Diversity Needs to be Front and Center
Efrain Talamantes, MD, MBA, is a Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholar at the University of California, Los Angeles. This is part of a series of posts looking at diversity in the health care workforce.
Diversity in health care is critical in providing quality health care to all Americans. As physicians, we care for patients from all walks of life and we strive to heal with our expertise, compassion and open-mindedness. Our health system and patients benefit greatly from health professionals who can speak and understand different languages, and who always strive to understand different backgrounds, cultures, practices, and beliefs. Research shows that diversity in the health care workforce enhances training for health professionals and improves access to quality health care.
There is an unprecedented demographic transformation happening in our country today; the majority of births are from Hispanics, Blacks, Asians and other racial and ethnic minorities. Since 1985, the number of underrepresented ethnic and racial minority medical school applicants, matriculates, and graduates has leveled off at about 15 percent, while their representation in the U.S. population has been nearly twice as high—and they are on pace to become the majority.
The Institute of Medicine’s “In the Nation’s Compelling Interest: Ensuring Diversity in the Health Care Workforce” and the Sullivan Commission’s “Missing Persons: Minorities in the Health Professions” 2004 reports made strategic recommendations to improve diversity in the health care workforce: create a culture based on diversity at medical institutions, improve the health professions pipeline, and utilize the backing of a major institutional commitment. Nearly 10 years after these recommendations, our health care systems continue to struggle to attract and produce a diverse workforce. Latino and Black physicians make up less than 7 percent of the physician workforce. Access to a health professions career remains largely separate and unequal.
Our medical education system is under substantial pressure to rethink how we produce the next generation of health care professionals. The last major medical education reform took place in 1910 when Abraham Flexner took a fettered medical institution and made it one of the most prestigious in the world. The Affordable Care Act will substantially increase the number of patients we care for, while the supply of physicians lags further behind. Medical education transformations are currently taking place at various medical schools throughout the country with proponents supporting new ways of selecting, training, and producing physicians. While Flexner’s reforms rendered medical education beyond the reach of poor African Americans and other minorities, we have ample opportunities to align individuals and institutions to redesign our health system to be more equitable and provide quality care for all.
As our field undergoes major transformations, diversity needs to be front and center throughout all levels of our medical education institutions, health systems, and health professional societies. The standards that our medical education and health systems institute will positively influence the K-12 educational reforms happening throughout America. As the health care needs of our populations grow, we have the opportunity to attract, train, and promote diverse health professionals to meet the needs of our patients. The Association of American Medical Colleges continues to make huge strides in improving our admissions approach to be more holistic, and less biased through the use of new admission practices like the multi-medical interviews. Mount Sinai's Icahn School of Medicine has moved away from requiring the traditional pre-medical requirements (i.e. biology, chemistry, organic chemistry, physics and MCAT) while implementing other rigorous academic measures and finding equal success among their students’ academic and professional achievements. In California, the University of California Program in Medical Education (PRIME) has found ways to harness the talents of diverse medical students with the needs of vulnerable populations.
Through the Robert Wood Johnson Foundation Clinical Scholars program, we are working with California community college students, where there is a wealth of socioeconomic and racial/ethnic diversity. Too many of these students go unnoticed and there is an abundance of misperceptions about their academic strengths and potential. Through one of our community partners, Medicos Para El Pueblo, a pre-health program for community college students in California based out of the UCLA Center for the Study of Latino Health and Culture by Dr. David E. Hayes-Bautista, we too often hear about community college students getting nudged to take a non-health professions paths. These notions about the hidden supply of high-achieving, low income students were further highlighted by Caroline M. Hoxby of Stanford and Christopher Avery of Harvard in a recent report from the National Bureau of Economic Research.
While these community college campuses are often far away from medical research and academic hospitals, we are working on finding sustainable mentorship and advising programming to provide these students with comprehensive resources that will help them transfer to a university, and continue on their path to receive a health professions degree. Our community-partnered strategies include our health system, medical schools, universities, community colleges, health providers and students to ensure that we make health professions accessible to all students.