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ACP opposes religious tests, refugee ban, denial of entry for persons with legal visas;
supports path to legal residency for "Dreamers"

January 31, 2017

Attributable to:
Nitin S. Damle, MD, MS, MACP, President, �������ý

Today, the �������ý (ACP) is releasing a comprehensive statement on U.S. immigration policy. It details ACP’s opposition to discrimination, religious tests, refugee bans, and denial of entry to persons with legal visas, and expresses grave concerns about the implications of the executive order on medical education, access to health care services, public health and families. The statement, as approved by the College’s Executive Committee of the Board of Regents on January 30, 2017, is presented below.

Background:

On January 27, 2017 President Trump signed an executive order that severely restricts immigration from seven Muslim-majority countries, suspends all refugee admission for 120 days, and bars all Syrian refugees indefinitely. It bans the citizens of seven majority-Muslim countries—Iraq, Iran, Syria, Somalia, Sudan, Libya, and Yemen—from entering the U.S. on any visa category. On Saturday, January 29, 2017, this included individuals who have student visas, permanent residency status (green cards), H-1B visas for foreign workers in specialty occupations who were traveling overseas to visit family or for work. Reports indicate that between 100 and 200 travelers from those Muslim-majority countries were being held at various airports around the U.S. as a result of the President’s order.

This includes at least two internal medicine residents who are ACP members. A second-year resident in internal medicine at Interfaith Medical Center in Brooklyn with an H-1B visa for foreign workers in specialty occupations was blocked from boarding a plane back to the U.S. from Sudan. A first-year internal medicine resident at the Cleveland Clinic was forced to leave the U.S., hours after landing at New York’s John F. Kennedy International Airport. She was given the choice of withdrawing her visa application “voluntarily” or being forcibly deported and not allowed back to the U.S. for at least five years. According to the Association of American Medical Colleges (AAMC), there are currently 260 applicants from the affected countries among the 35,000 people seeking residency and fellowship positions in this country. Restricting entry of such persons not only disrupts their training and potentially separates them from family members, it also will result in many thousands of patients losing access to their physician.

The executive order could deny entry or reentry to tens of thousands more persons, including medical students and physicians who are being trained in the United States and/or are delivering direct patient care. There are at least 90,000 visa holders, including those with tourist visas, who could be denied entry. It also creates a precedent for barring entry of international medical graduate (IMGs) based on their religion and country of origin. According to the Association of American Medical Colleges (AAMC), one-quarter of physicians practicing in the U.S. are international medical graduates. Approximately 30 percent of ACP members are IMGs. In 2016, 3,769 non-U.S. citizen IMGs obtained first-year residency positions. In the same year, 3029 (45.6 percent) of PGY-1 internal medicine positions were filled by international medical graduates. This figure includes both U.S. citizen students at offshore schools and non U.S. citizen IMGs. AAMC also stated that in 2016, 108 students with Deferred Action for Childhood Arrivals (DACA) status applied to medical school, and 34 matriculates with DACA status entered medical school, bringing total medical school enrollment to approximately 70 students, including several internal medicine residents.

Discrimination based on religion violates ACP's longstanding policies on non-discrimination based on gender, race, ethnicity, religion and other factors.

The ban on refugees will contribute to a public health crisis for those affected. According to the Atlantic, "the U.S. took in 12,486 Syrian refugees in 2016, a tiny fraction of the 11 million Syrians who have fled their homes since the war there started in 2011. Now, with the signing of President Trump’s executive order, that number will be brought to zero—indefinitely. This means the U.S. is effectively shutting out a group of people who are suffering from one of the worst humanitarian and public-health crises in recent memory. Syrians are living in medieval conditions, contracting diseases that had been long ago eliminated by vaccination, such as polio. Even highly treatable conditions like diabetes go unchecked, because the Syrian government and its allies have systematically targeted and killed nearly 700 Syrian doctors, according to Physicians for Human Rights."

In 2012, President Obama issued an executive order to protect men and women who were born in another country and brought illegally to the U.S. at a young age, called Deferred Action for Childhood Arrivals (DACA). DACA grants lawful presence in the U.S. and provides these individuals with work authorization, Social Security numbers, and in many cases state IDs and driver’s licenses, making it possible for them to attend medical school and residency training. Approximately 690,000 out of the 1.9 million estimated young adults in the U.S. who are undocumented immigrants have been granted DACA status. As a candidate, President Trump stated that he planned on revoking the DACA executive order. Many have urged him not to do so until a permanent pathway to lawful immigration for individuals with DACA status is approved by Congress. Several bills have been introduced in Congress to ensure a temporary stay of deportation for individuals with DACA status until such time that Congress approves a permanent fix, and to establish a path to legal immigration.

The executive order and the potential deportation of "Dreamers" have grave implications for medical education, access to health care services, public health, families and freedom to worship. It is essential that Congress, the courts and the administration re-think the current policies and replace them with non-discriminatory policies that support families, public health, and medical education while ensuring that persons entering the U.S. are thoroughly vetted before being granted visas.

Recommendations:

1. ACP supports expanding U.S legal residency status to refugees who are vulnerable to health consequences, including death, illness, starvation and persecution, with appropriate vetting. ACP opposes denying refugee status from persons in designated countries of origin who otherwise would meet refugee status law requirements in the United States.
2. ACP opposes policies that would broadly deny entry or re-entry to the United States for persons who currently have legal visas, including permanent residence status (green card) and student visas, based on their country of origin and/or religion. ACP is particularly concerned about the impact on medical students and foreign-born non-citizen physicians who have or will seek to have legal visas to study or provide medical care within the U.S. as authorized by current law.
3. ACP strongly opposes discrimination based on religion, race, gender or gender identity, or sexual orientation in decisions on who shall be legally admitted to the United States as a gross violation of human rights. The College reaffirms its view that practicing physicians, residents, fellows and medical students, including those of the Muslim faith, should not be subjected to discrimination and/or travel restrictions, based on their religious beliefs, and believes that this principle should broadly apply to all persons seeking legal admission to the United States.
4. ACP is concerned about the health consequences of policies that would split up families, including separating parents and children from each other. We oppose policies that would deny permanent or temporary entry to the United States to persons who otherwise would meet current law requirements for admission. Priority should be given to supporting families in all policies relating to immigration and lawful admission to the United States to live, study, or work.
5. ACP opposes deportation of undocumented medical students, residents, fellows, practicing physicians, and others who came to the United States as children due to the actions of their parents ("Dreamers") and have or are eligible for Deferred Action for Childhood Arrivals (DACA) status. We urge the administration to preserve the DACA action taken by the previous administration until such time that Congress approves a permanent fix. The College also urges Congress to promptly enact legislation to establish a path to legal immigration status for these individuals to ensure that “Dreamers” are permanently protected from deportation. These individuals should also have access to federal student loans and other appropriate opportunities.
6. ACP supports the establishment of a path to legal immigration status for undocumented children who came to the United States due to the actions of their parents.
7. ACP reaffirms its call for a national immigration policy consistent with the recommendations in its 2011 paper, National Immigration Policy and Access to Health Care.

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The �������ý is the largest medical specialty organization in the United States. ACP members include 148,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on and .

Contact: David Kinsman, APR (202) 261-4554, dkinsman@acponline.org