New tactics for diversity: Creating doctors from all racial, ethnic groups

Medical school efforts to attract more minorities have been hindered by myriad factors, including a small pool of applicants and socioeconomic barriers.

By — Posted Oct. 4, 2010

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Nineteen-year-old Rhoda Asimeng has dreamed of becoming a physician since she was 13. She helped care for her two parents, both of whom were diagnosed with cancer when she was a junior in high school. Her father died of pancreatic cancer in 2009. Her mother was diagnosed with multiple myeloma, which is now in remission.

"My parents having cancer, and really seeing what they have had to go through, I realized that helping somebody was something I really wanted to do," said Asimeng, now a pre-med sophomore at Siena College in Loudonville, N.Y. "I definitely want to become a doctor. That's what my calling is."

This summer, Asimeng completed a program at Montefiore Medical Center in the Bronx, N.Y., designed to encourage black, Hispanic and American Indian high school and college students to pursue a medical career. Asimeng, who is black, and other interns spent the summer attending lectures, doing research, learning medical techniques, and following physicians and other health care professionals.

Montefiore's program is one example of efforts taking place nationwide to increase the diversity of the physician work force by attracting more racial and ethnic minorities to medical schools.

Many medical schools offer programs designed to foster an interest in science and medicine in children as early as elementary school. Some schools guarantee admission for high school students and college undergraduates who complete certain requirements.

At the same time, the Assn. of American Medical Colleges' Holistic Review Project is encouraging schools to re-evaluate admissions policies to ensure that they graduate physicians who can serve an increasingly diverse population.

U.S. Surgeon General Regina Benjamin, MD, has challenged health leaders to increase the number of minority physicians, a figure that has remained about the same as it was a century ago.

In 2006, Hispanics made up 5% of the nation's physicians, while 3.5% of doctors were black and fewer than 1% were American Indians or Alaskan Natives, according to the latest data from the American Medical Association. However, these minority groups combined make up 30% of the U.S. population, according to 2009 U.S. Census Bureau figures.

"Having a diverse physician work force is key to making health care reform, as well as eliminating health care disparities, a reality," said Charles P. Mouton, MD, dean and senior vice president for health affairs at Meharry Medical College in Tennessee.

Medical schools have worked to increase diversity in the classroom for decades but with limited success, said Marc Nivet, EdD, the AAMC's chief diversity officer.

"We've stagnated really over the last decade in the number of minorities going to medical schools," he said. "The challenges are multiple. One of the largest and [most] long-standing is clearly the pipeline -- the availability of students applying to medical school."

Sometimes the efforts start earlier than college. The American Medical Association is working to increase the number of minority physicians through programs such as Doctors Back to School. Launched in 2002 by the AMA's Minority Affairs Consortium, the program sends minority physicians and medical students to schools to share their stories, raise awareness about the need for more minorities in medicine and serve as professional role models for children.

Overcoming barriers

Asimeng realizes that medical school won't be easy. But she knows how to overcome challenges, having lived in a crime-ridden portion of the Bronx. When she visits there now, her friends don't believe she's headed for medical school.

"They just look at me in astonishment. They just never thought that someone from that neighborhood would have aspirations to really be ambitious and try to do something more," she said. "Many people just live there, stay there and die there."

For many minorities from low-income families, becoming a physician seems like an unattainable goal, said Elizabeth Natal, MD, director of the Montefiore program and assistant professor at Albert Einstein College of Medicine in New York.

Children who grow up in poor, medically underserved areas often lack positive mentors, parental support or a strong educational foundation. And the cost of medical school seems insurmountable to families struggling just to get by, Nivet said.

Nationwide, high school dropout rates are higher among blacks and Hispanics, and fewer minorities go to college, said Lauree Thomas, MD, associate dean for student affairs and admissions at the University of Texas Medical Branch School of Medicine at Galveston. "Our educational system doesn't support minorities and first-generation [college] students going on to higher education. It is a tremendous uphill battle," she said.

Students from disadvantaged backgrounds need to learn to believe in themselves and stay away from negative influences, said Dr. Natal, who grew up in the Bronx and was out of school for eight years before pursuing a medical degree.

"Sometimes when we live in bad neighborhoods or bad areas, it's hard to get out of that. It's about learning that it's OK to be different and it's OK to strive for something more," she said.

Minorities today have more encouragement to become tomorrow's physicians.

For example, UTMB's Early Medical School Acceptance Program identifies college freshmen with an interest in the field and guarantees admission if they maintain a certain grade point average, make at least a 24 on the Medical College Admission Test and attend summer science courses.

The University of Chicago Pritzker School of Medicine offers summer programs for high school students interested in medicine and biomedical research. The university's Chicago Academic Medicine Program helps disadvantaged undergraduate college students get the credentials they need to apply to medical school, said Holly Humphrey, MD, the school's dean for medical education.

First-year medical students at Pritzker must take a course on diversity and health disparities, which has proved to be a draw for some minority students, she said.

One-year booster program

Drexel University College of Medicine in Pennsylvania admits about 25 socioeconomically disadvantaged students annually who have a four-year degree but don't have all of the prerequisites for medical school. The one-year program helps students get the scientific foundation they need and guarantees medical school admission upon completion.

"It's for students who have personality, experience, passion, drive and all the other attributes that would make them excellent physicians -- they just don't have the metrics," said Anthony Rodriguez, MD, Drexel's associate dean for student affairs and diversity.

Drexel participated in a pilot of the AAMC's Holistic Review Project that is getting medical schools to look beyond GPAs and MCAT scores. The goal is to ensure that schools capture a "broader picture of an applicant," including life experiences and what they bring to their classes, Nivet said.

For example, Drexel expanded its definition of underrepresented students to include first-generation college students and those who are educationally or economically disadvantaged.

"Each institution has to define what diversity means to them. How it will be implemented in each school will be a little bit different," said Ana Maria Lopez, MD, MPH, professor and associate dean for outreach and multicultural affairs at the University of Arizona College of Medicine.

Before it opens in 2011, Oakland University William Beaumont School of Medicine in Michigan will consider factors in admissions, such as a student's desire to practice in underserved communities and where geographically they are likely to serve.

"We are working on developing a focus and a framework for who we think would make a good medical student that goes way beyond test scores and grades," said Linda Gillum, PhD, the school's associate dean for academic affairs, faculty development and diversity.

In addition to attracting more minority and socioeconomically disadvantaged students, medical schools must learn to retain those students, Dr. Mouton said. Students must feel they have mentors and peers they can relate to, and the school is committed to serving communities.

At Meharry Medical College, students are encouraged to practice in underserved communities. The majority of its graduates enter primary care, and up to 85% go on to work in underserved areas.

Federal court decisions have affected how schools recruit underserved populations.

In some cases, such as Hopwood vs. Texas in 1996, the courts have ruled against affirmative action policies. But in Grutter vs. Bollinger, the U.S. Supreme Court found in favor of the University of Michigan Law School when considering race and ethnicity as a part of admissions. Justices said they supported the school's goals of creating a "critical mass" of underrepresented minority students, at least until such policies were no longer necessary.

Back in New York, Asimeng said she's learned not to let anything stand in the way of her dream of becoming a physician. She said the Montefiore program reinforced her aspirations and gave her new direction.

She first wanted to become an obstetrician-gynecologist. But she was inspired this summer after seeing the close relationships family physicians have with patients. She's now determined to go into primary care.

"I thought this was just going to be a resume builder, but it's much more than that," Asimeng said. "It has changed my whole definition of what a physician is and showed me that becoming a physician can be achieved if you have the drive and determination for it."

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Diversity in medical school

Minorities make up a small proportion of medical students compared with the overall population. For example, blacks, Hispanics, American Indians and Alaskan Natives made up just 14% of first-year medical students in 2009. Those groups together make up 30% of the U.S. population.

Race/ethnicity of first-year students
White10,694 (58.15%)
Asian3,734 (20.30%)
Hispanic1,412 (7.68%)
Black1,136 (6.18%)
Foreign241 (1.31%)
American Indian or Alaska Native45 (0.24%)
Native Hawaiian or other Pacific Islander33 (0.18%)
Other race18 (0.10%)
No race response583 (3.17%)
More than one race494 (2.69%)
Total18,390 (100%)

Source: Assn. of American Medical Colleges (link)

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