September 6, 2017

Ending DACA could worsen physician shortage, medical groups warn

Daily Briefing

Major medical groups have lambasted President Trump's decision to end the Deferred Action for Childhood Arrivals (DACA) program.

DACA, which was implemented under former President Barack Obama, protects approximately 800,000 undocumented immigrants ages 15 to 36 who entered the country as children from deportation and allows such individuals to work in the United States.

U.S. Attorney General Jeff Sessions on Tuesday announced that the Trump administration will end the program in six months, arguing that "the policy is vulnerable to … legal and constitutional challenges." He added, "Simply put, if we are to further our goal of strengthening the constitutional order and the rule of law in America, the Department of Justice cannot defend this type of overreach."

Trump has called on Congress to pass legislation to replace DACA before the six-month wind-down is complete.

According to The Atlantic, the administration's decision came after a threat from several state attorneys general that they would sue the administration if it did not begin to dismantle the program by Sept. 5. Trump in the past has expressed support for DACA recipients, The Atlantic reports.

DACA repeal could worsen doctor shortage, medical groups say

Doctors' groups said the administration's decision to end the program could exacerbate a health care provider shortage in the United States and endanger patient care, as hundreds of medical students, nurses, and other health care workers have DACA status.

The Association of American Medical Colleges (AAMC) said 65 individuals with DACA status enrolled in U.S. medical schools for the 2016-2017 school year and predicted that such enrollments would be higher for the 2017-2018 school year.

AAMC CEO Darrell Kirch in a statement released Tuesday said, "Even with the 'wind down process' described by the administration, the implications of this action for medical students, medical residents, and researchers with DACA status are serious, and will interfere with their ability to complete their training and contribute meaningfully to the health of the nation." He continued, "We believe that medical students, medical residents, and researchers with DACA status are important to the fabric of the nation's health care system, and their participation benefits all patients," adding, "We are extremely dismayed by the administration's decision to rescind the current executive action establishing DACA."

Further, the American Medical Association (AMA) in a letter sent Tuesday to congressional leaders expressed concern that ending DACA "could have severe consequences for many in the health care workforce, impacting patients and our nation's health care system." AMA wrote that the United States currently has a shortage of more than 8,200 primary care physicians and individuals with DACA status are helping to "fil[l] gaps in care." The group added, "Estimates have shown that the DACA initiative could help introduce 5,400 previously ineligible physicians into the U.S. health care system in the coming decades to help address these shortages and ensure patient access to care." AMA called on Congress to "act quickly" to protect individuals with DACA status.

Similarly, the Catholic Health Association in a letter sent Saturday urged Trump not to eliminate DACA. "As employers of millions of dedicated health care professionals, we have a very strong interest in ensuring a continued supply of great employees," the group wrote, adding, "We have seen firsthand how the DACA 'Dreamers' have benefited our organizations at many levels of our teams. As nurses, physicians, aides, dietary workers, and facility professionals, they are part of what makes American health care great."

DACA recipients speak out

DACA's potential repeal creates significant uncertainty for providers and medical students who have been able to stay in the United States and work under the program, The Atlantic reports.

Marina Di Bartolo, an internal medicine doctor at the University of Pennsylvania, said, "The day it is revoked, I have to take off my white coat." Di Bartolo's parents brought her to the United States from Venezuela at age 7 under a tourist visa and stayed beyond their visa's limit.

Denisse Rojas, who works with medically underserved patients in New York and was the first undocumented student to attend the Icahn School of Medicine at Mount Sinai, said she is considering moving to Canada if she is unable to continue working in the United States—a prospect she described as "devastating."

Sunny Nakae, the dean of admissions at Loyola-Stritch, said students with DACA status face "a huge chasm of uncertainty." According to The Atlantic, medical students under DACA who rely on financial aid might be unlikely to continue their studies as banks are unlikely to provide loans to students who would not legally be able to work in the United States upon graduation.

Cesar Montolongo, a professorial MD-Ph.D. student at Loyola-Stritch School of Medicine, said, "I won't be able to pay my living expenses, much less my tuition" without student loans. He continued, "It's bittersweet to have found something you're happy doing, knowing it might be taken away" (Japsen, Forbes, 9/5; King, Washington Examiner, 9/5; Raff, The Atlantic, 9/1).

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