WASHINGTON: The number of foreign medical graduates from Muslim-majority countries coming to the United States to become doctors has declined by 15 percent under the Trump administration, exacerbating shortages in America's physician workforce, a study said. International medical graduates represent about a quarter of practicing doctors in the United States. They are required to take several licensing exams and then complete two or three years of training to practice medicine in the United States.

Overall, citizens from Muslim-majority nations made up 4.5 percent of the US physician workforce in 2019, with Pakistan, Egypt and Iran historically providing the bulk. The number of graduates from Islamic nations applying for certification in the United States rose from 2009-2015, peaking at 4,244, before falling steadily to 3,604 in 2018 - a decline of 15 percent. A small drop occurred in 2016, the year in which Trump was elected but his predecessor Barack Obama was still in office, before hastening in 2017 and 2018.

The study appeared in the Journal of the American Medical Association, and was led John Boulet, vice president of the Educational Commission for Foreign Medical Graduates that oversees the certification process. Boulet and colleagues said that recent US policies, such as the travel ban on Muslim-majority countries "affect the inflow of IMGs International Medical Graduates) by restricting travel to the country for citizens from specific nations."

They added: "Even a perceived immigration ban could affect who chooses to complete the requirements for… certification" while potential difficulty obtaining a visa could dissuade the program directors of medical residencies from making a job offer.

The US demand for physicians has long outstripped supply for a variety of reasons, from population growth and aging, to a federal cap on funding for residency training. As a result, the United States could see a shortage of as many as 122,000 doctors by the year 2032, according to a 2019 report by the Association of American Medical Colleges.

Some economists also argue that the short supply of doctors has led to a surge in their wages - costs that are eventually passed down to patients. "To the extent that citizens from some countries no longer seek residency positions in the US, gaps in the physician workforce could widen," the authors said. The attractiveness of the United States as a destination may have also waned in comparison to other countries like Canada, New Zealand, Australia and Britain, the authors wrote.

In a related development, the US said Monday it would not allow foreign students to remain in the country if all of their classes are moved online in the fall because of the coronavirus crisis. "Nonimmigrant F-1 and M-1 students attending schools operating entirely online may not take a full online course load and remain in the United States," US Immigration and Custom Enforcement said in a statement.

"Active students currently in the United States enrolled in such programs must depart the country or take other measures, such as transferring to a school with in-person instruction to remain in lawful status," ICE said. "If not, they may face immigration consequences including, but not limited to, the initiation of removal proceedings."

ICE said the State Department "will not issue visas to students enrolled in schools and/or programs that are fully online for the fall semester nor will US Customs and Border Protection permit these students to enter the United States". F-1 students pursue academic coursework and M-1 students pursue "vocational coursework", according to ICE. Universities with a hybrid system of in-person and online classes will have to show that foreign students are taking as many in-person classes as possible, to maintain their status. M-1 vocational program students and F-1 English language training program students will not be allowed to take any classes online.

Critics quickly hit back at the decision. "The cruelty of this White House knows no bounds," tweeted Senator Bernie Sanders. "Foreign students are being threatened with a choice: risk your life going to class-in person or get deported," he said. For Gonzalo Fernandez, a 32-year-old Spaniard doing his doctorate in economics at George Washington University in the US capital, "the worst thing is the uncertainty". "We don't know if we will have classes next semester, if we should go home, if they are going to throw us out."

Most US colleges and universities have not yet announced their plans for the fall semester. A number of schools are looking at a hybrid model of in-person and online instruction but some, including Harvard University, have said all classes will be conducted online. Harvard said 40 percent of undergraduates would be allowed to return to campus - but their instruction would be conducted remotely.

There were more than one million international students in the United States for the 2018-19 academic year, according to the Institute of International Education (IIE). That accounted for 5.5 percent of the total US higher education population, the IIE said, and international students contributed $44.7 billion to the US economy in 2018. The largest number of international students came from China, followed by India, South Korea, Saudi Arabia and Canada.

According to Aaron Reichlin-Melnick, who works as the policy counsel at the Washington-based think tank American Immigration Council, the new rule is "almost certainly going to be challenged in court". He explained on Twitter that foreign students will likely struggle to continue their studies while abroad, due to time differences or a lack of access to technology or academic resources.

Trump, who is campaigning for reelection in November, has taken a bullish approach to reopening the country even as virus infections continue to spike in parts of the country, particularly the south and west. "SCHOOLS MUST OPEN IN THE FALL!!!" he tweeted Monday.

With more than 130,000 deaths linked to the novel coronavirus, the United States is the hardest-hit country in the global pandemic. While cracking down on immigration is one of his key issues, Trump has taken a particularly hard stance on foreigners since the health crisis began. In June, he froze until 2021 the issuing of green cards - which offer permanent US resident status - and some work visas, particularly those used in the technology sector, with the stated goal of reserving jobs for Americans. - Agencies