Sudanese-born Ahmed Alsayed graduated high school at age 15 with a single-minded goal: become a doctor.
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A precocious student, Alsayed managed to finish both college and medical school and realized his dream of becoming a practicing physician at the young age of 20. But just a few months into his professional life he knew he had to leave his home country of Sudan, a nation severely lacking in resources and technology.
What followed was a two-year journey punctuated by numerous obstacles — from passing required board examinations and completing elective surgery rotations to research assistant positions and volunteering at a free health clinic — all to earn spot at a highly competitive surgical residency in the United States.
Alsayed was certain that his efforts would pay off, but all that changed on Jan. 27, when President Donald Trump issued a sweeping executive order that banned travel from seven predominantly Muslim countries: Sudan, Yemen, Libya, Iran, Somalia, Syria, and at that time, Iraq.
The travel ban was halted by a federal judge in Washington in February and a revised order was issued earlier this month. On Wednesday, a federal judge in Hawaii issued a temporary restraining order on the revised ban, casting doubt over whether it will be implemented.
Amidst this uncertainty, Alsayed and thousands of other aspiring doctors — many of whom hail from outside the United States — are anxiously waiting to find out what careers await them in medicine.
March 17 is Match Day, the day that medical students and foreign medical graduates alike find out whether they have been accepted as resident physicians at institutions across the country, where they will delve deeper into specialties of their interest. It is the culmination of the process by which medical students transform into full-fledged doctors.
An estimated 850 foreign medical graduates are affected by the travel ban, according to the Educational Commission for Foreign Medical Graduates (ECFMG), the agency responsible for certifying international medical graduates for training in the U.S. Many of these students have been grappling with the possibility that their dream of working in the U.S. as a doctor could be over.
The immigration upheaval has hit residency programs as well. Foreign medical graduates largely come to the U.S. on J-1 or H1-B visas to complete their medical training — the very visa programs that the executive order targets.
“This is a very uncertain time because there hasn't been a lot of clarity on how policies may be changing with respect to the executive order,” said Dr. William Pinsky, president and CEO of ECFMG.
Hospital administrators must now weigh these competitive candidates against the reality that they may not be able to enter the U.S. to begin training or be able to leave the country abruptly for a personal emergency, creating vacancies that strain a hospital’s finances and ability to care for patients.
“I can’t remember a time when I ever thought, ‘Well gee, country of origin matters in how I'm going to rank a candidate’, and I’ve heard several program directors struggle with that as well,” said Dr. James Jarvis, President of the Association of Family Medicine Residency Directors.
Though the American Council of Graduate Medical Education (ACGME), a leading organization in advanced medical training and education, and ECFMG have both issued statements imploring residency programs to not weigh nationality and visa status when choosing candidates, some residency applicants say they are anxious that they will not be evaluated on their merits alone.
“I don’t feel like my chances are the same as before. It’s really frustrating,” said a female Sudanese national applying for a residency in the U.S. this year. "I spent a lot of time, money, effort, and at the very last end step, you find out that you’re not going to get as equal of a chance as other applicants.” This Sudanese national, along with two others, asked to remain anonymous due to the sensitive nature of the travel ban.
Applicants worry that a rejection now may dash their hopes forever. Traditionally, foreign medical graduates have just one shot at being accepted into a residency program. If they’re unable to earn a spot during their first application cycle, chances rapidly diminish thereafter, leaving many contemplating whether to pursue training elsewhere, such as the UK or Ireland.
“The major problem is ranking,” said another foreign medical graduate from Sudan, referring to the process in which residency programs select potential candidates for their incoming class. “The executive order may be temporary, but the damage is long lasting. If program directors don’t rank Sudanese nationals, then the opportunity is much less for us in the coming years.”
Pinsky doesn’t necessarily dispute these concerns. “Perception is reality. I think their concerns are certainly warranted,” he said.
If these potential doctors start to leave or other foreign-born doctors no longer wish to train in the U.S., it will be a staggering loss for America’s health care system, which depends on foreign medical graduates to fill critical gaps in the physician workforce.
These doctors often stay after their training is complete, practicing in underserved urban and rural medical communities as a part of a J-1 visa waiver system. By 2025, the U.S. will face a shortage of 61,700 to 94,700 physicians, according to the American Medical Association.
According to Jarvis, the current residents in the pipeline who graduated from medical schools in the original seven countries may go on to serve as many as 4.2 million patients in the U.S. once their training is complete.
Alsayed was fresh off the interview trail and confident that Match Day would turn out well for him when the original executive order was issued in January. He and other students have since scrambled to reassure programs of their long-standing commitment to training in the U.S.
“It’s disheartening, honestly, after working continuously, working very hard to be a competitive candidate for residency," said Alsayed. "I was so happy to get my interviews and with how well they went. And when the executive order came out, I just began contemplating whether or not I still have a future.”
Some have expressed frustration over what they see as a political decision entering into the selection process.
“We feel that this is unfair, unjust. We are being judged on our nationality at this last step of Match. Not qualifications, not merit,” said the female Sudanese medical graduate in the application cycle.
"We were shocked, frustrated, sad, angry," said another female Sudanese student also vying for a residency spot this year. "We can accept the situation, but it’s unfair. We are qualified, but we are being excluded from our dream because of a political reason.”
“My main focus was always training and medicine," said Alsayed. "I never focused on how politics would affect that. Now, this executive order is the first time I’ve thought back on all the sacrifices I made and whether or not they were worth it, contemplating whether any of this was worth it."