African American, Hispanic and Asian physicians are crucial to providing medical care in the nation’s most racially and culturally diverse communities. A new study shows that more than 54 percent of the patients from these backgrounds select or depend on physicians of color for their care.
Documenting the critical need for these physicians is important, explains study author Steffie Woolhandler, MD, PhD, because, “African Americans and Hispanics make up more than 25 percent of the United States population, but they are less than 15 percent of the physician workforce.” Woolhandler is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health Policy Fellow program (1990-1991), as is study author Danny McCormick, MD (2004-2005).
Priming the Pipeline is Key
In their article “Minority Physicians’ Role in the Care of Underserved Patients: Diversifying the Physician Workforce May Be Key in Addressing Health Disparities,” published online December 30, 2013, in JAMA Internal Medicine, the authors also report that 70 percent of non-English-speaking patients received care from African American, Hispanic or Asian physicians. Asian, Hispanic and Black patients were also found to be 19 to 26 times more likely to be cared for by physicians of their same race. And, low-income patients were one-and-a-half to two times more likely to be cared for by Black, Hispanic and Asian physicians.
The research serves as further confirmation of earlier studies that have shown the importance of culture when physicians and patients come together. “The fact that minority physicians are much more likely to care for disadvantaged patients suggests that expanding the racial diversity of the physician workforce could be key to improving access to care,” explains Lyndonna Marrast, MD, the study's lead author, in a recent interview.
According to McCormick, the study’s senior author, “the Patient Protection and Affordable Care Act is expected to expand insurance coverage for low-income patients. ... There is some concern that there will not be enough physicians to care for them.”
“There’s been a lot of discussion about the need for diversity among medical students,” adds Woolhandler. “Decades ago, the Association of American Medical Colleges set a goal to make the share of minority physicians equal to minorities' share of the population, but it has not occurred.”
Given that the study reflects not only physician availability but patient choice, Woolhandler points out, “this is not just a case of being fair to all students who want to attend medical school. It’s part of our duty to provide the best patient care in a way that meets patient needs.”
New Solutions to Old Problems
Citing a variety of approaches to making medical school more accessible to students from a broad range of backgrounds, Woolhandler says, “One of the most important things schools can do is help talented but under-prepared minority students to become prepared, rather than competing for the smaller pool of well-prepared students. The reality is that educational opportunity is a lot less available to many minority students.”
She points to programs such as those at Cambridge Health Alliance (affiliated with Harvard Medical School) that offer trainees special services such as education specialists to help with test-preparation skills, or language tutors to improve Spanish or Creole accents that interfere with spoken-English communication. Other worthwhile approaches include the on-campus, post-baccalaureate pre-med programs at the University of California, San Francisco, and the University of Pennsylvania’s recently stated commitment to achieve 25 percent diversity in its medical school.
“We need more loan forgiveness for students working in primary care. There’s been insufficient attention given to scholarships and different types of loan forgiveness programs to help students deal with the cost of going to medical school,” Woolhandler says.
She thinks it’s time for a dramatic and immediate change. “The medical admissions committees are meeting right now. They make their decisions in the middle of March,” Woolhandler says, “so they can wake up and do something about this problem right now. That’s the purpose of our study. That’s what we are hoping they will do.”