Despite propaganda to the contrary, there are many things we do well in this country. Clear standouts are science and medicine, where we are world leaders. We fund the most research, we publish the most, and we arguably produce the most influential papers in both science and medicine. Our hospitals are among the best in the world.
If there’s another thing we do well, it’s immigration. The society we created did not happen by accident. It was born out of a single brilliant document, the hard work of our forefathers and mothers, and a constant stream of capable and highly motivated immigrants.
Both immigration and science are under threat from the new administration with archaic policies, and now a new travel ban announced Monday by President Trump that takes effect March 16.
The threat to our medical and science system posed by policies that ban immigrants is real. According to the Association of American Medical Colleges, the United States graduates about 18,000 medical students per year. This may seem like a lot, but there are 30,000 residency spots in the country. This leaves a shortfall of 12,000 residents, and it is no surprise that these people come from abroad.
The 12,000 doctors we invite into the country are not getting residencies in the highest paying fields like dermatology and radiology. They are in primary care specialties like family medicine, internal medicine, and psychiatry. They have a great opportunity to come here and work hard, but they mainly do so at positions and in geographic areas U.S. graduates don’t want to go to.
The story in science is much the same, if not more extreme. According to Science and Engineering Indicators, which are regular reports to Congress, about half of our 23,000 post-doctoral scientists in this country are foreign born, most working here on visas.
Post-docs are the backbone of our laboratories, the people who do the experiments and analyze the data. They are also paid the least. They come here because of our great universities, but they also are part of the reason these institutions stay great.
These are skilled workers we are attracting to run our laboratories and work in our hospitals. A February 2017 article in BMJ, formerly known as the British Medical Journal, showed hospitalized patients taken care of by foreign trained internal medicine doctors had lower mortality than American educated doctors. The effect was small, but the study highlights that our foreign physicians do very well here.
One can debate the underlying reasons why we need to so many foreigners to accomplish this work, as well as the effect this brain drain is having on their countries of origin. But our need for great talent from abroad is real, and they are a source of strength for our country.
We have been down this ugly road of shutting down or borders before. In 1924, the Johnson-Reed Act was passed, which limited yearly immigration from a country to 2 percent of the total number of foreign-born citizens who were already in the United States.
The devil in the details: the 1890 census – before mass immigration from Southern and Eastern Europe – was picked as the baseline year. Italians and Jews were clear targets of the law. It also completely banned immigration from Asia, and severely curtailed immigration from Arab and African nations.
This law was rooted in the false science of eugenics as well as overt racism. A revision took place in 1952, and today we have a sensible immigration policy whose beneficiaries have included the founders of great companies like eBay and Google.
The ideas of liberty and equality, of immigration and conservation, of justice and mercy are in constant push and pull. There needs to be an appropriate balance. Of the 1.1 million immigrants, refugees, and visitors from the banned countries who have come here since 2001, none has contributed to a deadly terror attack.
Based on the statistics, immigration and security have been in a reasonable equilibrium. We are now swinging too far in one direction based on false threats. Another version of the ban from Muslim countries was just released. On March 3 the U.S. Citizenship and Immigration Services announced that as of April 3 expedited applications of H1-B visas, an entryway for foreigners with advanced training, would be suspended.
Physicians and scientists aren’t usually ones to speak out. And in society we know those who speak the least are the least recognized. The time has come for our voice to be heard on matters that affect us and our society. A starting point would be the April 22nd Rally for Science in Washington D.C. and at other sites across the country.
Michael J. Stephen, M.D., is Associate Professor of Medicine at Drexel University College of Medicine, and directs the Fellowship in Pulmonary and Critical Care Medicine. Follow him on Twitter @phillydocwriter.
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