Building a Diverse Physician Workforce

Abstract

THE ARTICLE BY GRUMBACH AND CHEN IN THIS ISSUE of JAMA confirms that postbaccalaureate programs are an effective means for increasing minority and disadvantaged students’ acceptance to medical schools. These findings are timely, because the medical profession in the United States is in great need of documented ways to achieve substantially more racial and ethnic diversity. Absent sufficient diversity, medicine simply cannot fulfill its obligation to provide optimum health care services to everyone. In 2005, only 1043 US medical school graduates were black, only 936 were Hispanic/Latino, and only 96 were Native American. In aggregate, these graduates comprised fewer than 13% of all graduating MDs that year. That value is about half of the representation of these minority groups in the US population—a population that is increasingly diverse. Grumbach and Chen’s findings are especially noteworthy because the University of California, the setting for their research, has been denied the use of affirmative action programs in medical school admissions since the 1996 passage of Proposition 209. This was a ballot initiative amending the state’s constitution to prohibit preferences based on race and sex in public contracting, employment, and education. One result is that the percentage of underrepresented minorities matriculating to California medical schools dropped from a high of 21.99% in 1992 to 15.6% in 2000. Consequently, this study offers an important approach to satisfying the 2003 Supreme Court ruling in Grutter v Bollinger et al, which called for institutions intent on using raceconscious admission policies to make a “serious, good faith consideration of workable race-neutral alternatives that will achieve the diversity the university seeks.” Justice O’Connor’s majority opinion in this case expressed the expectation that “25 years from now, the use of racial preferences will no longer be necessary.” To meet that deadline, much more research on the effectiveness of race-neutral alternatives to affirmative action is needed. Using California as their “laboratory,” Grumbach and Chen also offer a preview of the nation’s not-too-distant future. In this state, where “minority” populations are now in the majority, only 139—or just under 14%—of all California medical school graduates in 2005 were black, Native American, or Hispanic/Latino. This must be considered in the context of the California Wellness Foundation’s prediction that the state will experience “a shortfall of approximately 17,000 doctors by 2015.” Earlier this year, the Association of American Medical Colleges (AAMC) called for a 30% increase in enrollment at Liaison Committee on Medical Education–accredited medical schools by the year 2015 to offset the impending shortage of physicians nationwide. Implementing this increase will be a monumental undertaking. Doing so while remaining committed to increasing the racial and ethnic diversity of the entering medical school classes will be doubly difficult. But increasing physician supply and increasing diversity are both critically important and inseparable goals. Health care disparities, inadequate access to care, and gaps in the quality of care will only worsen if a larger physician workforce in the future is no more diverse than it is today. Preparing tomorrow’s physicians means substantially increasing the efforts to locate, encourage, and support talented and capable young people from diverse backgrounds and cultures who are willing and prepared to pursue careers in medicine. Postbaccalaureate programs are designed to prepare college graduates to succeed in applying to medical school, but they differ widely in size, format, curricula, and mission. Many are committed to increasing minority and disadvantaged students’ representation in medical school. Wayne State University School of Medicine established the nation’s first such program 37 years ago, enrolling black students who had initially been rejected by the school. After 1978, the program opened enrollment to all racial and ethnic groups. By 1997, 160 (83%) black students and 51 (94%) of other races/ethnicities who graduated from the program between 1969 and 1992 had completed medical school. Strengthening programs that reach minority students earlier in their education is also crucial; indeed, it is an essential strategy for closing medicine’s diversity gap permanently. Socalled “pipeline” programs refer to elementary school and high