Immigration ban hits underserved US communities hard

When the Trump administration fully suspended entrance to foreign nationals from 19 countries it deemed high-risk for exporting troublemakers, an unintended consequence was cutting off a helpful flow of qualified doctors and nurses. 

New research shows the U.S. communities most likely to experience the ill effects of the cutoff are already underserved due to clinician shortages. 

Worse, since the administration’s stance on immigration shows no signs of softening anytime soon, the staffing shortfalls are “unlikely to be offset by increases from elsewhere, potentially undermining health care access,” the researchers write. 

The authors are Harvard researchers Tarun Ramesh, MD, Michael Liu, MD, MPhil, and Hao Yu, PhD.

Their analysis posted May 30 in JAMA Network Open.

For the study, the team analyzed data maintained by the Paris-based Organization for Economic Cooperation and Development (OECD), concentrating on licensed and professionally active physicians and nurses from the 19 banned countries. 

The countries on the demerited list are Afghanistan, Burma, Burkina Faso, Chad, Republic of the Congo, Equatorial Guinea, Eritrea, Haiti, Iran, Laos, Libya, Mali, Niger, Sierra Leone, Somalia, South Sudan, Sudan, Syria and Yemen.

Also facing turnaways, according to the U.S. State Department, are “individuals traveling on any travel documents issued or endorsed by” the Palestinian Authority. 

Deep data, predictable patterns 

To identify U.S. counties with foreign-born physicians and nurses from the banned countries, along with the pertinent characteristics of these counties, the researchers used data from the American Community Survey (ACS), the HHS’s Area Health Resources Files (which are maintained by HRSA, the Health Resources and Services Administration) and the CDC’s Social Vulnerability Index (SVI).

Measuring the annual inflow of physicians and nurses from the banned countries into the US, Ramesh and colleagues then calculated the prevalence of physicians and nurses from banned countries among the overall U.S. healthcare workforce in 2023. 

Their key findings: 

• Annual physician inflow from banned countries increased from 350 in 2010 to 459 in 2023, accounting for approximately 2.5% of total physician inflow in 2023. 
   
• Annual nurse inflow from banned countries increased from 189 in 2010 to 368 in 2022, representing approximately 1% of total nurse inflow in 2022.  
   
• The banned countries with the largest number of emigrating physicians over the study period were Iran (1,772), Venezuela (918) and Cuba (807).
   
• The largest number of nurses originated from Cuba (1,312), Haiti (665) and Iran (486). 
   
• In 2023, 2.15% of all US physicians (23,745 of 1,104,420) and 1.41% of all US nurses (56,332 of 3,995,216) were from banned countries.

Is the cure worse than the condition?   

The analysts also found that, among 3,097 U.S. counties analyzed, 203 had at least one physician from a banned country. 

In those counties, only 1.58% of all physicians were from banned countries. 

However, in 222 counties with at least one nurse from a banned country, a considerable proportion of all nurses (14.14%) were from banned countries.

“The numbers of physicians and nurses immigrating from countries with complete immigration bans have significantly increased over the past decade, with these countries contributing nearly 24,000 physicians and 56,000 nurses to the entire U.S. healthcare workforce in 2023,” the researchers note in their discussion section. 

“Communities with physicians and nurses from banned countries,” they add, “were much more likely to experience ongoing healthcare workforce shortages.”

The study is posted in full for free.