A SECOND OPINION
A Second Opinion welcomes the freely written articles of our diverse membership, whether these conform to the opinions of our publishers, our Editorial Board or other groups. However, we ask that opinions remain collegial and respectful. The Editorial Board and Oversight Committee reserve the right to choose what is published. We invite you to share your thoughts with us, and to respond to others, at editor @ glms. org. Publication does not represent endorsement by Louisville Medicine or GLMS. Let us hear from you!
The Huddle Is Shrinking
by Mary Barry, MD
Unless you are a full-blooded Cherokee or Iroquois, etc., you, like me, have ancestors who were once“ the huddled masses yearning to breathe free.” All the rest of us in America are either immigrants, or descend from immigrants of various eras since Spain, France and England first laid claim to our continent, sending their“ wretched refuse” from the“ teeming shores.”
Teaching medical and nurse practitioner students and interns was one of the greatest joys of my practice. I was blessed to have been taught the physical exam first by Dr. Henry Post of cardiology( I used to babysit his kids) and then by the professors in the Emory University system, including at Grady Hospital, led by Dr. H. Kenneth Walker, one of the best teachers of all time.
With the other internal medicine interns at Grady Hospital in Atlanta( the Emory system’ s public teaching hospital), I was expected to not just spin down the patient’ s urine and examine it myself under the microscope, but also to smell it( we drew the line at tasting it, as professors of previous centuries had done). We also made a red blood smear, stained it and examined it under the microscope( also on every single Grady admission; we were sleepless by definition, for months). At my first ever Morning Report, I had admitted a patient whom I luckily could diagnose confidently with malaria, because of the ring forms on the blood smear. But I flamed out spectacularly when, utterly exhausted but still with 12 hours of work ahead of me, I worried out loud that my patient’ s malaria was“ catching.”
The person who saved me and did not laugh out loud was our fellow intern Dr. Bernardo Stein from Mexico. He was an old hand at malaria, and he knew not only that one caught it from mosquitoes, but also that
36 LOUISVILLE MEDICINE
it caused hematuria, and therefore was nicknamed“ Blackwater Fever.” Bernardo was erudite and patrician and was graduated summa cum laude from the National Autonomous University of Mexico. He taught cardiology for years and now as a Fellow of the American College of Cardiology, he heads an interventional heart lab in Clearwater, Florida. Saluting you, Bernardo!
Now, the current administration is seeking to cut our supply of foreign-educated and foreign-trained doctors. They have forced many to stop seeing patients after being“ pushed out of their jobs by a Trump administration policy that froze visa extensions, work permits and green cards for citizens of 39 countries and the Palestinian Authority,” per Miriam Jordan of the New York Times on April 4, 2026.
These doctors are the pros most likely to find lasting work in small town hospitals, in rural health care centers, in the prison systems, etc. – the less desirable workplaces for the average U. S. citizen, U. S. trained doctor.
Additionally, in the fall of 2025, the Trump administration ordered that new H1-B visa applications will only be processed as of 9 / 22 / 25, after payment of a new $ 100,000 fee to the Department of Homeland Security, via the U. S. Citizenship and Immigration Service. Technical experts and doctors must obtain an H1-B visa prior to immigrating here; typically, the fee is paid by the institution hiring them. The bill exempts current H1-B visa holders and allows them also to travel home just to visit, and to return without re-applying.
Thankfully however there is already bipartisan legislative pushback from Reps. Lawler, Bishop, Salazar and Clarke, as the“ Physicians and the Healthcare Workforce Act.” This would exempt physicians and
OPINION