Medical school enrollment is surging across the country, yet the proportion of students from underrepresented groups is declining – and will continue to dip unless schools fundamentally change the way they evaluate applicants.
That’s a predominant theme in a New England Journal of Medicine article written by four professors, including two from the UC Davis School of Medicine’s Center for a Diverse Healthcare Workforce (CDHW), who warn that fewer numbers of diverse doctors will impede efforts to reduce racial and ethnic health disparities in America.
The article published today in the journal’s Perspective section is titled, “Closing the Gap – Making Medical School Admissions More Equitable.” The authors are Efrain Talamantes, Mark Henderson, Tonya Fancher and Fitzhugh Mullan.
Overall medical school enrollment in the United States increased by 54 percent between 1997 and 2017, the article noted, but the proportion of entering medical students who were from underrepresented groups in medicine – African-American, Latino, American Indian and Alaska natives – actually dropped from 15 percent to 13 percent. When compared to the US population, the percentage of entering students from underrepresented groups dropped by 20 percent.
“Medical education is losing ground with respect to diversity and inclusion,” the authors stated.
The article noted that the same populations that are underrepresented in medicine continue to experience stark health disparities.
And while the article warns about the consequences of having fewer physicians from underrepresented groups, it also points to UC Davis School of Medicine’s success in training not only a larger proportion of diverse doctors than most schools but educating future providers who choose to practice in communities with the greatest health disparities.
“Fortunately, we have developed successful strategies to recruit, attract and train students from underserved backgrounds and it’s important to share our experience with other medical schools across the country,” said co-author Henderson, who serves as associate dean for admissions at UC Davis School of Medicine. “As minority and non-English speaking populations grow, there is evidence that nonwhite physicians provide a disproportionate share of care to these underserved populations. As such, there is an urgent need to increase minority representation among U.S. physicians, particularly in California, where only 5 percent of physicians are Latino compared to nearly 40 percent of the population,” Henderson added.
The makeup of UC Davis School of Medicine closely mirrors California’s rich cultural diversity and the school has developed tailored medical education tracks focused on meeting the unique health needs of the state’s rural, urban, and valley underserved communities and by addressing workforce shortages such as primary care.
“Innovative workforce development programs are critical vehicles for our nation to reduce disparities and increase access to care,” said Fancher, associate dean for workforce innovation and community engagement and also a co-author.
Disparities in medical school admissions encompass more than racial and ethnic gaps, the article stated.
“Most medical school matriculants come from middle- and upper-income families, but black and Hispanic medical students are three times as likely as their white counterparts to come from families with combined parental incomes of less than $50,000, according to data from the Association of American Medical Colleges (AAMC).”
The article notes that black and Latino students are more likely than white students to have attended high poverty schools. The article cautions medical school admissions committees against writing off students who attended community college: Research from the CDHW and AAMC shows that medical students who studied in community college are more likely to practice in family medicine, a discipline that plays a critical role in providing care to the underserved and improving the health of communities.
Other significant points made in the opinion article include:
- Since 2007, University of California medical schools have offered specialized coursework, programs and mentoring for students committed to working with underserved communities through its Programs in Medical Education (PRIME) initiatives.
- UC Davis School of Medicine has developed an adjustment for socioeconomic and education disadvantage without consideration of race and ethnicity. It incorporates parental education level, family participation in public assistance programs, the community where a student was raised and whether the medical school application fee was waived, among other criteria.
- States that bar race-conscious admissions policies, such as California, should consider a holistic admissions review process as promoted by the AAMC, which includes considering each applicant’s background, experiences, attributes, academic metrics and history with overcoming discrimination or adversity.
“We wrote this article to express our concern that medical education is slipping further out of reach for many poor and minority students, despite longstanding efforts of many people and institutions,” Henderson said. “We hope that those responsible for training the next generation of physicians – including medical schools, residency programs and national medical organizations – will work together to advance the mission of equity of opportunity for the benefit of future medical students, disadvantaged communities, and the country as a whole.”
In addition to Henderson and Fancher, co-author Talamantes was an assistant professor of internal medicine at UC Davis at the time of the writing and now practices at a Southern California-based health care network. Mullan is professor of health policy in the Milken Institute School of Public Health at George Washington University.