The repression of visas puts these rural doctors at risk

In his pediatric practice in Sioux Falls, South Dakota, Dr. Alaa Al Nofal cares for up to 10 patients per day. He knows some of them since they were born. Others, he still tries after they have graduated from high school.

“I treat these children for type 1 diabetes, thyroid problems, thyroid cancer, puberty disorders, and diseases of the adrenal glands,” he said.

Al Nofal’s experience is critical. 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 of rural America, it is a region plagued by a shortage of doctors.

“We are very lucky to have Dr. Al Nofal here. We cannot afford to lose someone with his expertise,” said Cindy Morrison, director of marketing for Sanford Health, a Sioux Falls-based nonprofit healthcare system that He runs 300 hospitals and clinics in predominantly rural communities.

Related: visa ban could worsen doctor shortages in rural America

However, Sanford Health may lose Al Nofal and several other doctors who are crucial to its health care network.

A Syrian citizen, Al Nofal is in Sioux Falls through a special workforce development program called the Conrad 30 Visa Waiver, which basically waives the requirement for doctors to complete their residency with an exchange visitor visa J -1 must return to their country of origin. for two years before applying for another US visa. The Conrad 30 waiver allows you to stay in the US. USA For up to three years, as long as you agree to practice in an area where there is a shortage of doctors.

After President Donald Trump issued a temporary immigration ban By preventing people from seven Muslim-majority countries, including Syria, from entering the US In the US, Al Nofal is unsure of his future in the United States.

“We agree that more must be done to protect the country, but this executive order will have a negative effect on doctors in these countries who are in great need throughout the United States,” said Al Nofal. “Maybe they don’t want to practice in the United States anymore.” The action is currently in legal limbo after a federal appeals court. temporarily detained prohibition

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In the past 15 years, the Conrad 30 visa exemption it has channeled 15,000 foreign doctors into marginalized communities.

Sanford Health has 75 doctors in total on these visa waivers and seven are from the countries listed in the executive order. “If we lose Dr. Al Nofal and our other J-1 doctors, we could not fill the critical gaps in access to health care for rural families,” said Morrison of Sanford Health.

And the ban could also harm the pipeline of new doctors. The Conrad 30 visa exemption program is powered by graduates of medical schools with J-1 nonimmigrant visas who have completed their residency in the US. USA

More than 6,000 doctors in practices from foreign countries enroll each year in US residency programs. USA through J-1 visas. According to the American Association of Medical Colleges, about 1,000 of these trainees are from countries caught in the ban. J-1 visa holders who were out of the country when the ban went into effect were prohibited from entering the US. USA And they cannot start or finish school while the ban is in effect.

The State Department told CNNMoney that the government can issue J-1 visas to people who are from one of the blocked countries if it is in the “national interest”, but did not confirm whether the shortage of a doctor qualify for such consideration.

“The stress and concern generated by the executive order in the short term could have long-term implications, as fewer doctors choose training programs in the states and, subsequently, increase the deficit of providers willing to practice in marginalized and rural areas” said Dr. Larry Dial, vice dean of clinical affairs at Marshall University School of Medicine in Huntington, West Virginia.

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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 proceeded on a fellowship at the Mayo Clinic and then applied for a J-1 waiver, which placed him in Sioux Falls.

Nineteen months after their three-year engagement, Al Nofal directly treats or serves as consult a doctor more than 400 pediatric patients per month on average.

He sees most of his patients at the Sanford Children’s Specialty Clinic in Sioux Falls, where families often drive appointment times. Once a month, he flies a small plane to see patients at a clinic in Aberdeen, about 200 miles away.

“It’s not easy being a doctor in this environment,” said Al Nofal, citing the long hours and famous cold winters of South Dakota. “But as a doctor, I am trained to help people in any circumstance and I am proud of it.”

It is one of the reasons why Al Nofal and his American wife Alyssa have struggled to come to terms with 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 grandchild.”

“I know that if we leave, I can probably never go back,” he said. He also does not want to travel to any part of the country at this time. “I am afraid of how they will treat me,” he said. He also fears being detained at the airport, even if he travels to another state.

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Almatmed Abdelsalam, who is from Benghazi, Libya, had planned to start practicing as a family doctor in Macon, Georgia, through the visa waiver program after completing his residency at the University of Central Florida School of Medicine in July .

Everything was going well. 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 to three hospitals in the Macon area, and began looking for houses to move himself, his wife, and their two young children over the summer.

But there was one last step. In order for your J-1 waiver application to be fully completed, you must obtain final approval from the Department of State and the United States Citizenship and Immigration Services.

“The executive order came in the middle of that process, stopping my application at the State Department,” he said.

Because he is a Libyan citizen (Libya is also subject to the visa ban), Abdelsalam fears the outcome.

“The Macon hospital urgently needs doctors. Although they have hired me, I am not sure how long they can wait for me,” he said.

“No one can argue that it is necessary to keep the country safe, but we must also keep it healthy,” he said. “Doctors like me, trained in the US In some of the best schools, are an asset, not a liability.”

CNNMoney (New York) First published on February 10, 2017: 7:47 p.m. ET