he first undocumented immigrants to openly apply to medical school are nearing graduation — and on Friday some will learn whether they’ve been accepted into the residency programs that will give them the hands-on training they need to practice medicine.
But the moment is laden with trepidation as well as joy.
Even students who get into top residencies know that their careers could crumble before they even start, if a judge — or the next president — overturns President Barack Obama’s executive order that protects from deportation young immigrants whose families came to the US illegally when they were children.
“All of this stuff can just disappear,” said one fourth-year medical student, who asked to be identified only by an initial, J, to protect family members who still face the threat of deportation. “The world that we live in, at this point in time, seems really uncertain.”
Obama’s 2012 order, known as DACA (for Deferred Action for Childhood Arrivals), granted two-year work permits to undocumented students who met certain conditions.
That policy change — and Obama’s subsequent effort to extend the work permits — allowed scores of medical schools to begin admitting undocumented students. Today, 61 out of 145 accredited medical schools in the United States will accept applications from DACA applicants. One of the first to open its doors to DACA students was the Stritch School of Medicine at Loyola University Chicago.
“There is a national emergency of talents being wasted,” said Mark Kuczewski, a professor of medical ethics at Loyola.
Students are jumping at the chance to pursue their passion for medicine: In 2014, just 26 students with DACA status applied to medical school. This year, 112 did, according to the Association of American Medical Colleges.
J actually enrolled in medical school at the University of California, Los Angeles in 2011, the year before DACA took effect. She said her undergraduate advisors at Harvard discouraged her from applying because they saw no future for her: They doubted she would be able to land a residency — and without a residency, she would not be eligible to get her medical license to practice in the US.
But J persevered: “When someone tells me I can’t have something, it makes me want it even more,” she said.
J was inspired to pursue a career in medicine because of her parents’ experiences. Her mother, a nurse in their native Mexico, moved the family to the US to seek better health care when she fell ill. J was only 8 years old at the time. Watching her parents struggle to get care without insurance or documentation whetted her appetite for knowledge and ignited a desire to serve communities with little access to health care.
J was accepted to UCLA’s David Geffen School of Medicine, but her legal status presented ongoing challenges.
After the first two years of medical school, students typically travel to different hospitals and clinics to see patients. But until DACA was enacted, California didn’t allow undocumented immigrants to get driver’s licenses. That made it difficult for J to reach training sites.
As soon as her DACA status was approved, J applied for a license — and said passing that test meant more to her than passing her first big medical board exam. “To me, that is a precious opportunity,” she said.
Tuition was another challenge, because DACA students are ineligible for federal financial aid. J got lucky midway through medical school, when California passed a law that let undocumented students get state aid and privately funded scholarships.
To ease the path for other DACA students, the Association of American Medical Colleges offered financial help with the application process. The common application used by most medical schools now includes a box where students can indicate their DACA status. The AAMC also trains medical schools and residency programs on DACA.
“We felt that it was absolutely the right thing to do to increase diversity” in the medical profession, said Geoff Young, senior director of student affairs and programs at the AAMC.
Other changes are also coming for undocumented medical students.
Last month, for instance, the Veterans Health Administration agreed to allow DACA students to train in its clinics and hospitals during their residencies. Before that policy took effect, undocumented students were often blocked from popular residencies because they included a rotation through VA facilities. “That’s a huge breakthrough,” Kuczewski said.
But all the gains could be overturned if DACA is struck down.
On April 18, the Supreme Court will hear a case that challenges Obama’s authority to expand the DACA program and offer other protection for other undocumented immigrants. A ruling against Obama could undermine the DACA program itself, said Matthew J. Maiona, a spokesperson from the American Immigration Lawyers Association..
Even if the court ruled for Obama, the next president could overturn DACA by executive order.
DACA medical students would suddenly lose both their legal protection against deportation and the work permits that let them train. That could hurt not just the students, but health care delivery, especially to immigrant communities. “It’s going to leave holes in the system,” Maiona said.
Belsy Garcia is all too aware of that risk.
Born in Guatemala, she moved to the United States with her family when she was 7 years old. Today she is one of 14 first-year DACA students attending medical school at Loyola University Chicago.
Garcia knows how tenuous her dream of practicing medicine is. It’s “difficult to think about,” she said.
So she takes it day by day. “That’s what I’ve learned to do, growing up undocumented,” Garcia said. “You have to make the most of what you have today. And that’s what I strive to do. … Focus and do well and prove myself and then hopefully things will work out in the end.”
A previous version of this story incorrectly rendered the name of the Association of American Medical Colleges.