In a letter to Homeland Security Secretary John F. Kelly, the AMA asked for clarification on the Jan. 27 executive order, “Protecting the Nation from Foreign Terrorist Entry into the United States,” and urged the Trump administration to proceed carefully on actions that would affect people with Deferred Action for Childhood Arrivals (DACA) status.
AMA CEO James L. Madara’s letter voices concern that the executive order is negatively impacting patient access to care and resulting in unintended consequences for the health care system. He noted reports that the president’s action is “affecting both current and future physicians as well as medical students and residents who are providing much needed care to some of our most vulnerable patients.”
“While we understand the importance of a reliable system for vetting people from other nations entering the United States,” he added, “it is vitally important that this process not impact patient access to timely medical treatment or restrict physicians and international medical graduates (IMG) who have been granted visas to train, practice or attend medical conferences in the United States.”
Amid a physician shortage, actions such as this order can have an impact on rural and low-income communities that rely on IMGs to meet their health care needs. One out of every four physicians practicing in the United States today is an IMG. “These physicians are licensed by the same stringent requirements applied to U.S. medical school graduates,” Dr. Madara wrote.
IMGs are more likely to practice in underserved and poor communities and fill training positions in primary care and other specialties that face workforce shortages, the letter says.
“Guidance is urgently needed from the administration to ensure the upcoming residency matching program in March 2017 does not leave training slots vacant and that all qualified IMG applicants can participate,” Dr. Madara wrote.
Protecting DACA students
Though President Trump has made recent comments about working to ensure that people with DACA status are able to remain in the United States to complete their studies, the AMA letter also urges the administration to carefully consider any future action that may affect the so-called dreamers.
The Homeland Security secretary in 2012 announced DACA as a way for people who came to the United States before age 16, and who meet other guidelines, to request deferred action to avoid deportation for a certain period of time. A number of medical students have found opportunity under DACA to continue their education and fulfill their dreams of becoming a physician.
“The AMA strongly supports medical students and physicians with DACA status,” Dr. Madara wrote. “These individuals help contribute to a diverse and culturally responsive physician workforce, which in turn helps benefit all patients.”
In 2016, 108 students with DACA status applied to U.S. allopathic medical schools, according to the AAMC. Thirty-four of those students matriculated, bringing total allopathic medical school enrollment of DACA-eligible students to about 70.
“One study has predicted that the DACA initiative could introduce 5,400 previously ineligible physicians into the U.S. health care system in the coming decades,” the letter says. “We urge the administration to retain the current DACA initiative until a permanent solution on lawful immigration status for DACA participants is implemented.”