By BETSY TAYLOR
On Aug. 22, Emelin Garcia Nieto and 160 other students at Loyola University Chicago Stritch School of Medicine took part in a white coat ceremony, where they received lab coats to mark the start of their medical education. Acceptance into medical school is an accomplishment for even the brightest of students. To claim her place, Nieto surmounted a hurdle beyond the academic competition — she grew up in the U. S. as an undocumented immigrant. Good timing — and a Trinity Health loan program — are helping her work toward her dream.
First-year student Emelin Garcia Nieto accepts her lab coat at the Class of 2019 white coat ceremony at Loyola University Chicago's Stritch School of Medicine.
Image credit: Erik Unger
She is among the first participants in the loan program at Stritch, funded by Trinity Health with loan management through a Chicago-based organization called The Resurrection Project. The program provides up to $2.5 million for tuition and fees for Nieto and six other students in her class who grew up as undocumented immigrants and therefore don't have access to federally backed student loans. "Without Trinity, I wouldn't be able to be here," Nieto said.
Trinity Health owns the Loyola University Health System, and Loyola University Health System's physicians have faculty appointments at Stritch. The Stritch School of Medicine itself is part of Loyola University Chicago.
Blazing a trail
In 2013, Stritch decided to become the nation's first medical school to accept undocumented immigrants in response to the Deferred Action for Childhood Arrivals program. The program, launched by President Barack Obama's executive action in 2012, allows undocumented immigrants who came to the U.S. before the age of 16 and meet certain academic and legal guidelines to apply for DACA status. This status allows them to remain in the U.S. legally and to obtain a social security number and a work permit. DACA recipients must re-apply every two years for the temporary immigration status, which is not a path to citizenship.
In the months after the executive order, Stritch leadership announced the school would consider DACA-status students for acceptance into medical school. The Jesuit medical school said providing these students access to a medical education was a matter of social justice. Their DACA status meant they could legally work in a clinical setting, a necessary component of medical school. DACA-status immigrants also can become licensed to practice medicine in most states, though some states have laws prohibiting it.
The Association of American Medical Colleges lists about 50 medical schools that have "reported willingness to consider DACA applicants," though anecdotal reports suggest the number of schools able to address the needs of these applicants is significantly lower, said Mark Kuczewski, chair of Stritch's department of medical education. He said Stritch knows of only six other students with DACA status who have matriculated at other medical schools across the country this year.
Funding med school
Kuczewski said DACA-status students are accepted to Stritch on their academic merits. However, under U.S. law, they can't qualify for federal student loans. The school began working with outside organizations in the winter of 2012-13 in anticipation of helping the DACA-status students fund their tuition costs, Kuczewski said. Stritch provides scholarships to cover their basic living expenses.
Last year, the first that Stritch accepted DACA-status students, all seven of those students received loans through funding from the Illinois Finance Authority. (The finance authority provides access to low-cost capital to public and private institutions that foster economic development, create and retain jobs and improve Illinois residents' quality of life. There is no federal involvement.) Any medical or dental school in Illinois can utilize this loan program. Immigrants must attend medical or dental school in Illinois to qualify for this specialized student loan program, but they can do their residencies and fellowships anywhere in the country. If they return to Illinois and practice in an area designated by the Illinois Department of Public Health as medically underserved, the interest on their loans will be forgiven.
Emelin Garcia Nieto, on the left in the center row, and other first-year students at Loyola University Chicago's Stritch School of Medicine at their white coat ceremony.
Image credit: Erik Unger
Stritch doesn't single out DACA-status students during the admissions process and has no quota for the numbers of these students it accepts, Kuczewski said. The medical school has become widely known for admitting DACA-status students, and the volume of inquiries it received about the program in 2014 led school administrators to realize more loans were needed for the 2015-16 academic year. Twice as many DACA-status students started at Stritch this academic year, 14, up from 7 students the first year they were eligible for acceptance, Kuczewski said. All 14 received financial support. Seven of them received loans through the funding provided by Trinity Health. Five got loans through the Illinois Finance Authority. One student had a relative who co-signed for a private loan, and one student entered an M.D.-Ph.D program and received funding from a separate university source.
Stritch, Trinity Health and The Resurrection Project began planning in April to create the new student loan program to meet the demand, the organizations explained. Trinity Health signed on as the sole funder of the loan program, agreeing to provide up to $2.5 million in student loans toward tuition and fees for DACA-status medical students at Stritch. Trinity said it is doing this by making a program-related investment in The Resurrection Project, an organization that works on community development in Chicago. The Resurrection Project said it is responsible for management, serving as the financial intermediary on the loans.
Nine months after completing a residency and/or fellowship, students begin to repay the principal and 5 percent interest through monthly payments that can stretch over 10 years. Loyola University will provide loan-related documents to students and initiate collections. In the pilot, Trinity has committed to underwriting loans for four years of medical school tuition and fees for the seven DACA-status students currently enrolled in the loan program.
Supporting physician diversity
Dr. Bechara Choucair, Trinity Health's senior vice president for safety net transformation and community health, called the student loan program "the single most upstream physician recruitment tool we've ever seen." He said Trinity Health is beginning a relationship with the students even before they matriculate into medical school by providing the loan funding.
He said, "We hope this investment will provide yet another tool for Trinity to recruit American-trained, bicultural physicians who possess skills and attributes that enable them to better serve some of the underserved and marginalized people within the communities within Trinity Health's ministries."
Nieto, now 21, said she has been able to meet physicians from Trinity Health and leaders from The Resurrection Project to thank them for creating the student loan program with Stritch.
Giving back
Nieto was brought to the U.S. from Mexico as a baby and raised by her biological mother's sister and her husband, who adopted Nieto. Growing up in South Carolina, Nieto said she thought of herself as an American, as much as anyone she knew. It wasn't until she considered getting her driver's license that her parents told her she was undocumented. Nieto had a tax identification number from the government but no social security number. She couldn't get a driver's license, couldn't get a paying summer job, she said. She had been receiving health care at free clinics, places more accepting of undocumented residents. Her siblings who were citizens born in the U.S. went to see doctors and dentists more routinely.
As a teenager, she volunteered as a translator at free clinics, including locations where she had received care. She earned an undergraduate degree from Columbia College in South Carolina, majoring in biology and Spanish, before entering medical school with a goal to practice medicine in a medically underserved area.
While many undocumented immigrants don't speak out publicly about their experience, Nieto said it's important that the public dialogue include positive stories about immigrants. She often hears pundits and politicians criticize undocumented immigrants as wanting to take from the U.S., but in her experience, the opposite is true. "We really do want to contribute back to this country," she said.