Where Should We Stand on DACA? Flexner Would Answer the Call

Equity issues are not new to medicine; they began with the legacy of Abraham Flexner, the father of academic medicine.

DACA students
Thousands of immigrants and supporters joined the Defend DACA March to oppose President Trump's order to end DACA on Sept. 10, 2017, in Los Angeles. Credit: David McNew/Getty Images

Editor’s note: The opinions expressed by the authors do not necessarily reflect the opinions of the AAMC or its members.

I first became aware of undocumented students in medicine around 2001. At the time, I was a program coordinator, running a pipeline program for prehealth students. My director advised me to process a stipend differently for one of our scholars and explained that she was undocumented. 

Ten years later, a young woman at the AAMC Career Fair approached me after my presentation. She explained that she was an undocumented immigrant and dreamed of becoming a physician. I gave her a summary of what I knew about the path she would have to take, mostly focusing on the barriers she would encounter. Even if she could manage to get private loans and graduate from medical school, she would experience a hard stop at residency, unable to proceed with her medical training because of her undocumented status. The woman listened intently and then ardently explained that this was her dream, and she would do anything to achieve it. The passion and resolve she displayed while fully aware of the tremendous barriers she would face is something I have come to know well in my work with undocumented students. I promised her that I would help in any way possible, and we agreed to keep in touch.  

In June 2012, President Barack Obama announced the Deferred Action for Childhood Arrivals (DACA) program. DACA provided a stay of deportation for nearly 800,000 young people living in the United States who entered the country before the age of 16. The program required applicants to register with the U.S. Citizenship and Immigration Services and to pay a fee. DACA allowed for work authorization, driver’s licenses, and an exit from the shadows. Because DACA recipients could legally work in the United States, it made residency training and subsequent licensure possible for undocumented medical students. Loyola University Chicago Stritch School of Medicine, where I work, formally expanded admissions eligibility to DACA recipients and matriculated its first cohort in 2014.

Now we are at a crossroads. The uncertainty that plagued these students in the years before DACA has returned. On Sept. 5, 2017, the Trump administration announced it was terminating the DACA program. Though imperfect and not a path to citizenship, DACA allowed many students to move forward, pursuing their dreams in education and careers. U.S. medical schools are fortunate to have nearly 100 MD trainees who are DACA recipients. At least six of those trainees will enter the Match this year, with hopes of beginning residency in July 2018.

“To value the splendor that academic medicine is today is to recognize that it was constructed with equity, advocacy, and a mind-set to remove barriers of ‘biological accident.’ We must stand firm with our undocumented students and their families to ensure medicine continues to be on the right side of history.”

What will become of these talented, bright, hard-working students who have sacrificed, borrowed money through private programs, and dedicated their lives to medicine? With a looming physician shortage and widening health equity gaps, we need every medical trainee. To meet the health needs of our communities, medicine must retain the talent of multilingual, multicultural physicians who understand the challenges of immigrants and who will dedicate their careers as providers and advocates for these individuals. 

Equity issues are not new to medicine; they began with the legacy of Abraham Flexner. He is widely credited with developing the medical education system in the United States and Canada, but what you may not know is that Flexner was incredibly progressive for his time. His modest upbringing and early professional time as a teacher in the South suggest he understood the limiting effects of poverty. In the 2010 book, Abraham Flexner: A Flawed American Icon, Michael Nevins, MD, wrote that Flexner hoped to build an educational system removed from “the shackles of poverty, race, color, every possible biological accident and social prejudice.” Flexner believed that individuals should be able to take their place in society based on their merits and envisioned a system that rewarded merit over birthright.   

Flexner himself was concerned with the lack of minority representation in medicine. He was the steward of a joint accreditation system for predominantly white medical schools and historically black medical schools during an era when separate but equal was the norm and would not be challenged for another 40 years. Women’s suffrage was a salient political battle during Flexner’s lifetime, and he marched in protests alongside his daughters to support their right to vote. 

Today we can apply Flexner’s legacy of advocacy, inclusion, and excellence. To value the splendor that academic medicine is today is to recognize that it was constructed with equity, advocacy, and a mind-set to remove barriers of “biological accident.” We must stand firm with our undocumented students and their families to ensure medicine continues to be on the right side of history. 

Sunny Nakae, MSW, PhD
Sunny Nakae, MSW, PhD

I call on leaders in academic medicine, future and current physicians, educators, and community leaders to stand up for undocumented students in medicine. We must be politically active in urging Congress to pass the DREAM Act of 2017 so that our 100 trainees, and their nearly 800,000 peers nationwide, will remain our colleagues and neighbors.

Dr. Nakae is an assistant professor of medical education and the assistant dean for the Admissions, Recruitment and Student Life Office at Loyola University Chicago Stritch School of Medicine in Maywood, Ill.