A small but important population of new and future physicians -- and a much larger number of Americans for whom they've pledged to care -- remains threatened by the Trump administration's move to end the Deferred Action for Childhood Arrivals program.
That's the message the Academy has again sent, this time by joining 32 other medical organizations in an amicus brief(46 page PDF) filed Oct. 4 with the U.S. Supreme Court in Department of Homeland Security, et al. v. Regents of the University of California, et al. to support a challenge to a 2017 order rescinding DACA.(www.dhs.gov)
The program, initiated in 2012, offered limited legal protection to 800,000 young people who entered the country illegally as children and gave them the right to work in the United States.
Some 27,000 of those people are health care workers and medical support staff -- dentists, pharmacists, physician assistants, nurses, home health aides, technicians -- who depend on DACA to continue their work, the brief notes.
And about 200 are medical students, medical residents and physicians.
- The AAFP joined 32 other medical organizations in an amicus brief to the U.S. Supreme Court supporting a challenge to a 2017 order that would end the Deferred Action for Childhood Arrivals program.
- The organizations noted that physicians and other medical professionals are among the 800,000 young people who depend on DACA.
- Ending the program would ignore the "serious reliance interests" of states and institutions that invested in educating and training people under DACA, the organizations said.
"If those trainees and physicians retain their work eligibility, each will care for an average of between 1,533 and 4,600 patients a year," notes the filing, which was initiated by the Association of American Medical Colleges. "Together, over the course of their careers, they will touch the lives of 1.7 to 5.1 million U.S. patients."(www.cdc.gov)
The brief filing continues advocacy the Academy first undertook immediately after the order was announced.
"We are already facing a shortage of primary care physicians. Ending DACA protections could further threaten patient access to care, particularly in medically underserved areas," the AAFP's then-President, John Meigs, M.D., of Centreville, Ala., said in 2017.
At the time, the Academy called on Congress to preserve the DACA status of 108 students who had applied to U.S. medical schools, among other affected individuals.
"Not only does the loss of DACA protection deprive these students of a future," Meigs said. "It also could deny Americans access to care."
The amicus brief points out that Congress has not intervened and the jeopardy to U.S. health care is still urgent.
Although current DACA recipients can continue to renew their status,(www.nilc.org) the government has stopped accepting new applications. Meanwhile, the brief says, schools, hospitals and sponsors of biomedical research have banked on DACA recipients to join a workforce that is already facing serious shortages.
"The effects of rescinding DACA will extend far beyond the impact on DACA recipients themselves," the filing says. "For years, health professional schools, hospitals and even states themselves have invested substantially in educating and training DACA recipients under the expectation that they would be able to return that investment with a lifetime of practice that benefits the public in ways that will be crucial over the next decades."
That disruptive element is key to the medical groups' argument.
Previous case law has dictated that an agency rescinding a policy must consider any "serious reliance interests." The Academy and its co-signatories -- including the American College of Obstetricians and Gynecologists, the American College of Physicians and the AMA -- identify the substantial investment that has been made in DACA-protected physicians and other medical professionals as just such an interest.
"The law is clear that the government cannot rescind a longstanding policy without, at a minimum, seriously considering the reliance interests that would be disrupted by such a change in course," the filing says. "Yet in this case, the government failed to make any serious effort to consider any of the substantial reliance interests affected by the rescission of DACA."
The filing goes on to say that the United States is not prepared "to fill the loss that would result if DACA recipients were excluded from the health care workforce."
In fact, it says, "the country will have between 46,900 and 121,900 fewer primary and specialty care physicians than it needs," with shortages in mental health, dentistry, nursing and other health professions also becoming more acute.
"These shortages will be felt most keenly in medically underserved areas, such as rural settings and poor neighborhoods -- precisely the areas in which DACA recipients are likeliest to work,"(static1.squarespace.com) the brief adds.
The U.S. District Court for the Northern District of California issued a preliminary injunction(www.cand.uscourts.gov) in January 2018 requiring the government to continue renewing DACA status for people already in the program, and that decision was upheld by the U.S. Ninth Circuit last November.
The U.S. Supreme Court is expected to hear the administration's appeal of that ruling and two related cases next month(www.scotusblog.com) and issue a ruling next summer.
Related AAFP News Coverage
AAFP Voices Concern About New 'Public Charge' Rule
Group of Six Calls on Administration to Rescind Rule, Protect Public Health