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No papers? No problem!

April 27, 2016

An immigration issue has come to my attention that I thought I would weigh in on.   I wrote a piece awhile back in support of Foreign Medical Graduates (FMGs) that bent a bunch of people over at KevinMD out of shape.  I guess that makes me an expert in all things foreign and medical-ly, because I was recently contacted by a reporter (Hi Alicia!) who wanted to know what I thought about admitting children of undocumented immigrants (themselves also undocumented if they were children when they came here) to medical school.  Apparently there are at least 60 medical schools in the country that are doing this.

I am not a believer in penalizing children for the sins of the parents.  Ever.  There are tons of good reasons and very few bad ones for granting children of undocumented immigrants the right to health care, education, and the same opportunities other kids have.  (I know!  Bless my bloody little liberal heart!)  The argument is made that denying such privileges further documental (documentary?) misbehavior on the part of people who want to come to this country to help their kids do better than they are.  How’s that working out so far?  The Department of Homeland Security says the population of undocumented immigrants grows by 275,000 each year (www.dhs.gov).  Denying resources to kids who arguably need them most perpetuates the poverty of their families and future generations of their families.  They’re coming.  They’re here.  Might as well help the kids, at least.

But wait, you say!  How About Helping Our Own Kids!?!?!  I’m not talking about a free ride through school.  The same chance for federal loans that everybody else gets would be fine.  Oh, did I mention?  Undocumented kids admitted to medical school are not eligible for federal financial aid.  So…not really an opportunity…really.

That political soapbox having been stood upon, let’s look at one of the discussions circulating around the issue of allowing the children of undocumented immigrants to go to an American medical school:  The Doctor Shortage.

Ah, The Doctor Shortage.  By this I assume what is meant is the lack of primary care and other services in poor and underserved neighborhoods and counties in the United States.  Because if you hold your arms out and spin slowly you’re bound to hit two or three doctors here in Boston.  We’re chock-a-block.  The Doctor Shortage problem has been farmed out to foreigners for years.  Everyone thought FMGs would fill this role.  Or People Who Speak The Language Of The Community (translation: black and latino doctors).  Now the undocumented.

Here’s a question for you:  Why the &^%$ would the children of undocumented immigrants be any more likely to go into primary care in their communities, or remote Appalachia, than any well-documented, voting-eligible medical student?  Especially if you deprive them of financial aid?  Out of the goodness of their hearts?  Out of concern for their paperless neighbors?  Maybe some of them.  But staring $200,000 in student loans in the face, especially high-interest private loans, makes plastic surgery a really attractive option, I don’t care who you are.  Also remember that putting anyone, but especially a smart, ethnically or financially challenged person, into the smart-kid, high achieving environment of medical school and residency, is inevitably going to show them the options available to them.  Furthermore, medical school and residency takes up most of people’s 20s.  Maybe a smart, talented immigrant falls in love with neurosurgery and the co-ed (non-immigrant) OB-GYN resident down the hall.  All the good intentions in the world aren’t going to convince this person that what they really want to do is take their beloved and treat colds and high blood pressure in a community in which only one of the couple feels connected.  Life happens while medical school happens.

Medical students, no matter where they come from or what papers they have, don’t go into primary care and/or into underserved communities for two reasons: money and money.  Medical school costs too much and primary care doctors get paid too little. (Well, one other reason – paperwork) I know!  More people getting their feathers up at KevinMD!  A doctor in such a community is making so many multiples more than the people they serve!  Doctors are so greedy!  Let me refer you here: http://www.kevinmd.com/blog/2011/04/real-life-medical-school-debt.html, or here: http://www.cbsnews.com/news/1-million-mistake-becoming-a-doctor/.

Here’s what I would suggest: children of undocumented immigrants are, arguably, lucky to be here and, if they’re smart, eager to grasp the opportunities their parents have attempted to provide them with.  If such a kid wants to go to medical school, great!  Provide him or her with the financial aid available to all kids, but put a binding contingency on it.  All undocumented students have to commit to a certain number of years of work in their communities or in other underserved areas.  And back it up with financial support.  The military already does this – medical students get med school paid for if they commit a certain number of post-residency years to military service.  Such a program also already exists in the private sector.  The National Health Service Corps offers substantial loan repayment for professionals who sign up for a certain number of years of service in an underserved area (https://nhsc.hrsa.gov/loanrepayment/).  The NHSC is, in my opinion, underutilized.

The Doctor Shortage will not be solved by making people who are Not Us do the work.  It will be solved by effective monetary and regulatory policies that make primary care in remote areas a viable and attractive option.

 

 

 

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