined to name them out of fear of jeopardizing those agreements.)
“There have been no significant changes specific to the J-1 visa application
process this year,” the State Department told The Intercept in a statement.
“Every visa applicant undergoes extensive security screening.”
What happened to the Pakistani doctors is likely an indirect consequence of the
White House’s immigration policies, such as increased vetting, said Matthew
Shick, director of government relations and regulatory affairs at the
Association of American Medical Colleges.
“[Pakistan] is not on the travel ban list, but in general there’s a lot of fear
in the Pakistani community over changes that have been happening,” said Greg
Siskind, a Memphis-based immigration lawyer and member of the International
Medical Graduate Taskforce, an organization of lawyers who work with
international medical graduates who want to work in the U.S.
This year’s batch of Pakistani physicians are completing residencies around the
country, in states such as Georgia, Kentucky, Minnesota, New York, and New
Jersey, Iqbal said. Many of them matched to hospitals in medically underserved
communities. “The foreign graduates get into programs where Americans don’t
want to go,” he said.
“They take care of the sickest of the sick and the poorest of the poor,”
Pederson said.
After completing their residencies, many international medical graduates seek a
waiver of the requirement that they return home for two years under a federal
program known as the Conrad 30. In exchange, they pledge to work for three
years in an area designated by the federal government as having a shortage of
health professionals or being medically underserved. Participation in the
Conrad 30 program creates a pathway to citizenship and as a result, many
foreign-born doctors launch their careers serving rural communities and
economically disadvantaged populations.
Small-town America has relied on foreign-born doctors for years, but, like the
rest of the country, the demand for doctors exceeds the supply. By 2025, the
U.S. will have a physician shortfall of between 61,700 and 94,700 physicians,
according to a 2016 AAMC report. The dearth of doctors is one reason to be
concerned about the Pakistani doctors’ visa denials, Shick said. “As we face
shortages, denying any physician that is accepted into a residency program is a
bit shortsighted,” he said.
In denying the doctors’ visa applications, American diplomatic outposts in
Pakistan cited a broad provision of the immigration code that says non-citizens
are not entitled to nonimmigrant visas unless they overcome a presumption of
immigrant intent, Pederson said. In other words, applicants must prove to the
satisfaction of the consular officer that they are not intending to fully
emigrate, a task often accomplished by showing family, employment, or financial
ties to the applicant’s home country. The consular officer’s discretionary
decision cannot be appealed (though they can start from scratch and reapply, as
many did), but it makes little sense to Pederson that dozens of applications
were denied this spring.
Both Pederson and Shick said they are not aware of a group other than Pakistani
physicians that saw a significant increase in J-1 visa denials this year,
although Shick said his group is still sorting through the data.
“It’s very anomalous in this situation since all of them virtually had been
issued B1/B2 visas [another class of temporary, nonimmigrant visas] for lawful
purposes such as taking the [United States Medical Licensing Examination],
attending in-person residency interviews, and undertaking observerships,”
Pederson said.
Although most of the doctors had their visas approved after reapplying, Iqbal
fears what happened this year will impact Pakistani physicians’ prospects in
years to come.
“It’s scary for medical graduates because it is a ripple effect,” he said.
“Now, for next year, the program directors will be reluctant to take the
Pakistani physicians there. They won’t get matched.”
Top photo: A Pakistani doctor examines a patient at the Dow Medical Institute
for Health in Karachi, Pakistan in 2013.
