No single medical association, school or pipeline program has the solution to the minority physician shortage. There are countless efforts underway by numerous organizations to attract more underrepresented minorities to the medical profession. Calls to increase the supply of minority physicians have gotten louder over the years in response to the country’s rapidly changing demographics.
If projections hold, the country is expected to be a majority minority society by 2050. Currently, blacks, Latinos and Native Americans make up 25 percent of the U.S. population but only 6 percent of practicing physicians, according to the Association of American Medical Colleges (AAMC). Furthermore, AAMC studies have found that minority physicians are more likely to practice in underserved communities, and minority patients are more likely to choose a health care professional of their own racial or ethnic background.
In 2007, more than 40,000 students applied to U.S. medical schools, with underrepresented minorities comprising just over 15 percent of the applicant pool combined, according to the AAMC.
The medical community has expressed great concern over those statistics, and organizations, including minority physician and medical associations, are involved in a number of initiatives to widen the pipeline.
In response to a projected overall physician shortage, the AAMC has a goal of increasing medical school enrollment 30 percent beyond 2002’s numbers by 2015. In addition, the AAMC launched an online resource, Aspiringdocs.org, in 2006 to provide comprehensive information for minority college students considering a career in medicine.
But Charles Terrell, chief diversity officer of the AAMC, says there are real barriers when it comes to at-tracting minorities to the field. “When you look at the academic trajectory of becoming a physician, with four years of college and four years of medical school, and the application standards, it’s a challenge that is uni-versal,” he says.
The AAMC runs its own pipeline program: The Summer Medical and Dental Education Program offers freshman and sophomore college students from underrepresented backgrounds six weeks of medical and dental preparation at 12 sites across the country.
Both progress made and progress yet to be made motivate medical school pipeline programs to continue their efforts to produce a physician workforce that is representative of 21st century demographics.
Long before the medical community at large initiated efforts to increase the number of underrepresented physicians, historically black medical schools primarily filled that role as early as 1868, when the Howard Uni-versity College of Medicine in Washington, D.C., was established. The three existing historically black medical schools—Howard, Meharry and Morehouse—continue to produce the largest percentage of black physicians. Xavier University of Louisiana, the nation’s only historically black and Catholic university, has sent the most African-American students to medical school per year for the past 15 years. In 2008, the university placed 56 of its students in medical school.
Although these institutions have arguably made the largest and most consistent contributions to providing the United States with the majority of its minority health care practitioners, they are not alone in making the minority physician pipeline a top priority.
The approaches taken by pipeline programs to achieve their intended goals are as diverse as their pool of students, yet they share common characteristics, including regional recruiting, summer bridge programs, early outreach efforts and MCAT prep courses. The following three programs are among the most well-known and well-respected.
The Early Starters
Dr. Michael Toney, executive director of the University of Illinois at Chicago’s (UIC) Urban Health Program (UHP), says their early outreach effort is the primary reason for the program’s success.
Over the past 30 years, the UHP’s Early Outreach Program has been exposing Chicago-area public and private school students as young as age 5 to health careers and research. Early exposure includes tours of medical areas such as anatomy labs and neonatal units. Students talk to medical professionals and medical students and have the opportunity to handle human organs. The Early Outreach Program also includes Satur-day, summer and Young Scientist programs. Once students graduate from college and enroll in one of UIC’s seven health science grad schools, UHP offers them tutoring, MCAT prep, research internships, mentors and regular interaction with medical residents and health care providers. The program’s efforts over three decades have had a significant local impact: It is estimated that nearly 70 percent of all black and Latino doctors prac-ticing in Chicago are graduates of UIC or UHP, according to program data. Many of their graduates practice in underserved areas.
“One of the challenges we have in this society is to try to eliminate health disparities,” says Toney. “So when we experience shortages of underrepresented health care professionals, it has a negative impact on the delivery of quality services in our black, brown and Native American communities.”
The National Center for Education Statistics (NCES) reports that UIC was the nationwide No. 2 producer of minority physicians in 2008, and in May 2009, 64 African-American and Latino students graduated with medical degrees. Despite the program’s success, Toney says UHP’s funding from the state has not increased since its inception.
Nevertheless, UHP officials remain focused on their mission. “We really know, through trial and error, how to produce a pool,” Toney says. “We all work together across colleges in a noncompetitive fashion to recruit students to the U of I Health Sciences…. You have colleges competing with each other for the same pool of students. We have more of a team approach. I represent medicine, for example, so if I think a student is inter-ested or better suited to dentistry, there’s no problem referring that student to the appropriate person on a team.”
Solving Science Shortages
When New Jersey-area medical school officials are looking for applicants from underrepresented groups, many of them call Dr. Kamal Khan, associate director of the Office for Diversity and Academic Success in the Sciences (ODASIS) at Rutgers University.
Since 1990, more than 400 ODASIS program graduates have gone on to complete graduate and profes-sional degrees in the sciences, and more than 200 of them became minority physicians and dentists. This spring 50 more black, Latino and Native American students are heading to medical school, and 23 ODASIS alumni graduated from medical and osteopathic schools in spring 2009.
ODASIS works with New Bruns-wick, New Jersey, high schools and the Rutgers undergraduate admissions office to identify students from underrepresented backgrounds who have expressed an interest in the sciences.
In their sophomore year, ODASIS students are encouraged to apply to the first phase of Access-Med, a joint program offered by Rutgers and Seton Hall universities and the Robert Wood Johnson Medical School (RWJMS) at the University of Medicine and Dentistry of New Jersey (UMDNJ). The second phase of Access-Med includes early admission to RWJMS, where students take medical courses as seniors. Fourteen students were accepted into Access-Med Phase II this year. The ODASIS programs are a likely contributor to UMDNJ’s status as one of the top producers of minority physicians, with NCES ranking it No. 1 in 2008.
One unique feature of ODASIS is its mandatory eight-month MCAT course. Rutgers senior and ODASIS student Justin Perez says the MCAT classes were one of the most challenging aspects of the program. “It was definitely one of the hardest things because of the pure time commitment,” says Perez, 21, who is applying to medical schools this year.
ODASIS aims to provide step-by-step academic guidance for students who want to pursue the sciences, and this often involves working with students who are academically unprepared. But it’s a task Khan is willing to take on. “The majority of students pursuing science want to be doctors. Is my goal to help kids go to medical school? Yes, 100 percent,” he says.
Summer Bridges Built
LaMont Toliver, director of the Meyerhoff Scholars Program at the University of Maryland, Baltimore County, takes what he calls an “intrusive” approach to help students achieve their goals.
Meyerhoff, which celebrated its 20th anniversary last year, was initially launched to increase the number of black men pursuing science, technology, engineering and mathematics-related fields, but has since been ex-panded to include women and other underrepresented minorities. The program typically narrows its 800-student applicant pool to 250. Admission is offered to approximately 90 applicants; about 50 students enroll per year.
Of the 47 students who enrolled this fall, 28 are underrepresented minorities. And as of spring 2009, 78 Meyerhoff alumni received medical degrees, with 98 more in the pipeline; 15 alumni received their M.D./Ph.D.s, with more than 50 currently in the pipeline.
Toliver takes advantage of the six-week summer bridge program, which operates seven days a week, to create a community of scholars and to introduce the students to college life.
“You can’t do that when they’re back on campus in the fall with 10,000 other students,” says Toliver. “What you need is a captive audience and talk about the features, functions and benefits of the program, and to ex-plain the methods to the madness. And then they get it.”
Toliver also says good academic advising is essential. “Sitting across from you is this student who aspires and wants to receive a Ph.D. or terminal degree in math and science. But in front of you is his or her transcript, with a C in calc 2 or calc 1. And perhaps their parents have said, ‘We have eight semesters of funding for you. You don’t have the time or wherewithal to repeat.’ You can pick up the phone and have a conference call with the parents about why it would behoove this student to do this. That’s advising,” says Toliver.
By all accounts, many individual pipeline programs have been successful at producing minority physicians. However, it is still unclear whether nationwide efforts to increase diversity within the physician ranks can be called a success.
Some in the medical community say the rhetoric to increase the pool of minority physicians is there, but would like to see more action.
“They talk about needing to increase diversity within the country in terms of medicine. So there are a lot of words, but there’s nothing with it,” says Khan of Rutgers.
Dr. Elena Rios, president of the National Hispanic Medical Association, says the real problem is the medical schools themselves. “Medical schools should be interested more so than they are in having a physician pool in this country that matches the population that they are about to take care of.”
But for those on the front lines to help deepen the minority physician pool, no accomplishment is too big or too small to celebrate. Just this year, an ODASIS student was admitted to Harvard Medical School, a first for the program since it began.
Rutgers graduate Mekeme Utuk says she was initially a little wary about attending Harvard because of some of the stereotypes surrounding Ivy League schools.
“But I saw it as an opportunity to open doors for other students like me,” says Utuk, who is black. “From the high school I came from, I never thought I’d be at Harvard Medical School. That never even crossed my mind.”
Hilary Hurd Anyaso is an editor and writer based in Chicago.
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