Nearly 1,000 sufferers come to Dr. Faysal Al Ghoula’s pulmonology clinic in southwestern Indiana yearly. Some come to handle persistent lung illness; others reckon with a brand new lung most cancers prognosis.
The 38-year-old physician additionally spends weeklong stretches in an understaffed ICU, watching over sufferers as ventilators hum and conversations tip between survival and loss. On his days off, he volunteers at a clinic for uninsured sufferers.
The father of two summed it up: “It’s busy.” But whilst demand for Al Ghoula grows, he fears that his capability to take care of sufferers is in danger.
Trump administration coverage adjustments are placing a rising quantity of immigrant doctors in limbo. And Al Ghoula is aware of he might be subsequent. He’s from Libya, one of the 39 international locations officers now name “high-risk.”
Many immigrants from these international locations who got here to the US legally are going through indefinite delays in choices on their functions for visas, work permits, inexperienced playing cards and citizenship. And some hospitals have already misplaced doctors, a loss felt throughout the communities they serve.
According to the Cato Institute, a libertarian suppose tank, roughly 2 million immigration functions are affected by these insurance policies. About 240,000 are for inexperienced playing cards.
Al Ghoula and doubtlessly 1000’s of different foreign-born doctors are actually caught in that limbo, and a few have been pressured to step away from work with out pay — jeopardizing their very own futures within the US. While they wait, some have filed lawsuits towards the federal authorities, hoping to guard their capability to maintain working.
“I really trusted the system. I believed in it,” stated Al Ghoula, who holds a visa that classifies him as somebody with “extraordinary ability.” “I wanted to be part of this great country, and now I’m receiving this message that I’m not good enough.”
Al Ghoula remains to be working, however his authorization to take action is about to run out in September.
Foreign-born doctors often employees rural and underserved hospitals. That’s one motive why specialists argue that though nationals from the 39 international locations focused by President Donald Trump’s journey ban characterize a small share of immigrant doctors, they play an outsized function. Their loss received’t pressure hospitals to close down, however sufferers will really feel the loss. And changing these doctors will take years.
Physicians are required to finish at the very least three years of residency, and a few — like Al Ghoula — prepare for seven years or extra to subspecialize in fields like pulmonary and demanding care drugs. NCS spoke with eight doctors affected by the sudden coverage change. All dwell within the US, and most have spent over a decade constructing their careers within the nation.
The American Medical Association, the biggest lobbying group for doctors, has known as on the US Departments of Homeland Security and State to exempt physicians from the ban, citing the “much-needed medical care” they supply. With workforce shortages projected within the decade forward, “foreign trained physicians play a critical role in filling this void, especially in areas of the U.S. with high-need populations,” the group wrote in a letter to the 2 businesses.
The letter stated strikes made by the White House are “harming foreign-trained physicians already practicing in the US and placing their immigration status and patient care at risk.”
US Citizenship and Immigration Services (USCIS) spokesperson Matthew J. Tragesser didn’t reply to particular questions on how the freeze may be lifted or whether or not the administration is contemplating exemptions for physicians. In a press release to NCS, he stated the Biden administration allowed “dangerous people, including national security threats, into our country.”
“Verifying [identities] and personal histories from various countries — especially those countries with poor records on their citizens — requires a rigorous process,” Tragesser wrote. “USCIS has paused all adjudications for aliens from President Donald Trump’s designated high-risk countries while we work to ensure they are vetted and screened to the maximum degree possible.”
A memo launched by the company in January mentioned that exemptions are doable, however doctors who spoke with NCS stated they’ve been unable to safe one.
Last month, USCIS said the company has “established an internal process for lifting holds on individual or group cases.”
David J. Bier, an immigration coverage skilled on the Cato Institute, stated the company’s description of the method was “incredibly vague.”
“It’s them pretending like they’ve done something meaningful here as opposed to actually meaningfully changing the policy,” he stated.
Historically, the federal authorities has exempted doctors from some immigration restrictions. In June, after a separate coverage change, the State Department directed officers to prioritize physicians’ visa functions. More just lately, bipartisan laws introduced within the House would exempt doctors from sure coverage shifts.
But it’s unclear whether or not the Trump administration will lengthen comparable carve-outs to doctors affected by the present pause.
Al Ghoula is filling a essential want in Evansville, Indiana, a group tucked alongside the Ohio River on the edge of Illinois and Kentucky.
“I like small cities,” he stated. “The pace of life is slower. You get to know your neighbors. They look out for you. You can really enjoy your life here.”
But that location additionally makes it a hard sell for most doctors in search of work.
International medical graduates who aren’t US residents make up about 18% of training US physicians. Many immigrant physicians, like Al Ghoula, help address the scarcity of doctors in medically underserved areas such as southwestern Indiana. A 2021 survey of non-US citizen physicians estimated that about 64% of respondents practice in these areas and different understaffed areas.
Iqbal, who’s initially from Afghanistan, practices in a single of these areas, too. He requested to be recognized by a pseudonym, citing fears of skilled retribution.
Like Al Ghoula, Iqbal enrolled in a program designed to assist doctors safe a path to authorized residency. In change, foreign-born doctors work in an underserved area within the US for up to five years.
Immigrants from the 39 international locations who’re both beginning or ending these packages are trapped within the freeze. Those on an H-1B visa — a standard pathway into the US workforce for brand spanking new immigrants — who request an extension have a 240-day grace period that permits them to proceed working whereas their case is examined.
Iqbal has practiced as a major care doctor in a rural space for a number of years. Last 12 months alone, he informed NCS, he took care of greater than 1,600 sufferers, a majority of whom are coated by Medicare or Medicaid.
He serves a metropolis that overwhelmingly voted for President Donald Trump in 2024.
“My patients often ask where I’m from, and when I tell them, that starts a conversation, and they ask questions,” Iqbal stated. “The more you know people, the more you talk with people, those prejudices fade away.”
But when he utilized to dwell and work completely within the US final 12 months, he too was pulled into limbo.
“I have abided by all the rules,” Iqbal stated. “Now there is no path for me to be able to continue.”
Iqbal remains to be working for now. But the small group may lose him when his work authorization expires in October.
Another group of physicians affected by the pause is doctors in coaching, generally known as residents and fellows. Hospitals supply a restricted quantity of these coaching positions annually, and so they’re essential to maintaining hospitals operating. Some specialties and prime packages are extremely aggressive, however throughout the nation, there nonetheless aren’t sufficient US doctors to fill all residency positions.
This 12 months, about 30,000 college students graduating from US medical colleges utilized for residency — greater than 10,000 quick of the roughly 41,000 residency positions accessible. Restricting foreign-born residents may deepen doctor shortages in lots of communities, the American Medical Association stated in its letter to DHS and the State Department.
Applying for a residency spot is extraordinarily aggressive and costly for foreign-born physicians, and plenty of spend years doing analysis to spice up their software. This 12 months, solely 56% of non-citizen worldwide medical graduates secured a residency place — the bottom price in 5 years — in contrast with 93% of new MD graduates from the US.
“Recent federal immigration policy changes have increased attention to visa sponsorship considerations in residency recruitment for foreign-born candidates,” the National Resident Matching Program, which is concerned in assigning residency positions, stated in a information launch.
Multiple doctors concerned in recruiting new resident physicians declined to talk with NCS. In the Midwest, a health care provider working in a big well being care system spoke on situation of anonymity for concern of skilled retribution.
The physician, who’s concerned in recruiting residents this 12 months, stated, “We have been told we cannot rank people from Afghanistan, and we cannot rank people from Sudan [who require visa sponsorship], and there may be other countries, as well.”
Medicare, the largest payer for residency coaching, provided a mean of $104,209 per resident in fiscal 12 months 2024. If a foreign-born resident doesn’t arrive — and isn’t changed — hospitals lose funding tied to that place.
At UConn Health’s inside drugs residency program, Dr. Rebecca Andrews, who chairs the policy-making physique of the American College of Physicians, stated her group’s choice course of wasn’t influenced by visa sponsorship issues.
Andrews, an affiliate program director for the residency program, stated she stays “very nervous” about July, the common begin date for all new residents.
She worries that doctor trainees from the 39 international locations will likely be caught within the coverage freeze if an exemption isn’t granted.
Elisa, an Iranian physician whose future within the US is now unsure, is an instance of such a case. She additionally requested to be recognized by a pseudonym, citing fears of skilled retribution.
“I’m crying every day and night,” stated Elisa, who matched into an ophthalmology program. In 2025, just 2% of worldwide graduates who utilized broke into the extremely aggressive discipline. “Everybody who matched is happy, and they’re going on vacation. But I have to be worried.”
Elisa, who lives within the Northeast, stated she calls USCIS daily, detailing the scripted responses she receives each time she calls. But calls to those that matter most to Elisa — her household in Iran — have gone unanswered.
Since the battle in Iran started, web blackouts have made it practically unimaginable to succeed in them. When the connection glints again — generally for a mere 30 seconds — the conversations flip to life and demise. Her profession within the US is absent from these moments.
“They think that I am starting residency with no problems. I don’t share my difficulties here [in the US] with them,” Elisa stated. “Somebody else is deciding [my future] for me. It feels so sad.”
Andrews predicts this summer time is perhaps much more chaotic than final 12 months. In July 2025, 20 residents in her program at UConn had “visa issues.” She added: “There were weeks where we just did not sleep.”
“We want to recruit the very best into medicine,” Andrews stated. “It is very nerve-wracking not to know who will be there on day one.”
It’s been 15 years since Dr. Ezequiel Veliz began medical faculty in his residence nation of Venezuela, however he nonetheless remembers what it felt like.
“I started medical school there with the illusion of, ‘Oh, my God, I’m gonna learn a lot, and I’m gonna help people,’” Veliz recalled. “But hospitals in my country started being a place where you would go to see people suffer instead of getting healed.”
A medical system on the verge of collapse meant drugs had develop into an train in helplessness. So the younger physician set his sights on training elsewhere: within the Rio Grande Valley of South Texas, an underserved space the place charges of diabetes, hypertension and weight problems all exceed 30%.
The group, nestled alongside the US-Mexico border, welcomed him two years in the past when he began his household drugs residency.
“Every time I saw a diabetic patient that got better because I took care of them, it really filled me with joy and fulfillment,” the 32-year-old stated. “I was doing something good for this society.”
Doctors on his group described Veliz as “one of the best” residents they ever labored with and a “tremendous” asset to the group, with many additionally saying they might “gladly” let him take care of their household and associates.
But when the Trump administration stripped deportation protections for Venezuelans final 12 months, he was left with out authorized standing to work. On November 7, Veliz misplaced his job — and Rio Grande Valley misplaced a health care provider it desperately wanted.
That identical day, one other physician who can be from Venezuela was dismissed. The physician requested to be recognized by a pseudonym, citing fears of skilled retribution.
“It has been one of the darkest moments of my life,” Maria stated. The immigrant physician has lived within the United States for 10 years, working as a server and nanny, washing vehicles and “whatever you can imagine” — at instances experiencing homelessness — whereas making use of for residency.
After two years of makes an attempt, she lastly matched final 12 months and began working in July. She known as the primary 4 months of residency — typically among the many hardest — the “happiest” she’s ever been. But she now feels defeated and remoted.
“I never experienced something like this before,” she stated. “It means that I lost my fight of 10 years. It would mean the end of this American dream.”
The program coordinator at Veliz’s residency program wrote that the loss was “felt profoundly and immediately across our institution and the region we serve.”
“Being stripped of it has been hard, and no one seems to care,” stated Veliz, who’s now searching for authorized standing to return to work. “This is about patients and personal lives, but we’re allowing politics to affect this.”
Last month, Al Ghoula and 14 different folks filed a lawsuit towards Joseph B. Edlow, in his capability because the director of USCIS, saying the plaintiffs have maintained lawful standing within the US for years.
“Defendant has not claimed that Plaintiffs pose any individualized security risk. Plaintiffs have already undergone extensive background checks as part of their prior visa applications,” the swimsuit acknowledged.
“They’re in limbo, but they’re in limbo in a very dark way,” stated the group’s lawyer, Curtis Morrison. “If [Al Ghoula] does not have work authorization, he has to stop working … which, in the context of him being a physician, is pretty insane.”
In response to the lawsuit, a authorities lawyer argued that forcing USCIS to carry the pause on Al Ghoula’s software and others prefer it may lead to swift denials, warning that the functions would most likely be rejected as a result of safety vetting is incomplete.
In a separate case filed in December, Morrison’s shoppers Dr. Zahra Shokri Varniab and her husband — two Iranian doctors — received a preliminary injunction that deemed the freeze illegal. The choice was restricted to their case.
Despite the early victory, USCIS denied Shokri Varniab’s inexperienced card software on March 20, claiming that she was not “sufficiently candid and truthful.”
Morrison known as the company’s denial a “manufactured allegation” that’s retaliatory in nature, alleging the appliance was denied as a result of Shokri Varniab is an Iranian nationwide.
On the identical day her software was denied, Shokri Varniab matched right into a six-year diagnostic radiology analysis observe residency — two years after first making use of for the inexperienced card. This 12 months, solely 16% of immigrants who utilized to diagnostic radiology packages secured a spot.
“It turned the best day of my life to the worst day of my life,” stated Shokri Varniab, who lives within the San Francisco Bay Area together with her husband. “In the middle of this war, [our family in Iran] is praying for us in the US — not for themselves.”
Shokri Varniab now faces the identical uncertainty as others, uncertain whether or not she’ll be capable of begin her residency in July. Morrison has since moved to problem the company’s choice.
Since December, Morrison stated, he has led greater than a dozen lawsuits — one with greater than 100 plaintiffs — difficult the pause. In May, Morrison plans to steer a class-action lawsuit, doubtlessly the primary of its variety to problem the maintain.
Stephen Yale-Loehr, a retired immigration regulation professor at Cornell University, stated it “might take years for litigation to conclude,” that means the ban may stay in place for the length of the Trump administration.
“The biggest issue with all of this is the uncertainty that it causes, and we don’t know what the long-term impact is,” stated an individual acquainted with foreign-born doctor workforce coverage, who requested anonymity for concern of skilled retribution. “Every physician matters … when one’s missing, it has a ripple effect.”
Al Ghoula is now fielding job presents in Canada, although he stated it could be a troublesome transition — and never one he’s prepared to make proper now.
“I don’t want to go to Canada. I came here. I believe in America,” Al Ghoula stated. “But this is what’s happening. A lot of the physicians are going to migrate and move to Canada, and in several years, there will be a significant shortage of physicians.”
Others, together with Iqbal, concern that they’ll ultimately need to self-deport again to their residence international locations. “It’s like a nightmare,” he stated. “I don’t have anywhere to go.”
His solely choice, he stated, is to return to his residence nation of Afghanistan, which is governed by the Taliban. The group, thought-about a specifically designated international terrorist entity by the US, enforces its interpretation of Islamic Sharia regulation and has imposed the world’s solely ban on educating women older than 12.
The father of two stated his youngsters have by no means been to Afghanistan — and neither is aware of the language.
“Their future will be just destroyed,” Iqbal stated. “My daughter will be deprived of her basic rights.”
Veliz, the physician who has already misplaced his job, has been out of work for 5 months. He now lives with a pal in Houston, unable to afford hire and caught in authorized limbo.
“I miss my job. I love what I do,” Veliz stated tearfully. “I’ve dedicated my life to medicine, and that has been taken away from me now.”
NCS’s Catherine E. Shoichet contributed to this report.