Georgia Republican Congressman Tom Price, the new White House healthcare czar, belongs to a physicians' association that just defied the rest of the American medical community by endorsing President Donald Trump's controversial Muslim travel ban.
The Jan. 27 ban, blocked again by a federal appeals court on Thursday, caused chaos for doctors and patients in the United States, with physicians unable to return home to see patients and medical students unsure if they would be able to study medicine in the United States. Dozens of other medical groups condemned the executive order, which attempted to halt travel from Syria, Iran, Iraq, Yemen, Libya, Sudan and Somalia. The fight over the order could soon head to the Supreme Court.
Now, the group has taken issue with immigrants working in the US healthcare system. Price, its most prominent member, will soon oversee the regulation of that system, following his Thursday confirmation by the Senate. Incoming Secretary Price's fellow Association of American Physicians and Surgeons (AAPS) member, writing the same day, hits nativist, xenophobic notes seldom heard from medical professionals.
"The US should be a beacon to attract the best and brightest, and it should welcome those who want to become Americans," wrote Jane Orient, a member of the politically conservative AAPS, which opposes regulation of the healthcare industry.
"Unfortunately, the lives of Americans, as well as the opportunities of aspiring foreign-born doctors, are threatened by those who desire to kill Americans and destroy our culture. These must be screened out," Orient added.
As Health and Human Services Secretary, Price will not only oversee the massive reorganisation of the public healthcare system that Republicans envision, but will also be able to help set regulations for physicians coming from overseas.
Right now, federal programmes provide visas that encourage foreign-born doctors to work in areas with few doctors.
Immigrants represent about a quarter of all American healthcare professionals, from surgeons to nurses and home health aides, according to the Migration Policy Institute.
Price's office did not respond to a request for comment about the AAPS letter, but Orient's words provide a window into the views of conservative doctors on the the impact of immigrants, and regulation, on the healthcare industry.
Orient blamed "endless bureaucratic requirements," such as maintaining medical certifications, for what keeps native-born Americans from going into medicine.
"Is medicine, like agriculture, now filled with ‘jobs that Americans won't do'? Actually we have more than enough Americans who love medical work," Orient wrote.
"For all the emphasis on ‘cultural competence' in American medical schools, and onerous regulations regarding interpreters for non-English speakers, what about familiarity with American culture and ability to communicate effectively with American English speakers? Some foreign-born graduates are doubtless excellent, but many American patients do complain about a communication gap," Orient writes, adding that foreigners provide "cheap, compliant labor" for hospitals.
In contrast to the AAPS endorsement, the ban shook most members of the American medical community.
"I had trouble sleeping last night, to tell you the truth," J B Silvers, a Cleveland health care finance professor told Stat News in the days following the ban.
"If you go to almost any hospital, a community hospital or a teaching hospital, you will find a very substantial number of people from the Middle East. This is just mind-blowing."
The head of the American Medical Association, Dr James Madara, wrote in the days following the ban that immigrants (IMGs) pick up the slack in poor and rural communities where US born doctors don't choose to work.
"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 US medical school graduates," Madara wrote in an open letter to President Trump.
"The AMA is concerned that this executive order is negatively impacting patient access to care and creating unintended consequences for our nation's health care system," he added.
Doctors who learned in the US and work there also present a positive face for the country when practising medicine abroad. Dr Hamid S Jafari, a Harvard-trained public health expert originally from Pakistan, has helped vaccinate people against polio in Egypt, where the crippling disease still lurks
"Medical officers from the U.S. who are immigrants from different ethnic backgrounds are great ambassadors," Jafari told researchers at George Mason University. "They break the stereotypes about Americans and help navigate difficult environments with language and cultural skills to gain the hearts and minds of people the initiative is trying to reach."
So far, the ban, although paused, has cast a cloud of uncertainty over the careers of aspiring doctors working or training in the US.
According to a report in Kaiser Health News, one Sundanese medical student planning to come to the US described huge expenses and effort to secure a job there training while treating patients. After graduating with a medical degree from the University of Khartoum, he spent as much as $20,000 on travel and educational expenses in order to try to get to the US.
"It's very devastating," said the student, who requested anonymity in order to avoid jeopardising his chances of getting a placement in a residency program. "Because you [are] born in an unfortunate situation, you have to pay the price for that."
AUTHOR: Wilson Dizard