Visa crackdown puts these rural doctors at risk
In his pediatric practice in Sioux Falls, South Dakota, Dr. Alaa Al Nofal sees up to 10 patients a day. He has known some of them since their birth. Others still deal with it after graduating from high school.
“I am treating these children for type 1 diabetes, thyroid problems, thyroid cancer, puberty disorders and adrenal gland diseases,” he said.
Al Nofal’s expertise is essential. He is one of five full-time pediatric endocrinologists in a 150,000 square mile area that covers both South Dakota and North Dakota.
Like most rural areas of America, it is a region plagued by a shortage of doctors.
“We are very fortunate to have Dr. Al Nofal here. We cannot afford to lose someone with his specialization,” said Cindy Morrison, marketing director for Sanford Health, a nonprofit-based healthcare system. in Sioux Falls which manages 300 hospitals and clinics in predominantly rural communities.
Yet Sanford Health could lose Al Nofal and several other doctors essential to its healthcare network.
Syrian citizen Al Nofal is in Sioux Falls thanks to a special workforce development program called the Conrad 30 visa waiver – which essentially waives the requirement that doctors who complete their residency on a visa D-1 exchange visitor must return to their country of origin for two years before applying for another US visa. The Conrad 30 waiver allows him to stay in the United States for up to three years as long as he agrees to practice in an area where there is a shortage of doctors.
After President Donald Trump issued a temporary immigration ban preventing people from seven Muslim-majority countries – including Syria – from entering the United States, Al Nofal is unsure of his future in America.
“We agree that something more needs to be done to protect the country, but this decree will have a negative effect on doctors in these countries who are absolutely needed across America,” said Al Nofal. “They may no longer want to practice in the United States.” The action is currently in legal limbo after a federal court of appeal temporarily suspended the ban.
In the past 15 years, the Conrad 30 visa waiver has transported 15,000 foreign doctors to underserved communities.
Sanford Health has a total of 75 doctors for these visa waivers and seven are from the countries listed in the decree. “If we lost Dr. Al Nofal and our other J-1 doctors, we would not be able to fill critical gaps in access to health care for rural families,” said Morrison of Sanford Health.
And the ban could also hurt the pipeline of new doctors. The Conrad 30 Visa Waiver Program is funded by medical school graduates with a non-immigrant J-1 visa who have completed their residency in the United States.
Over 6,000 medical trainees from foreign countries register for residency programs in the United States each year on J-1 visas. According to the American Association of Medical Colleges, about 1,000 of these interns are from countries affected by the ban. J-1 visa holders who were out of the country when the ban came into force were barred from entering the United States and could neither begin nor complete their studies while the ban was in effect.
The State Department told CNNMoney that the government could issue J-1 visas to people from one of the blocked countries if it was “in the national interest”, but would not confirm whether a shortage of doctors would be qualify for such consideration.
“The stress and worry generated by the short-term decree could have long-term implications, with fewer doctors choosing training programs in the United States and subsequently increasing the deficit of providers willing to practice in the underserved and rural areas, “said Dr. Larry. Dial, Vice-Dean of Clinical Affairs in the Faculty of Medicine at Marshall University in Huntington, West Virginia.
Al Nofal went to medical school in Damascus, the capital of Syria, and completed his residency at the University of Texas on a J-1 visa. He did a scholarship to the Mayo Clinic and then asked for a D-1 waiver, which placed him in Sioux Falls.
Nineteen months after his three-year engagement, Al Nofal directly processes or serves consult a doctor with more than 400 pediatric patients per month on average.
He sees most of his patients at the Sanford Specialized Children’s Clinic in Sioux Falls, where families often drive hours for an appointment. Once a month, he flies in a small plane to see patients at a clinic in Aberdeen, about 200 miles away.
“It is not easy to be a doctor in this context,” said Al Nofal, citing the long hours and freezing winters of South Dakota. “But as a doctor, I am trained to help people under any circumstances and I am proud of it.”
This is one of the reasons why Al Nofal and his American wife Alyssa had trouble accepting the visa ban.
“I have a 10 month old baby and I cannot travel to Syria now. My family in Syria cannot come here,” he said. “Now my family cannot meet their first grandson.”
“I know that if we leave, I will probably never be able to come back,” he said. He also doesn’t want to travel anywhere in the country right now. “I am afraid of the way I will be treated,” he said. He is also afraid of being arrested at the airport – even if he goes to another state.
Almatmed Abdelsalam, originally from Benghazi, Libya, had planned to start practicing as a family doctor in Macon, Georgia, as part of the visa waiver program after completing his residency at the College of Medicine University of Central Florida in July.
Everything was going fine. Abdelsalam, who treats hospital patients and veterans, applied for the visa waiver and was accepted. He signed an employment contract with Magna Care, which provides doctors for three hospitals in the Macon area, and he began looking for homes for resettlement, his wife and two young children over the summer.
But there was one last step. For her D-1 Waiver request to be fully completed, she must obtain final approval from the United States Department of State and Citizenship and Immigration Services.
“The decree intervened in the middle of this process, blocking my candidacy for the State Department,” he said.
Because he is a Libyan citizen (Libya is also subject to the visa ban), Abdelsalam is afraid of the result.
“The Macon hospital urgently needs doctors. Even if they have hired me, I don’t know how long they can wait for me,” he said.
“No one can say that it is necessary to keep the country safe, but we must also keep the country healthy,” he said. “Doctors like me, trained in the United States in some of the best schools, are an asset, not a liability.”