The Medical Education Futures Study Blog

As President Elect Obama prepares to assume office he faces unprecedented challenges, including the worst economic crisis in decades, military conflicts and a volatile international arena.   Winning with a platform promising change, government accountability and educational and health equity for all, expectations for the new president are unlike any before.

As this new administration begins to build a domestic policy agenda, health reform - and its choking economic impact- will be a first priority. We now know this effort will be capably lead by soon-to-be Secretary Tom Daschle.  If he can keep to his core vision that any re-crafting of our health system must be comprehensive and heavily weighted in favor of outcomes and effectiveness, then efforts to address lack of health insurance, high (and rising) costs of care, access to care, improving quality and reducing medical errors, may be within our collective reach.  However, central to addressing any and all of these broken, costly components of our health care system is, having an adequate number of scientifically well-trained, culturally – competent, racially and ethnically diverse health professionals.   

Today we have a significant , and  in some cases and places, desperate shortage of health professionals in nursing, medicine, pharmacy, public health and other health professions.

To make our healthcare system “work” – to make it a cost effective, outcomes driven system that can deliver quality care to ALL our citizens,  policy reforms are needed that can begin to immediately address this lack of trained manpower.

The increasing diversity of our nation’s population makes it imperative that efforts be made to develop a health workforce which is more diverse – racially, ethnically, and culturally.   One of the commentaries in The Sullivan Commission 2004 report, Missing Persons: Minorities in the Health Professions, was “the fact that the nation’s health professionals have not kept pace with changing demographics may be an even greater cause of disparities in health access and outcomes than the persistent lack of health insurance for tens of thousands of Americans.” 

Just last Friday, December 12^th, 2008,  a new report released by the Institute of Medicine, HHS in the 21^st Century, Charting a New Course for a Healthier America  identified “Strengthening  the HHS and U.S. public health and health care workforces” as one of   five key areas for recommended action.   

We have a new administration with a public commitment to develop a diverse, well trained health professions’ workforce to support our citizens in the 21^st century.

I am personally encouraged by the steps being taken by the President Elect and his senior leadership to engage the country in this crucial process.  I look forward to supporting policy changes that will directly and immediately begin to address and to close significant gaps in our nation’s health care workforce.

Louis W. Sullivan, M.D.

Chairman

The Sullivan Alliance 

With support from the Kellogg Foundation, The Sullivan Alliance was formed in 2005 to address the need for more diversity among the nation’s health professionals in efforts to improve access to health services for medically – underserved populations

A new study released in JAMA today shows racial and ethnic diversity within medical schools produces physicians who are better prepared to care for minority populations.  Affirmative action in schools is a long and ongoing battle.  In the 1978 Bakke case, the U.S. Supreme Court declared that while admission preferences based solely on race constitute discrimination and are therefore illegal, colleges were legally justified in taking race into account for the purpose of improving the delivery of health services to underserved communities and for the attainment of a diverse student body.  In 2003, the Supreme Court upheld the Bakke decision in a challenge of the University of Michigan’s admission policies.

Diversity within medical schools is critical for 2 practical reasons –

1.  Underrepresented Minority (URM) physicians are more likely to enter primary care and care for underserved and minority populations.  The same JAMA article showed “URM students are substantially more likely than white or nonwhite/non-URM students to plan to serve the underserved (48/7% vs 18.8% vs 16.2%).”  Another article released in today’s JAMA looking at medical student career choices, shows that although URMs made up only 11% of those surveyed (consistent with general URM numbers in medical schools), 18% of those planning to enter Family Medicine were URM students.

2.  Diversity in medical schools better prepares all of tomorrow’s physicians to care for minority populations.  This desired outcome is critical as the general minority population grows in the U.S.  The U.S. Census Bureau estimates that by 2010, 29% of the U.S. will be underrepresented minorities (Black, Hispanic or American Indian).

The question at this point is not whether diversity is important, but how do we increase diversity in American medical schools.  Step 1 is to uphold the Bakke decision.  In 1996 California passed Proposition 209 which barred public institutions from considering race and ethnicity in their admission processes.  By 2006, UCLA saw its lowest representation (just 2%) of black students in its incoming freshman class.  That same year, UCLA, amidst concerns over the lack of student diversity, changed their admission policies to a more “holistic” approach, in which applicant GPAs and test scores would be considered in the context of the personal experience.  By the fall of 2007, the number of black freshman had doubled.  However, the American Civil Rights Institute is indicating they will likely file suit against the university for violating Proposition 209.  If they do, it will be the first major test of the Bakke case in California since Proposition 209.

Step 2 is to not only to defeat challenges to increasing medical school diversity, but to propagate policies and programs to increase diversity.  Medical school admission policies should be re-evaluated to increase the national “holistic” approach.  Medical schools serve a primary goal – to train the physicians needed to care for the American people.  It’s time for admission policies to reflect the needs of the nation, rather than a desire to score well on the U.S. News and World Report rankings.  It’s also time to re-invest in this goal on a national level.  Title VII of the Public Health Service Act has supported diversity programs since the 1970s.  However, funding for these programs has been continually slashed in recent years.  The President’s FY08 budget all but eliminates the program.  The need here is clear.  The minority population in the U.S. is growing and a diverse, culturally sensitive workforce will be needed to care for this population.  It’s time to stop cutting Title VII and start re-investing in a physician workforce that meets the needs of the nation.