Diversity in the Physician Workforce

1. Diversity in the Physician Workforce Progress and Pitfalls American Medical Student Association Fall 2002

2. THE PROBLEM • Latinos, African Americans, and Native Americans account for 25% of the U.S. Population…. • but represent only 6% of practicing physicians.

3. THE PROBLEM • The medical education community recognized the problem in the 1970s. • The AAMC defined “underrepresented minorities” (URM) to include Black, Native American, Mexican American, and Mainland Puerto Rican Students. • Medical schools initiated programs to improve representation of these minorities.

4. 1970s - 2000s • In the past 3 decades, women made tremendous gains in representation in medical school, now nearing 50% of medical students. • Representation of URM students remains stagnant, however, fluctuating between 10-15% of matriculants since 1976.

5. 2002 • 46% of URM applicants were accepted in 2001, compared to 52% of white applicants and 50% other minorities. • In 2001, URM enrollees increased slightly from the previous year by 2.6%, the first increase in nearly a decade of steady decline.

6. FUTURE • The inability of institutions of medical education to improve their track record on diversity is particularly alarming in light of recent population projections...

7. Source: US Census Bureau

8. Importance of Diversity • Elimination of Health Disparities • Improving Health Care Access • Enriching Medical Education • Ensuring Equality of Opportunity

9. Eliminating Health Disparities

10. Elimination of Health Disparities • “ Racial concordance of patient and provider is associated with greater patient participation in care processes, higher patient satisfaction, and greater adherence to treatment.” Institute of Medicine, 2002

11. Improving Health Care Access • Minority Physicians are more likely to • Care for the Uninsured • Work in an Underserved Area • Treat Medicaid Patients

12. Enriching Medical Education • 70% of medical school graduates reported that the racial and ethnic diversity of the student body influenced their professional growth and development. AAMC Graduation Questionnaire 2000

13. Promoting Equity in Higher Education • It is widely recognized that education is a key determinant of opportunity, socioeconomic status, and health. • The continued lack of participation of large minority groups in institutions of higher education is a serious civil rights concern.

14. Recent Developments • May 17, 2001: University of California regents voted to reverse the ban on affirmative action in the University of California system.

15. Recent Developments • May 14, 2002: Sixth Circuit Court of Appeals ruled to uphold the University of Michigan Law School’s affirmative action admissions policies in Grutter v. Bollinger.

16. Recent Developments • Recent Reports • Institute of Medicine’s 2002 “Unequal Treatment,” Report on Health Disparities • Kellogg Foundation’s 2002 “The Color of Medicine,” Report on Diversity in Physician Workforce

17. Recent Developments • 2001: AAMC president Jordan j. Cohen appointed an Advisory Committee on the Definition of Underrepresented Minorities to review this term and consider revision of this definition to be more inclusive of other minority groups.

18. AMSA Diversity Scorecard Project • Objectives • Conduct a national assessment of medical school efforts to recruit and retain minorities in medicine. • Assess the efficacy of these efforts. • Examine the barriers to improving diversity in the classroom.

19. AMSA Diversity Scorecard Project • Objectives • Build on previous work by AMSA by comparing new data on the perspective of school deans and administrators to previous data on opinions of minority medical students. • Identify directions for future efforts to promote diversity in medical education and the physician workforce

20. AMSA Diversity Scorecard Project • METHODS • Instrument Developed with Input from the Diversity Coalition: • SNMA, NMA, AMWA, GLMA, NNLAMS, AAIP, AHMA, AMSA • Sent to Student Affairs Deans of all 144 (LCME and AOA accredited) US medical schools. 85 schools or 59% responded.

21. RESULTS -- URM Recruitment Initiatives in US Medical Schools • Pre-Admission Site Visits to Schools 93% • Pre-Admission Counseling 90% • Career Outreach to Area Grade Schools 87% • Financial Aid 85% • Minority Student Early Identification 81% • URM Student Recruiters 78% • Enrichment Programs (post-bach, pre-matric.) 75% • Community-based Education Programs 75% • Alumni Involvement 75% • Application Assistance 72%

22. Admissions Committee Membership • Responding schools reported few or no students on committees. • Mean: 2 African American Faculty • Mean: 16 White Faculty • Mean: 0 Latino Faculty • Mean: 0 Native American Faculty

23. BARRIERS TO RECRUITMENT Major Barriers: Low MCAT No URM Faculty No Role Models Low GPA Poor Science Preparation

24. NOT CONSIDERED MAJOR BARRIERS • Court Decisions, State Laws • Ineffective or Absent Recruitment Programs • Lack of Funding for Diversity Programs • Admissions Committee Membership

25. Schools Self-Assessment of Success in Meeting Diversity Goals 1 - least successful; 10 - most successful

26. In addition to URM students, what other student groups is your school interesting in recruiting?

27. Conclusions • Schools need to be held to a higher standard by where diversity is concerned. • Admissions committees should have meaningful representation of minority students and faculty.

28. Conclusions • MCAT and GPA have proven to be poor predictors of future clinical capability; these should not be central admissions criteria. • Research needed to determine applicant characteristics that are predictors of later clinical ability.

29. Conclusions • Medical schools are interested in recruiting and tracking minority and disadvantaged groups other than URM. • Research and awareness is needed on the contribution of gay and lesbian students to diversity in the physician workforce

30. URM Student Support • URM Medical Students are more likely to • Require an extra year to finish • More likely to fail USMLE exams • 3-5 times more likely to fail first-year courses • Leave medical school

31. US Medical School Support and Retention Strategies • Student Counseling 91% • Student Loans 89% • Individual Tutoring 88% • Post-admission Counseling 88% • URM Student Mentors 83% • Pre-admission Counseling 83% • Academic/Merit Scholarships 80% • Tutoring Groups 78% • URM Alumni Mentors 68%

32. Perspectives from Minority Medical Students • Focus Groups of Minority Medical Students • AMSA - Study Group on Minority Medical Education, 1996 • Kellogg Foundation - Color of Medicine, 2002

33. Perspectives From Minority Medical Students • “Medical schools put more resources into recruiting minority students than into supporting and retaining them.” • Some support programs are effective, some are just “window dressing.”

34. Perspectives from Minority Medical Students • Diversity programs’ effectiveness highly variable from school to school. • In some places minority affairs office is a strong source of support, in others it is weak due to lack of resources and respect within the institution.

35. Perspectives from Minority Medical Students • More Support for Minority Students Needed • Academic • Financial • Psychosocial

36. Perspectives from Minority Medical Students • Psychosocial Stressors • Discrimination/racism: peers, faculty, patients. • Pressure to assimilate to school environment. • Pressure to not “sell out” minority community. • Pressure to perform to avoid justifying negative stereotypes. • Pressure to work twice as hard to be considered just as good.

37. Perspectives from Minority Medical Students • Sources of Support • URM Students • URM Faculty/Mentors • URM Student Groups

38. CONCLUSIONS • Although schools in this study felt they had a variety of programs effective in supporting minority students, students feel these programs are not always well-run or designed to meet minority student needs.

39. Conclusions • National survey of minority medical students needed to understand the minority medical student experience. • Individual schools should collect feedback from students on effectiveness of support programs.

40. Conclusions • An large, active minority student and faculty community fosters support for students and enhances recruitment and support programs. • Schools should support and encourage student-initiated activities and mentorship programs