DACA: Losing one ‘dreamer’ in medical school ‘can have a huge impact’ on patient care
As the government debates immigration and the fate of the Deferred Action for Childhood Arrivals, medical schools envision the possible implications for students who are protected from deportation and allowed to work despite arriving in the United States as undocumented immigrants.
In the wake of a second ruling against ending the Deferred Action for Childhood Arrivals (DACA) program, the Supreme Court on Friday is expected to decide whether to hear an appeal from President Donald J. Trump without waiting for an appeals court ruling.
This back-and-forth creates much uncertainty and can confuse even those with law degrees, Matthew Shick, JD, director of Government Relations and Regulatory Affairs at the Association of American Medical Colleges (AAMC), told Healio.
“Imagine students with DACA status, coming out of undergrad and having no idea as to what their current status is,” he said.
Healio spoke with Shick and Mark G. Kuczewski, PhD, director of the Neiswanger Institute for Bioethics and chair of the department of medical education at the Loyola University Chicago Stritch School of Medicine, to discuss the possible ramifications to medicine if former President Barack Obama’s executive order is successfully repealed.
Diversity and the workforce
Academics and medicine overall approached DACA as an issue of diversity and inclusion, in that individuals – known as “dreamers” – within the program add substantial value to education and to the workforce, according to Shick.
“Not only are these individuals the cream of the crop who have attended medical school and will go through residency training here in the U.S., but they have overcome substantial hardship and bring some additional cultural competency to the workforce,” Shick said. “It’s difficult [enough] to even get into a [medical] school.”
Kuczewski added that the repeal would be acutely felt by patients living in underserved communities who may not have a physician because of the repeal of DACA.
“[These individuals] are typically bi-lingual and bi-cultural and therefore highly qualified to serve communities who lack physicians and culturally aware health care professionals,” Kuczewski said. “Their drive and resilience are manifest in the fact that these young people have had to overcome significant obstacles, such as ineligibility for federal student loans. Their challenges have led many to feel a strong commitment to serve those patients who lack access to health care and who struggle to find physicians who are linguistically and culturally prepared to treat them effectively.”
Additionally, fellow medical students gain cultural awareness and skills from training with their DACA-recipient peers and become more capable physicians, according to Kuczewski.
What DACA recipients bring to the table in terms of diversity and cultural competency creates a domino effect, Shick said.
“With cultural competency, what we’re looking at is probably the individuals you would think of in terms of minority or low-income backgrounds, but also the immigrant population in general, have faced a unique experience that DACA students can relate to,” he said.
Currently, experts estimate there are approximately 100 individuals in medical school or residency training. And while that may seem like a small number, Shick said it’s not insignificant.
“When you think of the underserved communities that they could go back to, one position can have a huge impact,” he said.
DACA recipients not only have the potential to help better serve the growing diverse patient population, but also can help address the looming physician shortage.
“Professional and educational organizations such as the AMA and AAMC believe these 100 represent just the tip of the iceberg and that many more will successfully compete for admission to medical schools in the coming years,” Kuczewski said.
Prior to DACA, students who were previously undocumented had little opportunity to attend medical school because without proper work authorization, the undocumented immigrants would not be able to participate in residency training.
“Now we’re just seeing that first wave,” Shick said. “There’s still close to 600,000 to 700,000 students with DACA status in the undergraduate pipeline that haven’t had the opportunity in the past to apply to medical school.”
Medical schools and universities have been taking a variety of steps to keep their campuses safe and welcoming environments for quite a long time, Kuczewski said.
Schools have required a warrant for disclosures of students’ personal information, provided know-your-rights training to students, and offered ally training to faculty and staff.
Additionally, many institutions including the Stritch School of Medicine – the first to enroll DACA recipients – have connected those students with basic legal services to help screen for any adjustment of immigration status that might be possible based on individual circumstances of their case.
“The back-and-forth within Congress, the courts and the administration, creates a lot of uncertainty, and it’s always hard to act with that era of uncertainty,” Shick said. “One of the last things we want to do is admit a medical student if they don’t have a scholarship and have them take on 4 years of debt and not be able to practice medicine and pay that off.”
Besides providing immigration services as well as additional guidance to residency program directors and admissions counselors, institutions are providing services to help with mental health stresses, according to Shick.
“When most medical students are celebrating admission or their white coat ceremonies, or focusing on their exams and studying, these students face the extra hardship of having to do that while at the same time not knowing what their status is going to be in anywhere from a few weeks to 2 years from now,” he said.
Work permits that come with receipt of DACA must be renewed every 2 years, Kuczewski said. “Should renewals of these permits completely stop, medical students will have no way to complete residency training,” he said. “This situation has led the AAMC and AMA as well as many universities and medical schools to advocate for a permanent resolution.”
As for individuals currently employed in the medical field, Kuczewski said there are few obvious steps they could take that would be effective if DACA is repealed and not replaced.
“Renewing their work permits during the window that has been opened by the recent court decision will provide them protection for 2 years,” he said. “But, beyond that time, there is no systematic remedy available. As a result, many are working with their institutions to advocate for a legislative solution such as the DREAM Act.”
“The high-profile ‘travel ban’ on several Muslim-majority nations has likely damaged the reputation of the U.S. as a welcoming and desirable place to train and practice as physicians,” Kuczewski said. “The effort to unwind DACA may indirectly add to that perception, but that is not as clear.”
The current administration’s immigration policies, such as changes to visa policies and the travel ban, may have had a chilling effect on individuals from other countries wanting to come to the U.S., according to Shick.
“That certainly is a concern of ours,” he said. “We are combing through the data; The AAMC has filed an amicus brief with the Supreme Court in those cases and have said, ‘Not only is this a matter of fairness but also, there’s so much uncertainty in the process, that uncertainty and how welcoming our country is to emigrating physicians definitely has an impact on our workforce.’”
However, Shick said it’s slightly different with the case of DACA recipients because they have likely always viewed themselves as Americans.
“They don’t necessarily have attachments to other countries, they have lived their whole life in the U.S.,” he said. “So really, it’s less of a recruitment issue, but do they even have the opportunity to apply? I don’t think we’ll have trouble recruiting these individuals to health professions or to medical schools, but the question is will we be able to follow through on their desire to attend medical school because of their undocumented status.” – by Ryan McDonald
Disclosures: Kuczewski and Shick report no relevant financial disclosures.