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AMA: Reversing DACA puts patient care at risk, could worsen doctor shortage

Group has called on Congress to consider alternatives that will not hinder the healthcare workforce.

Tom Sullivan, Editor-in-Chief, Healthcare IT News

U.S. Attorney General Jeff Sessions announced on Tuesday the Trump administration's decision to end the Deferred Action for Childhood Arrivals program. (CNN)U.S. Attorney General Jeff Sessions announced on Tuesday the Trump administration's decision to end the Deferred Action for Childhood Arrivals program. (CNN)

In reaction to President Donald Trump's decision on Tuesday to reverse the Deferred Action for Childhood Arrivals program that protects about 800,000 immigrants, the American Medical Association has called on Congress to consider alternatives that will not hinder the healthcare workforce.

"President Trump's recent announcement to end the DACA program in six months fails to recognize the enormous contributions of hundreds of thousands of individuals who are living, working and providing vital services in the United States, including healthcare," AMA CEO James Madara, MD, wrote in a letter to lawmakers. "We particularly are concerned that this reversal in policy could have severe consequences for many in the healthcare workforce, impacting patients and our nation's healthcare system."

[Also: Trump administration, HHS stepping away from Affordable Care Act promotion, bundled payments]

While Madara's letter naturally focuses on AMA's physician membership, ending DACA would also have a widespread impact in the technology workforce, particular to healthcare and other sectors. As such, top executives including Apple CEO Tim Cook, Microsoft chief Satya Nadella and its President Brad Smith, Facebook head Mark Zuckerberg, Google CEO Sundar Pichai, Amazon founder Jeff Bezos and others are publicly recommending that Congress find legislative solutions as quickly as possible.

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Microsoft's Smith, in fact, told NPR that DACA should now be Congress' top priority, even ahead of tax reform, even though "the entire business community cares about tax reform," Smith said. "Tax reform can wait."

AMA sent the letter to Senate Majority Leader Mitch McConnell, House Speaker Paul Ryan as well as Democratic Leaders Chuck Schumer and Nancy Pelosi.

The meat of Madara's argument is the ongoing talent shortage. One out of four doctors practicing today is an international medical graduate and many of those have DACA status. He also cited the Health Resources and Services Administration statistics that America is amidst a primary care physician shortage of more than 8,200 doctors, a figure the Association of American Medical Colleges projects will rise to at least 61,700 possibly as high as 94,700 physicians by 2025.

Eliminating DACA protections will not only make the shortages worse, it will also hit rural and underserved areas hard and those are places that DACA physicians are likely to work.

What's more, DACA has the potential to make approximately 5,400 physicians eligible to practice medicine in the coming years, he added.

"The AMA is concerned that the quality of care provided in these communities will be negatively impacted and that patient access to care will suffer," Madara wrote. "DACA recipients should be able to continue to study, work, and improve patient access to care without the fear and uncertainty of being deported before their training is completed."

President Trump publicly said that Congress has six months to legalize DACA or he will revisit the issue. To that end, the AMA urged the lawmakers to take immediate action and pass the Dream Act of 2017 to protect DACA recipients from legal challenges. 

Other options Congressional officials have put forth included the Recognizing America's Children Act, proposed by Republican Florida Rep. Carlos Curbelo to create new options for immigrants to achieve legalization that include higher education and work authorization.

Democratic Illinois Rep. Luis Gutierrez sponsored the Hope Act, which does not grant legalization based on work or education but enables qualified immigrants to apply for citizenship in five years.

And then there's the Bar Removals of Individuals Who Dream and Grown our Economy or Bridge Act, which Colorado Republican Rep. Mike Coffman first introduced to keep DACA in place for three more years.

"Those with DACA status contribute to a diverse and culturally responsive physician workforce, which benefits all patients," Madara wrote. "These individuals have demonstrated their commitment to the United States in numerous ways by attending medical school, training to become doctors, caring for patients, conducting research, and improving our health care system. We therefore urge Congress to support these DACA recipients and pass a legislative solution in the near future."

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