Jennifer Chang celebrated when she got her acceptance letter from Yale School of Medicine. She thought her dream of becoming a doctor was finally within her grasp. But now, the 26-year-old med student says she's not so sure.
Chang has the grades to make it. She's committed to serving her patients. But she is also undocumented.
"I was brought to the United States from China by my parents when I was 5 years old," she told CNN. "We entered legally and even submitted an application for permanent residency. But it took over 10 years for the final rejection to happen, and by then I considered the United States to be my home."
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Like legions of other children who arrived or stayed in this country illegally with their parents, Chang has gotten a temporary reprieve from deportation under a program called DACA, or Deferred Action for Childhood Arrivals. The Obama-era initiative also grants work permits to participants, who can renew their status every two years.
DACA set the stage for Chang to pursue her goal of practicing medicine. She's now one of about 70 DACA-status students studying at med schools in the US, according to the Association of American Medical Colleges.
But Chang, like other students who spoke with CNN, worries that President Trump's crackdown on illegal immigration could threaten the program -- and their career aspirations.
"If DACA gets eliminated and not replaced by anything, I will have to put my dream on hold," said Gloria Rinconi, a DACA recipient and biology major at Richland College in Dallas who decided to pursue medicine as she watched her mother, who also is undocumented, battle breast cancer.
Parsing Trump's promises
Trump has vowed to preserve protections for DACA recipients, who often are called DREAMers, a reference to the related DREAM Act. If approved by Congress, it would give DACA participants permanent legal status.
But the President also has decried purported abuses of the DACA program, alleging that gang members and drug dealers are among its ranks, even though serious criminal offenders are barred. And weeks into his term, Trump expanded the power of immigration officers to deport people and made clear that no one in the country illegally is safe from removal.
For undocumented students who want to become doctors, DACA status is key, said Greg Siskind, an immigration lawyer who is chairman of the International Medical Graduate Taskforce.
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"The employment cards DACA recipients get don't limit them as far as the type of work they can do," he said. "So if someone completes medical school and is accepted into a residency program, they can pursue their graduate medical training. And they can potentially receive a medical license and practice medicine."
So far, that territory remains uncharted. Given that DACA is only five years old, med students with that status are only now in their first year of residency, said Matthew Shick, director of government relations and regulatory affairs for the medical colleges association.
"Licensure has not yet been in any way challenged legally," he said, adding that in other professions, requiring citizenship for a license has been ruled unconstitutional.
Facing a physician shortage
"Right now, the US has a physician shortage, and it will be foolish if we have people capable of addressing this crisis and we choose to drive them away," Siskind said. A study released this week predicts a shortfall of as many as 105,000 physicians by 2030.
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"Letting DACA recipients go into the medical field is as much about serving our national interests as it is a question of compassion," he said.
DACA-status students also are more likely to be bilingual, to come from diverse cultural backgrounds and to intend to practice in high-need places, Shick added.
But DACA status doesn't mean the path to an MD is smooth. Only about half of US medical schools report "willingness to consider future applicants with DACA status who are still working toward their undergraduate degree," the medical colleges association wrote in a December letter to Trump. Undocumented students also are barred from federal student loans, and their access to state loans and private financing is spotty.
Numbers expected to swell
Though the number of DACA-status students now studying medicine is small, experts expect it to swell. Since the program started in 2012, more than 1.5 million DACA applications and renewals have been approved. Only now are many of those children working their way through college.
Alma Reyes Gonzalez is a DACA recipient who is double-majoring in biology and philosophy at the Eastern Connecticut State University. She worked at a meat-processing plant to save up for college before securing a scholarship through a program called TheDream.US, which helps DACA-status students pay for school.
She aims to study medicine.
DACA recipient Alma Reyes Gonzalez, center, is double-majoring in biology and philosophy at the Eastern Connecticut State University.
"Growing up in the United States presented many challenges for me as it did for many other undocumented children, such as the language barrier and the lack of sense of belonging," she told CNN. "However, school became my safe haven in spite of the challenges I faced as an undocumented student."
Another scholarship recipient, Lucero Gil, is majoring in biology on the pre-med track at Lehman College in New York.
"I'm the first generation from my family to go to college, and I want to become a pediatrician one day," she told CNN.
DACA-status student Lucero Gil is majoring in biology on the pre-med track at Lehman College in New York.
Motivated to serve patients
Despite her legal status, Yale awarded Chang a scholarship to cover tuition and issued her a loan to help pay living expenses, she said. Still, concern lingers about how the nation's immigration policies might affect her career.
"To be honest, as of now I am focusing on getting over one obstacle at a time and trying not to worry about the future a few years from now, especially as nowadays everything is constantly in flux," she said.
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Chang wanted to study medicine because of her father, who suffers from a severe chronic illness and is effectively disabled.
"Due to immigration status and lack of money, he did not have health insurance and was not able to see a physician to manage his symptoms," she said. "I grew up taking care of him, and seeing everything he has gone through has really inspired me to work in health care.
Already, Chang has volunteered at a local hospital and at a clinic that serves patients without insurance, including undocumented people.
"The US has a great shortage of physicians, and US-born professionals are not meeting the demand," she said. "Allowing undocumented immigrants to continue to pursue their medical training will help to overcome this shortage, and will directly improve the health and well-being of current American citizens."