In the JournalsPerspective

Trump immigration policy threatens clinical research efforts

Foreign medical graduates play a substantial role in clinical and biomedical research efforts; thus, Trump-era immigration policies that deny individuals from certain foreign countries threaten such efforts, according to findings published in Annals of Internal Medicine.

Recently proposed changes to U.S. immigration policy, such as President Donald J. Trump’s executive order suspending the entry of persons from several Muslim-majority countries and stricter regulations on work visas, have raised moral, legal and geopolitical questions for the United States,” Dhruv Khullar, MD, MPP, from Weill Cornell Medical College and Columbia University, and colleagues wrote. “They also have engendered clinical and biomedical research concerns for the U.S. medical community.”

Khullar and colleagues performed an analysis of data from Doximity, a cross-sectional database of all physicians in the United States, to assess the scientific contributions of foreign medical graduates to biomedical research. Physicians who graduated from a medical school not located in the United States, including United States citizens who were educated abroad, were considered foreign medical graduates.

The researchers found that in 2015, there were 778,781 physicians practicing in the United States; of whom, 21.1% were foreign medical graduates. In addition, 18.3% of academic physicians in the United States were foreign medical graduates and 15.1% of full professors completed medical school in other countries. Foreign medical graduates contributed to 18% of all publications, 18.5% of first-authored publications and 16.5% of last-authored publications. Despite foreign medical graduates being ineligible for certain NIH awards, they led 12.5% of NIH grants, as well as 18.5% of clinical trials.

These data suggest that foreign medical graduates are critical components of clinical teaching, mentorship and biomedical research, according to the researchers.

“Physicians educated abroad but working in the United States play a critical role in promoting and maintaining America’s biomedical competitiveness,” Khullar and colleagues concluded. “Our findings suggest that they account for nearly a fifth of U.S. biomedical research scholarship. By hampering the ability of [foreign medical graduates] to learn from and contribute to the academic medical community in the United States, we risk worsening the health of patients, weakening our position as a global leader in medical innovation, and compromising our aspirational commitment to the ideals that spur scientific progress: collaboration, understanding and the free exchange of ideas.” – by Alaina Tedesco

Disclosure: Khullar reports no relevant financial disclosures. Please see the study for all other researchers’ relevant financial disclosures.

Foreign medical graduates play a substantial role in clinical and biomedical research efforts; thus, Trump-era immigration policies that deny individuals from certain foreign countries threaten such efforts, according to findings published in Annals of Internal Medicine.

Recently proposed changes to U.S. immigration policy, such as President Donald J. Trump’s executive order suspending the entry of persons from several Muslim-majority countries and stricter regulations on work visas, have raised moral, legal and geopolitical questions for the United States,” Dhruv Khullar, MD, MPP, from Weill Cornell Medical College and Columbia University, and colleagues wrote. “They also have engendered clinical and biomedical research concerns for the U.S. medical community.”

Khullar and colleagues performed an analysis of data from Doximity, a cross-sectional database of all physicians in the United States, to assess the scientific contributions of foreign medical graduates to biomedical research. Physicians who graduated from a medical school not located in the United States, including United States citizens who were educated abroad, were considered foreign medical graduates.

The researchers found that in 2015, there were 778,781 physicians practicing in the United States; of whom, 21.1% were foreign medical graduates. In addition, 18.3% of academic physicians in the United States were foreign medical graduates and 15.1% of full professors completed medical school in other countries. Foreign medical graduates contributed to 18% of all publications, 18.5% of first-authored publications and 16.5% of last-authored publications. Despite foreign medical graduates being ineligible for certain NIH awards, they led 12.5% of NIH grants, as well as 18.5% of clinical trials.

These data suggest that foreign medical graduates are critical components of clinical teaching, mentorship and biomedical research, according to the researchers.

“Physicians educated abroad but working in the United States play a critical role in promoting and maintaining America’s biomedical competitiveness,” Khullar and colleagues concluded. “Our findings suggest that they account for nearly a fifth of U.S. biomedical research scholarship. By hampering the ability of [foreign medical graduates] to learn from and contribute to the academic medical community in the United States, we risk worsening the health of patients, weakening our position as a global leader in medical innovation, and compromising our aspirational commitment to the ideals that spur scientific progress: collaboration, understanding and the free exchange of ideas.” – by Alaina Tedesco

Disclosure: Khullar reports no relevant financial disclosures. Please see the study for all other researchers’ relevant financial disclosures.

    Perspective
    Jack Ende

    Jack Ende

    The American College of Physicians is resolute in its opposition to Executive Orders barring immigration of vetted foreigners to the United States based upon religion or origin from Muslim countries, and, also imposing travel bans to and from the U.S. for medical students, medical trainees, physicians, and physician-scientists based solely upon religion and country of origin.

    ACP has spoken out on the negative impact of such bans upon clinical care within the U.S., notably in rural and impoverished areas where foreign medical graduates have provided valued service to the medical community. Earlier this year, ACP released a comprehensive statement on U.S. immigration policy, detailing ACP’s opposition to discrimination, religious tests, refugee bans, and denial of entry to persons with legal visas, and expressing concerns about the implications executive orders on medical education, access to healthcare services, public health and families.

    The article published in Annals of Internal Medicine focuses on the impact of these same restrictions upon medical research. Not surprisingly, the impact is profound.

    The data presented in this article depicts only a portion of this impact. What about non-physician scientists from Muslim-majority countries? What about PhD candidates, post-doctoral researchers, as well as senior non-MD researchers? We desperately need these talented and well-trained scientists in our universities, hospital and institute laboratories. It is short sighted to set back our critical medical research initiatives based upon religion or country of origin. America can and must do better than that, as can and should our American medical research enterprise.

    • Jack Ende, MD
    • President of ACP Professor, Perelman School of Medicine at the University of Pennsylvania

    Disclosures: Ende reports no relevant financial disclosures.

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