Academic leaders were already worried about diversity within the medical profession well before the Supreme Court’s decision this week to let stand Proposition 209. The measure and the UC Regents’ ban on affirmative action have been blamed for a reduction in minority applicants to California medical schools this year. Last week the American Association of Medical Colleges issued a report showing that underrepresented minorities in states with restrictions on affirmative action, such as California, are eschewing careers in medicine.

Last week Kevin Grumbach, research director of the Center for the Health Professions, urged action to halt this trend, which, if left uncorrected, could cause the health care for people in low income minority communities to suffer. In a brown bag lecture about the overabundance of specialists in California and the lack of diversity among physicians, Grumbach outlined the trends in physician supply and medical education in California and made recommendations for creating a better-serving physician population. His talk was based on a report published earlier this year by the California Primary Care Consortium in conjunction with the Center for the Health Professions.

In addition to calling for a reduction in training specialists, the report, co-authored by Grumbach, calls for increasing the number of underrepresented minorities in medical school and residency programs. The report states that “physicians play a major role in meeting the health care needs of underrepresented minorities in California, especially those living in low-income communities. Yet there are far too few underrepresented minority physicians.” Latinos and African-Americans are particularly underrepresented in California’s physician population. Overall, Latinos comprise 26 percent of the state’s population but only four percent of physicians; African-Americans are seven percent of the population but only three percent of physicians.

Grumbach described the Regents’ decision to repeal affirmative action as “troubling” and a threat to UCSF's ability to maintain a diverse student body. “One in five UCSF students were from underrepresented minorities in 1990-1994,” he said. “While training sought-after graduates, we’ve managed to achieve incredible diversity.”

This fall’s incoming class at the medical school had 12 African-Americans and 14 Mexican-Americans. The medical schools in the UC system as a whole had 27 African-American and 41 Mexican-American students. Grumbach said the drop in these numbers have produced “a lot of concern from public health professionals.”

“We need to take action now on affirmative action,” Grumbach said. “The banning of affirmative action is a 180 degree turn in wrong direction.”

Grumbach, who was recently elected to the Institute of Medicine (a prestigious appointment that requires a commitment to health policy issues), said he is concerned that medical schools are not producing a physician workforce that’s representative of the population and thus will not serve Californians well. “In California, race and ethnic characteristics in a community have much to do with where physicians practice,” Grumbach said. For example, in California, African-American and Latino physicians are more likely to practice in communities that are under-served than white physicians are. “African-American physicians say half their patients are African-American compared with non-African-American physicians whose patients are only 10 percent African-American,” Grumbach said.

“In low income, urban areas, the whiter the community the more doctors practicing in the area,” Grumbach said. “Even in areas that are not low income, predominately white communities have almost twice as many physicians as communities that are highly minority.”

Grumbach said measures must be taken immediately to offset the UC ban on affirmative action, the training of too many physician specialists and the poor geographic distribution of physicians.

By Paula Murphy

1st appeared 11/07/97

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