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Can undocumented immigrants become family physicians?

The researchers are of the opinion that the immigrants can help ease the nationwide shortage of primary care physicians, particularly in underserved, low-income areas
The researchers are of the opinion that the immigrants can help ease the nationwide shortage of primary care physicians, particularly in underserved, low-income areas
Robin Wulffson, MD

With the recent surge in Central American youths entering the United States, addressing who and under what circumstances foreigners should enter our nation has become a hot-button issue. In addition, how to handle those who are already here is a major challenge. A portion of that population comprises some individuals who want to achieve the American dream as a productive professional rather than an unskilled laborer. A publication, which was authored by researchers at the UCLA Center for the Study of Latino Health and Culture, urges medical schools to participate in promoting enrollment of undocumented immigrants seeking access to the medical professions. It appears on August 5 in the journal Academic Medicine.

The study, “Undocumented Students Pursuing Medical Education: The Implications of Deferred Action for Childhood Arrivals,” notes that the prospective medical students are often highly motivated and qualified; thus, the researchers are of the opinion that the immigrants can help ease the nationwide shortage of primary care physicians, particularly in underserved, low-income areas. They explain that the number of primary care physicians is shrinking in the nation mainly because medical school graduates are frequently opting for medical specialties, which are generally more lucrative. The decreasing numbers of primary care physicians comes at a time of an increased need for these physicians because of factors such as an aging population and the implementation of the Obamacare, which is expected to make healthcare accessible to an estimated 30 million previously uninsured individuals.

“This country is in great need of primary care physicians to fill the ongoing shortage, yet qualified undocumented pre-medical students are still being denied access to medical schools because of concerns regarding their status,” noted lead author Dr. Yohualli Balderas-Medina Anaya, a resident physician in the department of family medicine at the David Geffen School of Medicine at UCLA. The authors suggest that Deferred Action for Childhood Arrivals (DACA), which allows certain young undocumented immigrants to work legally in the United States without fear of deportation, could increase the number of primary care physicians in the nation.

On June 15, 2012, the Secretary of Homeland Security announced that certain individuals who came to the United States as children and meet several guidelines may request consideration of deferred action for a period of two years, subject to renewal. They are also eligible for work authorization. DACA notes, “Deferred action is a use of prosecutorial discretion to defer removal action against an individual for a certain period of time. Deferred action does not provide lawful status.”

Anaya explained, “With DACA, undocumented pre-med students can help address this growing shortage. We are calling upon the medical and academic community to support undocumented students applying to medical school. We can all benefit from helping these students enter and successfully complete medical school.”

Currently, it is estimated that there are approximately 1.8 million undocumented immigrants who can prove they arrived in the United States when they were younger than 16. With DACA, the government allows them to obtain work permits, Social Security numbers and, in 45 states, driver’s licenses, all of which are renewable every two years. The policy applies to those who were younger than 31 in June 2012 and who have lived continuously in the US since June 15, 2007. Qualified immigrants must be enrolled in high school, be high school graduates or have obtained a GED certificate; furthermore, they must not have been convicted of a felony, significant misdemeanor, or three or more other misdemeanors.

The study authors estimate that admitting students who would qualify for DACA to medical schools could range from 5,400 to 31,860 potential future physicians. In addition, research has shown that many of these potential medical students are underrepresented minorities who are highly likely to specialize in primary care and who may have a strong commitment to return to and serve underserved, low-income communities.

The authors propose a number of methods that would increase accessibility to medical school for these individuals, including:

  • Improving these students’ access to accurate information about their eligibility for admission to medical school. For example, by publishing a national list of schools that accept DACA students.
  • Providing these students with financial-planning advice early on, including information on private need- and merit-based scholarships, private loans, and school loans, as well as creating paid opportunities such as paid research and internships.
  • Providing them with psychosocial support and a welcoming environment that can help ensure their success in medical school.

The authors wrote: “It is time for broad discussions among medical school administrators, faculty, students, and staff to develop institutional responses and to make standards readily available and more transparent for interested undocumented students. We call upon the medical community to support these students as they pursue medical careers. “Specifically, we encourage medical programs to consider accepting undocumented students and to openly promote their stance on eligibility, so as to make it easier for these students to navigate the application process. We also hope that schools will offer additional financial support to undocumented students, as their documentation status still prevents them from accessing federal financial aid, and this remains the steepest barrier for this group. Finally, we hope that our peers in the medical community will be aware of state policies that affect undocumented students, and be sensitive, empathic, and supportive when encountering these students seeking access to the medical professions.”