New tactics for diversity: Creating doctors from all racial, ethnic groups

Nineteen-year-old Rhoda Asimeng has dreamed of becoming a physician since she was 13. She helped care for her two parents, both of whom were diagnosed with cancer when she was a junior in high school. Her father died of pancreatic cancer in 2009. Her mother was diagnosed with multiple myeloma, which is now in remission.

"My parents having cancer, and really seeing what they have had to go through, I realized that helping somebody was something I really wanted to do," said Asimeng, now a pre-med sophomore at Siena College in Loudonville, N.Y. "I definitely want to become a doctor. That's what my calling is."

This summer, Asimeng completed a program at Montefiore Medical Center in the Bronx, N.Y., designed to encourage black, Hispanic and American Indian high school and college students to pursue a medical career. Asimeng, who is black, and other interns spent the summer attending lectures, doing research, learning medical techniques, and following physicians and other health care professionals.

Montefiore's program is one example of efforts taking place nationwide to increase the diversity of the physician work force by attracting more racial and ethnic minorities to medical schools.

Many medical schools offer programs designed to foster an interest in science and medicine in children as early as elementary school. Some schools guarantee admission for high school students and college undergraduates who complete certain requirements.

At the same time, the Assn. of American Medical Colleges' Holistic Review Project is encouraging schools to re-evaluate admissions policies to ensure that they graduate physicians who can serve an increasingly diverse population.

U.S. Surgeon General Regina Benjamin, MD, has challenged health leaders to increase the number of minority physicians, a figure that has remained about the same as it was a century ago.

In 2006, Hispanics made up 5% of the nation's physicians, while 3.5% of doctors were black and fewer than 1% were American Indians or Alaskan Natives, according to the latest data from the American Medical Association. However, these minority groups combined make up 30% of the U.S. population, according to 2009 U.S. Census Bureau figures.

"Having a diverse physician work force is key to making health care reform, as well as eliminating health care disparities, a reality," said Charles P. Mouton, MD, dean and senior vice president for health affairs at Meharry Medical College in Tennessee.

Medical schools have worked to increase diversity in the classroom for decades but with limited success, said Marc Nivet, EdD, the AAMC's chief diversity officer.

"We've stagnated really over the last decade in the number of minorities going to medical schools," he said. "The challenges are multiple. One of the largest and [most] long-standing is clearly the pipeline -- the availability of students applying to medical school."

Sometimes the efforts start earlier than college. The American Medical Association is working to increase the number of minority physicians through programs such as Doctors Back to School. Launched in 2002 by the AMA's Minority Affairs Consortium, the program sends minority physicians and medical students to schools to share their stories, raise awareness about the need for more minorities in medicine and serve as professional role models for children. Overcoming barriers

Asimeng realizes that medical school won't be easy. But she knows how to overcome challenges, having lived in a crime-ridden portion of the Bronx. When she visits there now, her friends don't believe she's headed for medical school.

"They just look at me in astonishment. They just never thought that someone from that neighborhood would have aspirations to really be ambitious and try to do something more," she said. "Many people just live there, stay there and die there."

In 2006, 5% of the nation's doctors were Hispanic, 3.5% were black, and 1% were American Indians or Alaskan Natives.

For many minorities from low-income families, becoming a physician seems like an unattainable goal, said Elizabeth Natal, MD, director of the Montefiore program and assistant professor at Albert Einstein College of Medicine in New York.

Children who grow up in poor, medically underserved areas often lack positive mentors, parental support or a strong educational foundation. And the cost of medical school seems insurmountable to families struggling just to get by, Nivet said.

Nationwide, high school dropout rates are higher among blacks and Hispanics, and fewer minorities go to college, said Lauree Thomas, MD, associate dean for student affairs and admissions at the University of Texas Medical Branch School of Medicine at Galveston. "Our educational system doesn't support minorities and first-generation [college] students going on to higher education. It is a tremendous uphill battle," she said.

Students from disadvantaged backgrounds need to learn to believe in themselves and stay away from negative influences, said Dr. Natal, who grew up in the Bronx and was out of school for eight years before pursuing a medical degree.

"Sometimes when we live in bad neighborhoods or bad areas, it's hard to get out of that. It's about learning that it's OK to be different and it's OK to strive for something more," she said.

For example, UTMB's Early Medical School Acceptance Program identifies college freshmen with an interest in the field and guarantees admission if they maintain a certain grade point average, make at least a 24 on the Medical College Admission Test and attend summer science courses.

The University of Chicago Pritzker School of Medicine offers summer programs for high school students interested in medicine and biomedical research. The university's Chicago Academic Medicine Program helps disadvantaged undergraduate college students get the credentials they need to apply to medical school, said Holly Humphrey, MD, the school's dean for medical education.

First-year medical students at Pritzker must take a course on diversity and health disparities, which has proved to be a draw for some minority students, she said. One-year booster program

Drexel University College of Medicine in Pennsylvania admits about 25 socioeconomically disadvantaged students annually who have a four-year degree but don't have all of the prerequisites for medical school. The one-year program helps students get the scientific foundation they need and guarantees medical school admission upon completion.

"It's for students who have personality, experience, passion, drive and all the other attributes that would make them excellent physicians -- they just don't have the metrics," said Anthony Rodriguez, MD, Drexel's associate dean for student affairs and diversity.

Drexel participated in a pilot of the AAMC's Holistic Review Project that is getting medical schools to look beyond GPAs and MCAT scores. The goal is to ensure that schools capture a "broader picture of an applicant," including life experiences and what they bring to their classes, Nivet said.

For example, Drexel expanded its definition of underrepresented students to include first-generation college students and those who are educationally or economically disadvantaged.

"Each institution has to define what diversity means to them. How it will be implemented in each school will be a little bit different," said Ana Maria Lopez, MD, MPH, professor and associate dean for outreach and multicultural affairs at the University of Arizona College of Medicine.

Before it opens in 2011, Oakland University William Beaumont School of Medicine in Michigan will consider factors in admissions, such as a student's desire to practice in underserved communities and where geographically they are likely to serve.

"We are working on developing a focus and a framework for who we think would make a good medical student that goes way beyond test scores and grades," said Linda Gillum, PhD, the school's associate dean for academic affairs, faculty development and diversity.

In addition to attracting more minority and socioeconomically disadvantaged students, medical schools must learn to retain those students, Dr. Mouton said. Students must feel they have mentors and peers they can relate to, and the school is committed to serving communities.

At Meharry Medical College, students are encouraged to practice in underserved communities. The majority of its graduates enter primary care, and up to 85% go on to work in underserved areas.

Federal court decisions have affected how schools recruit underserved populations.

In some cases, such as Hopwood vs. Texas in 1996, the courts have ruled against affirmative action policies. But in Grutter vs. Bollinger, the U.S. Supreme Court found in favor of the University of Michigan Law School when considering race and ethnicity as a part of admissions. Justices said they supported the school's goals of creating a "critical mass" of underrepresented minority students, at least until such policies were no longer necessary.

Back in New York, Asimeng said she's learned not to let anything stand in the way of her dream of becoming a physician. She said the Montefiore program reinforced her aspirations and gave her new direction.

She first wanted to become an obstetrician-gynecologist. But she was inspired this summer after seeing the close relationships family physicians have with patients. She's now determined to go into primary care.

"I thought this was just going to be a resume builder, but it's much more than that," Asimeng said. "It has changed my whole definition of what a physician is and showed me that becoming a physician can be achieved if you have the drive and determination for it."

The print version of this content appeared in the Oct. 11 issue of American Medical News.

Minorities make up a small proportion of medical students compared with the overall population. For example, blacks, Hispanics, American Indians and Alaskan Natives made up just 14% of first-year medical students in 2009. Those groups together make up 30% of the U.S. population.

Race/ethnicity of first-year students White 10,694 (58.15%) Asian 3,734 (20.30%) Hispanic 1,412 (7.68%) Black 1,136 (6.18%) Foreign 241 (1.31%) American Indian or Alaska Native 45 (0.24%) Native Hawaiian or other Pacific Islander 33 (0.18%) Other race 18 (0.10%) No race response 583 (3.17%) More than one race 494 (2.69%) Total 18,390 (100%)

What happened to post-racial America? I really don’t care what ethnic group the doctor’s from, but I do know the good ones from the ones that don’t know anything except what the drug companies told them in medical school!

In the famous Bakke Supreme Court case, the less-qualified minority student that took Bakke’s place in med school went on to... lose his license after killing a patient.

Pull the PC on something that’s not a matter of life and death.

I am basing my guess based on watching TV but at least half of all Doctors, Lawyers, Judges, Psychiatrists, etc. are Black and around 70% of those are females.

In 2006, 5% of the nation's doctors were Hispanic, 3.5% were black, and 1% were American Indians or Alaskan Natives.

I notice they leave out Asian and Pacific Islanders. Here in northern Ohio about half the doctors are Filipino, Pakistani, Korean, and assorted other "Asian origins."

If they want to get more black doctors, why don't they just say so. Fine by me. But quit hiding behind the figleaf of "diversity."

I’m all in favor of anybody who can hack medical school getting the chance to prove it. Right now, medical schools intentionally limit their students and graduates, to keep the supply of physicians low.

I figure if some States got together their own medical training schools, open to any who pass their standardized tests, the US would finally have enough doctors to have rural doctors. It is worth it enough so that if students make it through their undergraduate work, States should pay for their post-graduate medical studies.

This last part is important, so that they would not become doctors with horrific debt over their heads, but could move right into their practice, so they would get financial stability quickly.

*Every* time I see a minority or female doctor...lawyer....cop...fireman,etc,etc...I wonder "hmmmm,genuine merit,or affirmative action?."

Now,of course there are minorities and women who are qualified to hold jobs like that (well,in the case of women,the first two at least).My primary care doctor is a woman and all the evidence suggests that she's a darn good one.

Also,I worked in a world famous hospital for 20 years.I certainly saw some white male doctors who appeared to me to be of questionable capabilities but a greater percentage of the female and minority ones seemed to fit that category.Not all of them,certainly....not even most of them...but a noticeable percentage of them.

getting medical schools to look beyond GPAs and MCAT scores. The goal is to ensure that schools capture a "broader picture of an applicant," including life experiences and what they bring to their classes

Recipe for disastrous erosion of clinical excellence. They destroyed the liberal arts and humanities this way, why not medicine. Nurse-practitioners will be doing all the heavy lifting with patient care anyway.

I’ve always wondered why they don’t award medical doctor degrees from a variety of schools that have their own admission qualifications. But, all doctors would have to disclose what school they graduated from when you solicit their services. So, if people don’t care if their doctor was a D student, they can still see a doctor.

I don't care one hoot about the ethnicity of my doctors. I care only about their medical competence. Why should anyone of any ethnicity need anything else? Why should anyone of any ethnicity need “one of their own”?

“Diversity” WILL naturally occur on its own, when in the natural course of human events, over time, as gradually the 2nd, 3rd and 4th generation descendants of immigrants assimilate and by their own choices, increase their ranks in the professions (as it was with every other ethnic "minority" in the past). Funny, we had no "diversity" programs then.

call me way behind the curve, but could someone explain why ethnic/racial “diversity” is important? It doesn’t seem to be a goal in basketball, BET, or the Black Caucus... so why in medical schools?

Two solutions to go around the induced shortage:

1. H1B visas for foreign doctors.
2. There are now some insurance plans in the works that pay for a patient to go to India, Mexico, and probably several Asian nations for surgical procedures. Apparently it’s still cheaper even taking air fare and hotel stays into account.

Affirmative action is why I prefer white Jewish male doctors, followed by white Protestant male doctors.

They actually got in based on brain power and effort.

Archie Bunker said it best when he looked for a Jewish lawyer, rather than any lawyer. I took his words to heart ever since and will always pick the Jew first - why, because he (or she) got there on merit. I will run for the hills from a doctor with a name like Shondra, although most people with those types of names are smart enough to not advertise them. After the Jews come other ethnic minorities, such as Indians and Asians. Of course looking at pictures definitely helps. Also, a given Hispanic may be fine doctor, and no there are many, but I will put my family at risk if he got there with some ‘help’.

Finally, all this freedom to choose might become mute as we become a single-payer health care system and I’ve always believed, from Hillary’s stab at it through today, that real purpose of socialized medicine was to provide jobs for these protected minorities, particularly as more people start to think like myself.

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