At his pediatric practice in Sioux Falls, South Dakota, Dr. Alaa Al Nofal sees up to 10 patients a day. He has known some of them since they were born. Others he still treats after graduating from high school.
“I treat these kids for type 1 diabetes, thyroid problems, thyroid cancer, pubertal disorders and adrenal gland diseases,” he said.
Al Nofal’s experience is essential. He is one of five full-time pediatric endocrinologists in a 150,000-square-mile area covering both South and North Dakota.
Like most of rural America, it is a region plagued by a shortage of doctors.
“We are very fortunate to have Dr. Al Nofal here. We cannot afford to lose someone with his expertise,” said Cindy Morrison, chief marketing officer for Sanford Health, a nonprofit health care system based in Sioux Falls which operates 300 hospitals and clinics in predominantly rural communities.
Related: Visa ban could further worsen doctor shortage in rural America
However, Sanford Health may lose Al Nofal and several other doctors who are crucial to its healthcare network.
Al Nofal, a Syrian national, is in Sioux Falls through a special workforce development program called the Conrad 30 visa waiver, which basically eliminates the requirement for doctors to complete their residency on a J-1 exchange visitor visa. must return to their country of origin. for two years before applying for another US visa. The Conrad 30 waiver allows you to remain in the US for up to three years, as long as you commit to practicing in an area where there is a shortage of doctors.
After President Donald Trump issued a temporary immigration ban By restricting entry into the United States to people from seven Muslim-majority countries, including Syria, 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 the doctors in these countries who are greatly needed throughout the United States,” Al Nofal said. “They may no longer want to practice in the United States.” The action is currently in legal limbo after a federal appeals court temporarily detained prohibition.
For the past 15 years, the Conrad 30 visa waiver has channeled 15,000 foreign doctors into underserved communities.
Sanford Health has 75 total physicians with these visa waivers and seven are from the countries listed in the executive order. “If we lost Dr. Al Nofal and our other J-1 physicians, we would not be able to fill critical gaps in access to health care for rural families,” said Morrison of Sanford Health.
And the ban could also hurt the pipeline of new doctors. The Conrad 30 visa waiver program is intended for medical school graduates with J-1 nonimmigrant visas who have completed their residencies in the US.
More than 6,000 medical students from foreign countries enroll in US residency programs through J-1 visas each year. About 1,000 of these students come from countries affected by the ban, according to the Association of American Medical Colleges. J-1 visa holders who were out of the country when the ban went into effect were barred from entering the U.S. and were unable to 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 from one of the blocked countries if it is in the “national interest,” but did not confirm whether the doctor shortage would affect qualify for such consideration.
“The stress and concern generated by the executive order in the short term could have long-term implications, with fewer physicians choosing training programs in the states and subsequently magnifying the shortfall of providers willing to practice in rural and underserved areas,” said the Dr. Larry Dial, vice dean for 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 earned a fellowship at the Mayo Clinic and then applied for a J-1 waiver, which placed him in Sioux Falls.
Nineteen months into his three-year engagement, Al Nofal is either directly dealing with or serving as medical consultation to 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 for hours to make an appointment. Once a month, he travels by small plane to see patients at a clinic in Aberdeen, about 200 miles away.
“It’s not easy being a doctor in this environment,” Al Nofal said, citing the long work hours and South Dakota’s famously frigid winters. “But as a doctor, I am trained to help people in any circumstance and I am proud of that.”
It’s one of the reasons Al Nofal and his American wife Alyssa have had a hard time accepting the visa ban..
“I have a 10-month-old baby and I can’t travel to Syria now. My family in Syria can’t come here,” she said. “Now my family can’t meet their first grandchild.”
“I know if we leave I’ll probably never be able to come back,” he said. She also doesn’t want to travel anywhere in the country right now. “I’m afraid of how they will treat me,” she said. He also fears being stopped at the airport, even if he travels to another state.
Almatmed Abdelsalam, originally from Benghazi, Libya, had planned to begin practicing as a family physician in Macon, Georgia, through the visa waiver program after completing his residency at the University of Central Florida College of Medicine in July.
Everything was going well. Abdelsalam, who treats inpatients and veterans, applied for a visa waiver and was accepted. He signed a work contract with Magna Care, which provides doctors to three hospitals in the Macon area, and had begun looking for homes to relocate himself, his wife and his two young children to over the summer.
But there was one last step. For your J-1 waiver application to be fully complete, you need to obtain final approval from the Department of State and U.S. Citizenship and Immigration Services.
“The executive order came in the middle of that process, stalling my application at the State Department,” he said.
As a Libyan citizen (Libya is also subject to the visa ban), Abdelsalam fears the outcome.
“The Macon hospital is in urgent need of doctors. Although they have hired me, I am not sure how long they will be able to 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 United States at some of the best schools, are an advantage, not a disadvantage.”
CNNMoney (New York) First published February 10, 2017: 7:47 pm ET