What Will It Take to Diversify Medicine?

Jan 28, 2015, 3:00 PM, Posted by Sheree Crute

Every few weeks, Dana Todd, MD, does something rare for an American physician:  She makes a house call. The visits are her way of making life easier for a bedridden stroke survivor and her caregiver daughter.

“One afternoon, I looked out into the clinic waiting room and there they were,” Todd recalls. “My patient was laying on a stretcher. Her daughter was by her side. Her family was adamantly against putting her in a nursing home because she is only in her 50s, so coming in was the only way she could get care. I just hated seeing her that way so I said, ‘Next time, I’ll come to you.’”

Todd is one of four primary care physicians who, along with a small group of nurse practitioners, provide care for residents of Greensboro, Ala., population 2,440, in rural Hale County. The little town, though, is a lot more to Todd than a place to work. 

“It’s my hometown. We have four stoplights,” Todd says with a laugh, “I know. I’ve counted every one of them. Friends and family often ask why I came back here after medical school. I explain that this is where I wanted to be, a place where I can make the greatest impact on people’s lives.”

Growing up, Todd did not think that becoming a physician was possible. That all changed when a high school guidance counselor suggested she participate in the University of Alabama’s Rural Health Leaders Pipeline program, a project initially supported by the Robert Wood Johnson Foundation (RWJF).

“That was the first time I thought medicine was something I could do. They also taught us that it was difficult to attract doctors to rural areas. That motivated me to come back to Greensboro and take care of the people I’d known all my life,” Todd says.

Commitment to Community

Research shows that physicians such as Todd — African-Americans, Hispanics, Native Americans, and Alaska Natives — are more likely to specialize in primary care and serve patients who share their backgrounds. The culture connection also produces other benefits. When patients see physicians and nurses  from similar backgrounds, they report greater satisfaction with their care and they are more likely to stick with treatment protocols.

“When a provider understands a patient’s culture, you will see things you might have otherwise missed. It also increases trust between patients and providers,” says Rosa Gonzalez-Guarda, PhD, MPH, RN, an RWJF Nurse Faculty Scholar who works to bring minority students into health disparities research.

Or, as Todd puts it, “when I see one of my diabetes patients putting unhealthy food in the buggy at the grocery store, I can pull up a chair and ‘go there,’ when she visits my office. She will listen because she knows I understand how important food is in Southern black culture.”

While awareness of these important facts has increased, minority students still face significant barriers to attending medical school. A 2014 report from the American Association of Medical Colleges (AAMC), Diversity in the Physician Workforce: Facts and Figures, shows that just 4 percent of physicians are African-American. The 2004 percentage was 3.3 percent.

“The medical school applicant pool has remained steady for some time now, in part because too many talented potential applicants are in poor-performing K-12 schools with limited resources,” explains Marc Nivet, EdD, AAMC’s chief diversity officer. “Unfortunately, there aren’t any initiatives to address this issue at a national level.”

The Power of the Pipeline

Lynne Holden, MD, founder of Mentoring in Medicine (MIM), which prepares underrepresented minority students for medical school, and a 2009 recipient of an RWJF Community Health Leader Award, agrees. “Reaching children in high school is too late. You have to get to them in elementary school as we do in our program, but there are also cultural issues that many academic administrators don’t understand.”

Citing a recent project in one of Washington, D.C.’s poorest schools, Holden says, “We were asked to do an after-school program. A large number of students signed up, but they could not show up after school. The administrators did not realize that these students often had to go home to take care of siblings or work to help support their families. When we switched to a lunch and learn program, the sessions were packed.”

There are other factors that may stop students from becoming physicians. “There’s the notion of stereotype threat. Society sometimes sends the message that minority kids can’t achieve,” says Michael Hernandez, a 2012 participant in RWJF’s Summer Medical and Dental Education Program (SMDEP).

The grandson of a migrant farm worker and the first person in his family to pursue a career in medicine, Hernandez, who is studying at Columbia University College of Physicians and Surgeons, adds: “So many of the minority students who entered school with me gave up on becoming doctors. I’ve heard professors steer kids to other careers because they don’t think they can get into medical school.”

He credits his mentor, Vanessa Rivas-Lopez, MD, and the SMDEP program with showing him that “I cannot be placed in a box based on my race. I can become a doctor.”

To nurture more students such as Todd and Hernandez, Holden, an emergency room physician at the Albert Einstein College of Medicine of Yeshiva University, says, “We must address the social determinants of education. That means taking on the full range of challenges these kids face at home and in school, including dwindling scholarship funds. We are not going to succeed in getting more of these young people into medical school until that occurs.”

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.