Ending DACA would damage the provider workforce
Hospitals and health systems stand to lose thousands of future workers if the Obama-era program protecting Dreamers is phased out.
With President Donald Trump threatening to end the Deferred Action for Childhood Arrivals (DACA) program, dozens of medical groups are pressing Congress to approve legislation that would create a pathway to permanent, legal residency for undocumented individuals brought to the U.S. as children.
In a Sept. 14 letter, the American Medical Association (AMA), Association of American Medical Colleges (AAMC) and 68 other health and medical organizations urged leaders of both parties in the House and Senate to pass the bipartisan Dream Act of 2017 (S. 1615, H.R. 3440). “By providing a legal pathway to permanent residency for undocumented Americans brought to the U.S. as children, Congress can help our country produce a diverse and culturally responsive health care workforce to meet the needs of underserved populations, improve cultural awareness, and promote health equity,” the letter states.
An end to DACA wouldn't directly impact a large number of would-be health professionals, but it would worsen provider shortage issues, particularly in already underserved areas. It would also make it harder for provider groups to create and maintain a diverse staff with a variety of cultural backgrounds and helpful skills like speaking another language. It's hard to say whether Congress will manage to stop the phasing out of DACA, though, as legislators have so far failed to find bipartisan solutions to other issues facing the country.
Exacerbating the physician shortage
At a time when the U.S. is already experiencing a shortage of healthcare professionals, ending DACA would only make matters worse, experts say. The AAMC projects the physician shortage could reach 105,000 by 2030. While the share of medical students and residents with DACA status is negligible now, that’s in part due to the fact that most of the 800,000 current DACA recipients are still working their way through undergraduate degree programs.
It’s not known exactly how many Dreamers, as DACA recipients are called, are currently enrolled in medical school or residency programs. The AAMC previously reported that 55 students matriculated over the past three to four years. A deeper dive into the data show up to 99 medical students with DACA status, says Matthew Shick, AAMC director of government relations and regulatory affairs. But that number will increase when the details of this year’s class are confirmed.
For residency programs, the numbers are likely to be even lower. Without citizenship or documentation, individuals can’t get the work authorizations required to work in a teaching hospital. In addition, most schools are reluctant to accept anyone with little chance of being able to eventually practice — both because it takes a slot away from somebody else and because of the debt students would assume without any chance of entering a residency program.
Those numbers will surely grow if dreamers are allowed to remain in the U.S. with legal status. In a Sept. 5 letter to Congress, AMA Executive Vice President and CEO James Madara said DACA could add 5,400 previously ineligible doctors to the U.S. healthcare system, helping to ease the growing physician shortage.
But the brain drain wouldn't just affect physicians. The U.S. healthcare system also stands to lose nurses, nurse practitioners, pharmacists, medical researchers and slews of other professional and nonprofessional healthcare workers.
“A hospital’s workforce is its most vital asset in ensuring patients receive high quality care, and any potential disruptions in staffing are worrisome,” Colin Milligan, a spokesman for the American Hospital Association, told Healthcare Dive via email. “We are hopeful that lawmakers can find a bipartisan solution to this issue.”
But losing these students isn’t just about numbers. It’s about filling the gaps that might otherwise exist, says Shick. Often, these students are multicultural and bilingual, from disadvantaged backgrounds or rural areas that have trouble recruiting physicians.
There is also the cultural competency factor. Studies have shown that when physicians train in teams that are culturally diverse, it improves outcomes because everyone is sensitized to the needs and customs of patients from immigrant and minority backgrounds.
“While the numbers are fairly small, turning away highly qualified applicants is certainly a bit foolhardy,” Shick tells Healthcare Dive. “And these are individuals who are more likely to return to underserved areas.”
Bipartisan push for a solution
Trump gave Congress six months to fix DACA before the program is phased out next year. But he has also asked lawmakers to pass broad immigration reform that includes a solution for Dreamers, as well as funding for a wall on the border with Mexico.
Several bills are pending in the House and Senate. The Dream Act of 2017 would not only provide a legal pathway to permanent residency, but would also allow Dreamers to take out federal student loans — something current DACA recipients are ineligible to receive. This would remove a major barrier to medical school education.
There is also the Bar Removal of Individuals who Dream and Grow our Economy (BRIDGE) Act (S. 128, H.R. 496), which would provide three-year provisional status for current DACA recipients while Congress works on a more permanent pathway. Both the Dream Act and BRIDGE Act have bipartisan support.
Sen. Thom Tillis (R-N.C.) is leading efforts to draft a “conservative Dream Act” that would extend permanent residency to people brought to the U.S. illegally as child, but with much more rigorous vetting. Under the SUCCEED Act (Solution for Undocumented Children Through Careers Employment Education and Defending our nation), applicants would face security and background checks upon entering the program, five years later and again after 15 years, if they apply for citizenship. There would also be more ways a person could be disqualified. The bill (S. 1852) was introduced Sept. 25 and referred to the Senate Judiciary Committee.
Meanwhile, the future of 800,000 Americans — along with prospects for would-be physicians and healthcare workers — hangs in the balance as Trump and Democratic and Republican lawmakers search for a solution all can agree on. A new ABC News/Washington Post poll shows 86% of Americans support legal residency for undocumented immigrants who came to the U.S. as children.
And in a new Harvard Harris Poll, 77% of respondents — and 65% of Republicans — said they support work permits and a pathway to citizenship for dreamers, The Hill reports. An equal share of respondents favor a pathway for all undocumented immigrants who learn English, pay fines or back taxes and hold tax-paying jobs.
But Congress hasn't exactly shown a track record of passing bipartisan legislation this year. Immigration reform will have to compete with other priorities of the controlling party, including a tax system overhaul and repeal of the Affordable Care Act.
Trump’s announcement on DACA came as first-year medical students were participating in white-coat ceremonies and embarking on a new stage in their careers, says Shick. “It’s supposed to be a joyous time, but for DACA students, they have this fear hanging over them of what might happen.”