As the Loyola University Chicago Stritch School of Medicine has been something of a flagship institution for the movement to enable qualified recipients of the Deferred Action for Childhood Arrivals (DACA) program to matriculate into medical school, we are increasingly being asked for tips for DACA recipients applying to residency. We sent our first five graduates who were current DACA recipients to residency positions on July 1, 2018, and recently matched nine more on Match Day 2019. Two of us have navigated this system as DACA recipients. So, we have some success under our belts.
We’ve learned that there are many programs that appreciate the specific contributions that DACA recipients will make to the physician workforce and who hope to be on the right side of history during this period of anti-immigrant sentiment. We wish to share what we think we’ve learned with medical students who are DACA recipients, their mentors, and others who wish to help them. Below are our top six tips.
First, applicants should bring up their DACA status during their residency interviews. We know that many applicants would like to be considered simply on their academic merits and clinical skills and think that raising their DACA status might harm their chances. However, when we talk with DACA-friendly residency program directors, they suggest it would be a tremendous help for applicants to bring it up. Program directors are often advised by their hospital legal counsel to not ask about immigration status for fear of being perceived as discriminatory. But program directors may not be fully aware of what is happening with DACA on the judicial and political level, which could lead them to conclude that another program might be more suitable for DACA recipients. So, program directors welcome applicants opening the discussion and helping them to understand the limited risks involved for their program. They also hope to learn how they could be supportive of a DACA resident when they match to their program.
Second, a faculty member or key administrator should be available to serve as the point person to whom applicants can refer program directors if they need an update on current developments around DACA or wish to ask other questions. Program directors may not have their own in-house resources and may want to double check information, such as the ability of DACA recipients to obtain a medical license or to learn about guidance and support from the National Resident Matching Program (NRMP). Applicants can carry the business card of this person to give to program directors if needed or they can put the program director and the point person in touch via e-mail after the interview.
Third, mentors and other faculty members should consider assisting in identifying DACA-friendly residency programs. This can be done by inquiring through the specialty listservs to which mentors belong. Programs eager to utilize the diversity and talents of these applicants may readily respond. Such progressive programs can put themselves on the radar of applicants who might not have considered these particular programs.
Fourth, our limited experience suggests that larger residency programs may be more receptive to DACA recipients than very small programs. While we do not have enough data to statistically verify this perception, we fear that smaller programs may be unnecessarily skittish, fearing that they would not be able to cover the loss of a DACA resident as well as large programs would. However, we hope that with additional information, small programs will come to see that any interruptions in the service of a resident owing to a legal or legislative development will be foreseeable and can be ameliorated with the support of the NRMP. Thus, while applicants may wish to apply to a blend of large and small programs, we hope that both kinds of programs will see the risk to be very minimal and not let it prevent them from considering this talent pool strictly on their merits.
Fifth, DACA applicants will do well to attend to all the things that other applicants do, especially those niceties that help establish a dialogue with residency programs. For example, if you don’t hear from a residency program within a month or so of submitting your application, send an e-mail to the program directors and coordinators. Send letters of interest after interviews as well. It’s important to stay on their radar and show them that you’d like to be part of their program for specific reasons. The more DACA applicants can do to be seen as unique individuals and not just as candidates with special circumstances, the more likely it is that they will get full consideration by residency programs.
Sixth, obtaining a medical license has so far not presented a barrier for DACA recipients who have matched. Following precedents in regard to admission to the bar in the legal profession, some anticipated that licensure could pose a significant issue in many states, while others were more optimistic. Nevertheless, some states that have explicit legislation pertaining to denying professional licenses to undocumented immigrants may attempt to deny DACA recipients medical licenses. Consultation with legal counsel may be prudent in advance of ranking programs in these states.
Our discussion would be incomplete if we didn’t offer words of encouragement.
To the student seeking to match: You have come this far against so many obstacles. Continue to believe in yourself and use all the resources at your disposal to find a program that appreciates you and will help you become the physician you always dreamed of being.
To the medical school mentors supporting future residents with DACA status: Be bold and creative in your efforts to find supportive individuals in graduate medical education who will respect and admire these amazing students as much as you do. And expect that the students will not take your advice very often. After all, they have achieved their goals by pursuing options others told them were long shots or impossible. So, while you may develop a list of what you think are the best places for your students to match, remember to be proud when they stake out a novel path and pull off the improbable. Witnessing such feats is part of the privilege of being an ally to some of the most amazing medical students in the United States.
By: Mark Kuczewski, PhD, Aaima Sayed, MD, Rosa Aramburo Paredes, MD, and Aaron Michelfelder, MD
M. Kuczewski is the Fr. Michael I. English Professor of Medical Ethics; director, Neiswanger Institute for Bioethics and Health Policy; and chair, Department of Medical Education, Loyola University Chicago Stritch School of Medicine; Twitter: @BioethxMark.
A. Sayed is a first-year psychiatry resident, Loyola University Chicago Health System.
R. Aramburo Paredes completed a year of general surgery residency and will be starting a residency in obstetrics and gynecology at Creighton University Medical Center.
A. Michelfelder is professor of family medicine and chair of the Department of Family Medicine, Loyola University Chicago
Stritch School of Medicine; Twitter: @citywolf26.
Further Reading
Kuczewski MG, Brubaker L. Medical education for “Dreamers”: Barriers and opportunities for undocumented immigrants. Acad Med. 2014;89:1593-1598.
Nakae S, Rojas Marquez D, Di Bartolo IM, Rodriguez R. Considerations for residency programs regarding accepting undocumented students who are DACA recipients. Acad Med. 2017;92:1549-1554.