Immigration & the Future of Healthcare: Looking to a Greater Good

By  |  September 5, 2018 | 

It’s been 20 years since my third year of medical school. I studied endlessly, worked tirelessly, and forged the identity that created the physician I am today. Those were the days.

I still remember them well. Attendings cursing my missteps in the operating room. My senior resident constantly dressing me down. I arrived at the hospital at 4 a.m. and left by 9 p.m. Those were the hellish days.

Nostalgia is not all it’s cracked up to be. For many centuries, it was a classified medical illness. If you were a doc in the 19th century, you would diagnose nostalgia in soldiers feeling ill at the front lines, longing for home. Nostalgia possesses positive connotations, but often it’s the residue that’s positive, with all the negativity blown away.

Medical school was formative years, but many rotations were unnecessarily tormenting. The good ol’ days are harkened fondly, as though we are heading in a world of misery, yet the evidence shows the world is heading in a better direction.


Nostalgia and the Immigrant Story

 My last blog was an attempt to use chicken soup to bridge 500 years and connect a nostalgic run from the history of hospitalists in Renaissance Florence to the early 1900s birth of the deli in New York City. It was a post awash with positivity. The dill-tinted aroma of chicken soup wafting brings back fond memories of my family. Chicken soup is a staple in many cultures. For me, it’s a cup of matzo ball soup during the holidays or thrown together for someone under the weather. Chicken soup is the Jewish penicillin, imbued with some mystical qualities for the imbiber. Do you want to know what the secret ingredient is that cures the common cold? It’s the care and compassion that comes from the bubbe delivering the bowl. That’s the aftertaste of nostalgia years later. Remembering those immigrant stories, many that were similar to those of my family three generations ago – sailing from distant lands, arriving here with a hope for creating something better.

Yet, that journey was fraught with hardship, filled with many bumps and potholes. Twist the bowl around, and the journey describes struggles that are long-lasting, and each sip is a sip of a past wanting to be forgotten. The soup is the manifestation of the lack of food, income, security. The one made of the leftovers, the bowl of water, with some salt chicken flavoring, the forgotten bits, the pieces that no one else wants to eat. Memories of that chicken soup leave a bitter aftertaste.

Drinking that bowl in the Lower East Side in the late 19th century meant being part of an immigrant story that defines this country. In the early 1900s, the Lower East Side was the most densely populated area of the United States. If you visit the Tenement Museum in the area, you will hear about over a century of diverse families living there. Ten people in a 325-square foot apartment. Children working at young ages all hours of the day and night. A pluralistic community, with various nationalities of immigrants arriving daily to seek a better life. They worked hard in back-breaking jobs with long hours. The inner city squalor being dealt with because, they knew life was better here. This is America.

The tenements became a public health crisis. One that was exposed with the cutting-edge photography of the day by Jacob Riis. In How the Other Half Lives, Riis challenged his readers to confront societal ills. Riis’s 1890 treatise of social criticism was written in the belief “that every man’s experience ought to be worth something to the community from which he drew it, no matter what that experience may be, so long as it was gleaned along the line of some decent, honest work.”


Immigration: Critical to the Future of Healthcare

Our profession, physicians, internal medicine, healthcare in general, is filled with immigrants. I’m deeply concerned that things will get worse in the short term for all immigrants. The current administration is reportedly planning to limit access to health care for immigrants, including legal immigrants. Those that are on the path for citizenship will be denied that path if they receive any public assistance, including subsidies for Obamacare or children’s health insurance. These are people trying to go through the legal process, jumping through hoops to become American citizens, who will be denied that path.

The arguments are often in relation to immigrants not doing their fair share. Let’s look at our healthcare environment. Immigrants put in more money than they get out of health care. This is not someone taking advantage of the system. As The New Yorker calls this, “consigning a large number of immigrants to a state of perpetual exclusion.”

We can have a mind frame that there is a certain size of the pie and that gain for one will be a smaller slice for others. Or, we believe in many instances that the pie can grow. This country’s advances in technology, science, education were built on immigrants. We are a country of immigrants. More than 25% of current physicians have medical degrees from foreign countries. Foreign-trained physicians are more likely to practice in underserved areas, filling in areas with shortages of physicians.

For these reasons and more, SHM recently expressed its support for the Fairness for High-Skilled Immigrants Act, legislation that will ensure that highly-skilled medical professionals and their families will not be turned away from working in the United States based on per-country limitations.

One of the great aspects of medicine is internalizing the core tenets of what it means to be in medicine. Professionalism as our core mission, with its cornerstones of social justice, patient autonomy, and primacy of patient welfare. I learned those values in medical school, again in residency, and then try to live them and teach them today. How far do we carry those ideals outside our hospital walls?

Nostalgia is looking backward. I want to look forward to a greater good. Let’s discuss over a bowl of chicken soup.

“What are you going to do about it? is the question of to-day.” -Jacob Riis


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About the Author: Jordan Messler

Jordan Messler
Jordan Messler, MD is the Executive Director, Quality Initiatives at Glytec and works as a hospitalist at Morton Plant Hospitalist group in Clearwater, Florida. He previously chaired SHM’s Quality and Patient Safety Committee. In addition, he’s been active in several SHM mentoring programs, including Project BOOST and Glycemic Control. He went to medical school at University of South Florida, in Tampa and completed his residency at Emory University. He recognizes the challenges of working in a hospital that lines the intracostal waterways of a spring break mecca and requests that if you want to be selected as a mentored site, you will have a similar location with palm trees and coastline nearby. He tries to find time to sit on the beach with his family to escape the hospital’s miasma. While there, he looks forward to reading about the history of hospitals/medicine, and how it relates to quality. But inevitably, he will have his daughter dumping sand on him and then has to explain to his wife why their daughter is buried up to her neck.


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