Can medicine cure what’s wrong with U.S. immigration policy?


Recent events seem to be signaling an increasing sentiment toward hitting the metaphorical “pause button” on immigration or perhaps even adopting more anti-immigrant postures in the US and in many other places around the world. The Supreme Court of the United States (SCOTUS) issued its deadlocked non-decision in United States v. Texas, No. 15-674 which will prevent Deferred Action for Parents of Americans and Lawful Permanent Residents or DAPA from taking effect. As a result of this 4 to 4 tie, several million undocumented immigrants who have lived for many years in the United States and parent children who are U.S. citizens in a kind of legal and personal limbo. This deadlock, of course, occurred within a broader context. For instance, the Republican presidential nominee, Donald Trump, has made caricaturing and denigrating Mexicans and Mexican-Americans a centerpiece of his campaign. There’s little need to rehearse how the candidacy was launched with the impetus of an initial statement promising to “build a wall” to keep out the people Mexico was “sending” to the U.S. who “bringing drugs … bringing crime. They’re rapists.”

In contrast, my experience as an educator in a medical school suggests that the problem is not that we need to hit the “pause button” but that we have been stuck in inaction for more than a decade. The result is a crisis in which we risk wasting a generation of our most precious resource, the talent of young people who have grown up, been educated in our communities, and often wish to serve society by practicing medicine or other health professions. This should come as an affront to our sense of justice and concern us from an economic perspective. We must take our finger off the pause button as soon as possible and act to steward these precious human resources.

At the Loyola University Chicago Stritch School of Medicine, we benefit from the fact that 21 of our current students are persons who are said to be “DACA-mented.” That is, they are undocumented immigrants who have a social security number and employment authorization document (a work permit) owing to the Deferred Action for Childhood Arrivals (DACA) program that President Obama create by executive memorandum on June 15, 2012. Fortunately, this program is not directly affected by the recent Supreme Court decision. Nevertheless, our experience with these students of DACA status shows how important a mechanism of bringing undocumented immigrants out of the shadows can be. And it shows that more action is needed to arrive at a long-term solution that advances the common good.

Shortly after President Obama issued the executive memorandum creating DACA, we amended the admissions policy of our medical school to explicitly state that persons with DACA status were eligible to apply to our medical school and compete on a “level playing field” for admission. We were prepared to become the first medical school to take this step because we were aware of the assets these students might bring to our school. We had received an inquiry a year earlier from a mathematics professor describing a student who had a 3.9 grade point average, had completed a dual major in biology and Spanish, had a strong record of volunteer service, and who was simply the best student he had ever taught. He asked whether it was possible that such student might attend medical school given that she was undocumented. The reasons to include such students in our applicant pool are obvious. We want the best and the brightest in our physician workforce. And demonstrated resilience is important to meet the demands of treating sick patients for a career. Such students are also commonly bilingual and bicultural. They usually desire to serve patients in the communities in which they were raised, commonly communities that ae desperately underserved by our health care system. And having a critical mass of these students within our student body has promoted understanding of immigrant populations among all our students. This enables our graduates to serve the diverse patient population most will encounter in their practices.

What is so striking in our experience is how it contrasts with recent anti-immigrant sentiment and rhetoric. Such sentiment seems driven by an assumption that immigrants, especially undocumented immigrants, are trying to take something from others that doesn’t belong to them. Our experience suggests current immigrants are like previous waves of immigrants to the United States: talented, energetic, young people who wish to contribute to our communities and society. And it is our laws, laws that our government has so long failed to reform, that prevent them and limit their contributions.

The barriers that remain are still formidable and choke off opportunities for many. Students with DACA status remain ineligible for federal student loans. Student loans are an enormously important source of financing higher education and without access to them, most of this student population will be unable to reach their educational potential. We have worked diligently with visionary partner institutions to create alternate loan opportunities for our medical students. But, such efforts are necessarily inadequate to the need. As a result, the investment made in their K-12 education cannot bear its full fruit and return on investment. Our failed immigration laws have taken on the role of Jim Crow laws segregating much of this population from the opportunity to participate effectively in their communities, often the only communities they can recall.

Of course, more fundamental than the need to access student loans, those of DACA status need a more permanent immigration status. Their status should not vary with the results of each presidential election. Legislation such as the DREAM Act (Development, Relief, and Education of Alien Minors) was first introduced in 2001 and has come close to passage on several occasions over the last fifteen years. Its key provisions were included in the comprehensive immigration reform bill that passed the U.S. Senate in 2013 but never came to a vote in the House of Representatives. Year after year, these young people have watched these failures of political leadership and been prevented from taking their place as citizens of their country.

Some wonder why we at Stritch are so aggressively investing qualified students of DAA status when DACA could be revoked at the whim of the next president. However, we believe that such thinking fails to prioritize the greater concern. We should be far more concerned that a generation of talent is being wasted by inaction. How much longer will our nation segregate these students from opportunity? We must be on the right side of history by directly creating opportunities whenever possible and call upon our fellow citizens to move beyond a caricature of their immigrant neighbors toward a beneficial policy of inclusion.

Mark Kuczewski is chair, department of medical education, Loyola University Chicago Stritch School of Medicine, Maywood, IL. He can be on Twitter @BioethxMark.

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