UCSF Study Finds Underrepresented Minority Physicians More Likely to Practice in Calif. Following Residency

By Twink Stern

A UCSF study of the migration patterns of underrepresented minority Californians in medicine found that those who attend medical schools in the state are more likely to enter residency programs in California and remain in the state to practice.  However, a decreasing number of California minorities who attend medical school are entering medical schools in California. The report was issued November 1 by the California Policy and Research Center/Program on Access to Care.

“California needs to hold onto more of our own when it comes to underrepresented minorities enrolling in US medical schools,” according to Kevin Grumbach, MD, UCSF professor of family and community medicine and Director of the Center for California Health Workforce Studies at UCSF. “We need to implement policies to reverse the exodus of qualified minority medical students from California. Increasing the number of minorities educated in California and practicing in the state is critical if we are to meet the health care needs of an increasingly diverse California population.”

Some studies of underrepresented minority students have suggested that anti-affirmative action policies in California have contributed to the decreasing enrollment of minorities in California medical schools. Another roadblock to representation is that the capacity of the state medical schools is far less than the number of applicants.

“There are fewer underrepresented minority Californians entering medical schools anywhere in the nation,” said Grumbach, “and in recent years, those who do get accepted into medical school are less likely to stay in the state for their medical education.  Minorities seem to consider California a less hospitable place for their medical education.”

Latinos, African-Americans and Native Americans are underrepresented in California’s physician workforce, and this is a serious problem in California, the study found, because many medically underserved areas in the state have large Latino and African-American populations.  Previous studies have shown that African American and Latino physicians in California are more likely to practice in underserved communities and care for uninsured and Medi-Cal patients.

The study assessed the relationship between practice location and location of medical school and residency.  Data on location of medical school and residency were analyzed for 3,007 Californians who graduated from medical school between 1985 and 1999.  For location of practice, data were analyzed for Californians who graduated from medical school between 1985 and 1992.  More recent graduates were excluded from the analysis of practice location because many of them have not yet finished residency.


Major findings of the report include the following:

—The number of Californians attending medical school far exceeds the capacity of the state’s medical schools.  In 1999, a total of 1,868 Californians enrolled in medical school as first-year students.  Forty-four percent entered California medical schools and 56 percent entered medical schools in other states.  California exports more medical students to out-of-state schools than any other state.

—In addition to location of medical school, location of residency training is an important predictor of practice location. Approximately 70 percent of physicians who complete residency training in California remain in the state to practice.

—Among underrepresented minority Californians practicing in the state, more than half (57 percent) completed both medical school and residency in California.  Approximately one-third (31 percent) attended medical school in other states, but returned to California for residency.  Underrepresented minority Californians who completed residency in other states accounted for only 12 percent of those practicing in the state.  These findings reinforce the conclusion that increasing the number of underrepresented minority California completing medical school and residency training in the state would increase the number who practice in California.

The study had several recommendations to increase the number of underrepresented minority Californians attending in-state medical schools and residency programs.

—Strengthen specific strategies to increase the number of underrepresented minorities, including expansion of outreach programs, more extensive recruitment activities and provision of financial aid packages comparable to those offered by medical schools in other states.

—Expand the Charles Drew/UCLA Undergraduate Medical Education Program established in 1978.  The mission at Drew is to educate health professionals who intend to practice in medically underserved communities and to provide care to disadvantaged populations.

—Develop a new University of California program in the Central Valley to prepare additional medical students dedicated to practicing in California’s underserved communities.  At present there are no medical schools in the Central Valley, but there is an existing residency training program at UCSF Fresno which trains more than 200 US medical students per year at the clinical sites.

“It’s a very exciting prospect to consider adding a medical school to our successful residency training program,” said Deborah Stewart, MD, associate dean, UCSF Fresno Medical Education Program. “It would be a perfect complement to our UCSF Fresno pipeline programs which currently helps prepare Central Valley junior high, high school and college students for future careers in the health professions,” Stewart added.  Medical education programs in the valley would emphasize preparation of physicians who intend to practice in underserved areas. “Currently more than 50 percent of the UCSF Fresno graduates remain in the valley to practice,” Stewart said.  Latinos constitute at least one-third of the population of most counties in this region, and recent immigrants from Southeast Asia are a growing population in the area.

—Develop a voluntary registry of underrepresented minority Californians enrolled in medical schools throughout the US for use by California residency training programs to recruit applicants. Because underrepresented minority Californians who complete residency in California are much more likely to practice in the state, the study encourages state policymakers to assist California’s residency programs in recruiting minority Californians.

—Provide funding to residency training programs in California to increase information to underrepresented minority physicians about opportunities in the state and to encourage them to apply.  The state should establish a grant program to support focused recruitment efforts, including production of materials, travel and other communication methods.

Collaborators for the study include Rebecca Levin, research associate, Association of American Medical Colleges (AAMC); and Lois Colburn, assistant vice president, Community and Minority Programs, AAMC.

Funding for the research was provided by CPRC’s California Program on Access to Care and the Center for Health Workforce Information and Analysis, U.S. Bureau of Health Professions, HRSA.