In recent years, American medical schools have publicly committed to enhancing the diversity of their student bodies. In its diversity and inclusion mission statement, the Association of American Medical Colleges promises to “cultivate human capital” by collaborating with institutions of medical education to “use diversity as a driver of excellence.” Similarly, Brown’s own Diversity and Inclusion Action Plan states that the University will take tangible steps to “identify, recruit and retain faculty, students and staff who have been historically underrepresented in higher education.” More specifically, the Alpert Medical School has set out to “develop a diverse graduate and medical student body at Brown, with the specific goal of doubling the number of graduate students from historically underrepresented groups by 2020-2022.”
Currently, two of the most underrepresented groups in medicine are individuals who are undocumented or recipients of the Deferred Action for Childhood Arrivals program. To be clear, medical schools often treat the two groups differently; the Medical School, for example, accepts applications from DACA students, but does not accept applications from undocumented students. But when it comes to medical school admission, undocumented students should not be denied the consideration afforded to their DACA counterparts just because they might have missed a certain eligibility date. Medical schools should not, and cannot afford to, leave these students behind. At the moment there about 100 DACA medical students in the United States; approximately 32 of them are at Loyola University Chicago’s Stritch School of Medicine. Because of DACA and undocumented medical students’ potential to make meaningful contributions to American health care — and because we have an ethical obligation to honor their humanity — I call upon medical schools across the country to proactively work to increase the representation of DACA and undocumented individuals in medicine.
DACA was implemented in 2012 following the failure of the DREAM Act in Congress in 2010. In order to qualify for DACA status, an individual must be under the age of 31, have entered the country prior to age 16, resided continuously in the U.S. since 2007 and have no record of a felony or record of three or more misdemeanors. Approximately 800,000 individuals benefit from DACA; this number has fallen since the suspension of DACA in September 2017. Despite the benefits of DACA — which allows recipients to obtain a work permit, a social security number and a driver’s license — access to medical school remains limited at best. According to the AAMC, 26 DACA students applied to medical school in 2014, 46 in 2015 and 113 in 2016. Eight students checked the DACA category on their Electronic Residency Application Service form in 2015 and at least three did in 2016. Currently, leaders of Pre-Health Dreamers — an organization empowering undocumented youth to pursue health careers — whom I personally know estimate that at least eight DACA students matched into residency programs this 2018 cycle.
The low but rapidly increasing number of applicants is a testament to the barriers DACA and undocumented students must overcome before their application lands in the hands of admissions committees. DACA students are not eligible for federal loans or aid, which typically form the basis of most financial aid packages at medical schools across the country. Many medical schools, especially state schools, do not consider DACA applicants — such as my home state’s public medical school, despite years of my paying taxes that benefited the medical school and state health care system. In my personal experience, some state schools, like those in California, offer aid to DACA medical students who are in-state but do not offer any aid to out-of-state individuals. Furthermore, some schools in Texas will not allow DACA students to matriculate despite being accepted, as was the case with a colleague of mine. At times, a DACA student’s access to medical school is highly predicated on their state of residence. With a limited number of medical schools to apply to and the uncertainty of securing financial aid, DACA students are at a disadvantage from the start.
This disparity is unfortunate because DACA and undocumented medical graduates could help reduce the country’s growing physician shortage and support efforts to bolster the cultural competency of the American medical system. AAMC’s diversity and inclusion report estimates an overall shortage of 104,900 physicians by 2030, with vulnerable populations most affected. (The same report also found that the country will experience a deficit of 33,800 to 72,700 specialty care physicians by 2030.) Most DACA students hail from underserved communities themselves, and many express a desire to serve underserved communities. In a letter to Congress, the American Medical Association estimates that in the coming decades DACA students could contribute more than five thousand primary care physicians, thus helping to alleviate some of the shortage. As such, medical schools should proactively recruit and support DACA and undocumented students, as they are a largely untapped source of talent. With their community-based experience and expertise — 98 percent are multilingual — DACA medical school graduates are well-positioned to navigate the intersection of politics and the the social determinants of health. After all, as Rudolf Virchow, the father of social medicine once said, “Medicine is a social science, and politics is nothing more than medicine on a large scale.”
Beyond pragmatic concerns, however, medical schools should open their doors to DACA and undocumented students because it is the ethical thing to do. The Hippocratic Oath, taken by physicians upon their induction into the medical profession, states: “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.” The modern-day Hippocratic Oath is in many ways a code of conduct, a guiding principle for the ethical practice of medicine. I believe this oath applies not only to our treatment of patients but also to how we treat our colleagues and our fellow human beings. With this in mind, in my opinion it is short-sighted to think about increasing the representation of DACA and undocumented individuals in medicine solely using a pragmatic framework. As current and future medical professionals, we ought to open doors in times of crisis to raise the next generation of physician leaders who will advocate for the health of America’s increasingly diverse patient population.
In line with the University’s DIAP goals, I believe that the Medical School should start recruiting undocumented students and improve its efforts to recruit DACA students. As a private institution, the Medical School has the ability to accommodate these students in ways that state institutions may not due to state regulations. By partnering with local banks and creating a financial aid fund for DACA and undocumented students — in the model of Loyola, which has partnered with in-state financial institutions to provide interest-free loans to DACA students — to help reduce the burden of private loans, the Medical School has the opportunity to lead the way among Ivy League medical schools. Some peer institutions, like Yale, already do accept applications from and provide aid to undocumented medical school applicants. I believe now is the perfect opportunity for the Medical School community to come together and continue to pave the way in medical education by proactively working to train the next generation of diverse leaders in the American health care workforce.
Krissia Rivera Perla ’15 MD ’21 is a co-founder of the Alpert Medical School Immigrant Rights Coalition and can be reached at krissia_rivera@alumni.brown.edu. Please send responses to this opinion to letters@browndailyherald.com and op-eds to opinions@browndailyherald.com.
