“There is certainly a moral case to keep DACA alive, but the effects of its repeal on the healthcare system writ large make apparent that it’s also a bad idea for all Americans.”
-Suhas Gondi
The Trump administration’s recent announcement to end the Deferred Action for Childhood Arrivals (DACA) program instilled fear and outrage in communities across the country. As a medical student with friends and classmates with DACA status, I am particularly disappointed in the poor and compassionless judgment of our nation’s leader. I fear for my peers who have worked incredibly hard and overcome the most daunting of obstacles to get where they are today, and who now could see it all taken away from them. Their now tenuous situation is unimaginable to me. But I also fear the impact of this decision on my non-DACA classmates, on our training, and on our futures. There is certainly a moral case to keep DACA alive, but the effects of its repeal on the healthcare system writ large make apparent that it’s also a bad idea for all Americans.
The American Medical Association (AMA) letter to Congress spells out many of the reasons why. Study after study has shown that, due to multiple demographic changes, physician demand will far outpace supply over the next decade. By 2030, the US will face an estimated shortfall of up to 104,900 physicians. Even now, we are witnessing how a lack of doctors in rural and other federally designated Health Professional Shortage areas results in inadequate access to care for too many, and directly contributes to worse health. As AMA CEO James Madara wrote in the letter, “the DACA initiative could help introduce 5,400 previously ineligible physicians into the U.S. health care system in the coming decades,” and work towards alleviating this persisting issue.
Less easily quantifiable is the potential for tremendous loss of academic and economic productivity. DACA protects hundreds of medical students, PhD candidates, residents, post-doctoral scientists, and others who contribute their time, skills, and intellectual capacity towards the advancement of science and the relief of suffering. As if that were not enough, the economics student inside me can’t help but also think about all the publicly and privately invested resources that, through either explicit sponsorship or indirect subsidies, went into the schooling and training of these bright, promising young adults. Deportation eliminates the chance of any “return” on that investment – probably in the form of productive careers of science and service with immeasurable benefits to society.
But the value that medical students and residents with DACA status add to the healthcare workforce and patient care is far understated by numerical estimates and productivity losses. Many of these trainees are multilingual and come from diverse ethnic backgrounds – attributes that are underrepresented among today’s doctors, but are critical in caring for the patient populations that most sorely need effective and compassionate care. Immigrant and minority populations face myriad barriers to accessing healthcare, with difficulties in communication and distrust of the medical establishment chief among them. Having more providers who share a language and culture with these patients can help close these gaps. And for the thousands of undocumented immigrants with pressing medical needs, my classmates with DACA status offer a level of connection and shared experience – foundations for a strong doctor-patient relationship – unlike any the rest of us can offer.
The unique experiences and backgrounds of these individuals enrich the education and development of their colleagues, as well as the care of their patients. Their stories are both inspiring and instructional to those of us with more traditional or more privileged upbringings who hope to serve the most vulnerable patients in our communities. For at least ten years now, evidence has accumulated in the literature of the importance of diversity in medical schools – it builds stronger, more confident, more empathetic doctors who are better prepared to provide culturally competent care and promote health equity. My future patients will benefit if I can learn alongside and from these peers of mine.
Now is not the time to scale back. The deportation of trainees with DACA status would constitute an irrecoverable loss of diversity from our schools and the entire profession. I can say with confidence that my clinical development, and that of my classmates, would be hurt by such a loss.
In the coming days, medical students and trainees at my institution and others across the country will assemble in protest of this executive decision. We do so not only for our classmates with DACA status but also for our future patients and the future of American healthcare.
Clearly, revoking DACA protection isn’t just antithetical to our core beliefs as Americans – it’s also decidedly detrimental to the public interest. While we await the details of a tentative agreement struck between President Trump and Democratic leaders in the Senate, advocates seeking to influence policymakers should draw on both the remarkable stories of individuals protected by DACA and the strong economic and public health cases against repeal.
Congress now faces the opportunity to prevent this blunder and solidify protection for children of illegal immigrants – it’s time to make DACA the law of the land. Our representatives can seize this moment to update our immigration policies to match our nation’s economic goals for the 21st century and our public health needs for the next decade.
“Dreamers” are our friends, our peers, our lab partners, and our teachers. What we can learn from them can’t be learned from a book or a computer, but what they can teach us will make us better doctors. In more ways than one, they make our healthcare system – and our country – stronger.
Suhas Gondi is a medical student at Harvard Medical School and did his undergraduate studies at Washington University in St. Louis. He previously worked at the Centers for Medicare and Medicaid Services, the Brookings Institution, and the US Senate. He is interested in the systemic problems in American healthcare and hopes to pursue leadership in public service at the intersection of government and healthcare.