A new report, based in part on case studies of the UCSF School of Medicine and Stanford University School of Medicine, has determined five elements critical to increasing racial and ethnic diversity in medical schools and ultimately, the physician workforce.
There have been overall increases in US medical school racial and ethnic diversity from the 1960s through the early 2000s, according to the study’s analysis of medical school and demographic trends. However, Blacks, Latinos, American Indians and Alaska Natives, and Native Hawaiians and Other Pacific Islanders remain underrepresented in medicine relative to their numbers in the US population, the study authors report.
The issue is of critical importance because the nation and California will be much more racially and ethnically diverse within the next 20 years, the authors emphasize.
“Diversity of the physician workforce bears directly on people’s access to care, and the quality and outcomes of care, in addition to impacting future benefits of research to the health of diverse populations,” said report co-author Philip R. Lee, MD, UCSF chancellor emeritus and professor of social medicine emeritus, UCSF School of Medicine. “Unless we act on multiple levels to reduce racial, ethnic and other disparities from kindergarten through college, we will not be able to continue to increase diversity in our medical schools. And we risk losing generations of young physicians to meet the health needs of an increasingly diverse nation and state.”
The analysis, titled “Diversity in US Medical Schools: Revitalizing Efforts to Increase Diversity in a Changing Context, 1960s-2000s”, was released by the UCSF Philip R. Lee Institute for Health Policy Studies.
The authors sought to understand the mix of public and private interventions needed to increase diversity statewide and nationally among medical school applicants, students and graduates. They examined federal, State of California, University of California, Stanford University, and UCSF and Stanford medical school policies, as well as other efforts, affecting diversity from the 1960s through the present.
UCSF and Stanford medical schools were early leaders in attracting and maintaining diverse student bodies, and remain so today. Keys to their success include:
- Recognizing and mobilizing leadership of many types, including students, faculty, senior administrators, and activist community members, to advance diversity within and outside their schools.
- Linking diversity to excellence in meeting the medical schools’ interrelated missions of education and training, research, patient care, and public or community service.
- Renewing leadership over time to develop and modify a mission-driven, multidimensional approach focused on action in eight critical policy areas, including outreach and recruitment; admissions; retention or student support; curriculum reform; student financial aid; campus environment; educational and health care partnerships; and cross cultural education and training.
- Supporting students over their educational and career continuum to develop diverse physician leaders in primary and specialty patient care, academic medicine, research, and public and community service.
- Making diversity part of the universities’ and medical schools’ strategic plans.
At UCSF, those underrepresented in medicine made up from 20 to 25 percent of entering classes for the great majority of years, beginning in 1969 and continuing through to the present; in five of these years, the percentages ranged from 26 through 31 percent.
At Stanford, underrepresented entrants accounted for 20 percent of entering classes for the great majority of years, beginning in 1969 and continuing through to the present; in five of these years, the percentages of underrepresented entrants were between 25 and 30 percent.
“These institutions offer a roadmap for continued increases in the diversity of medical school populations, but sustained change requires additional actions,” said Patricia E. Franks, senior research associate, UCSF Philip R. Lee Institute for Health Policy Studies, and co-author of the report. “Laws and policies at the federal level, such as the Civil Rights Act of 1964, and the state level are driving forces in advancing—or impeding— medical schools’ efforts to increase diversity. These include policies in civil rights, health care, health workforce, health professions education, higher education, and elementary and secondary education.”
“Students also need family, social, and financial support and life experiences that encourage them to apply to and enter medical school,” said Claire D. Brindis, DrPH, director of the UCSF Philip R. Lee Institute for Health Policy Studies. “Costs of undergraduate education and medical education are rising, along with the associated debt, while the availability of public and private financial aid has not kept pace with the increasing costs.”
“Increasing diversity at UC medical schools is a systemwide priority and one that is in keeping with our responsibility to recruit and prepare future physicians who will meet state needs,” said John Stobo, MD, University of California senior vice president for health sciences and services. “Bolstered by PRIME, UC has achieved a systemwide level of medical student diversity that is much needed. The UCSF study identifies useful steps to further these important efforts.” Each UC medical school has created a “PRogram in Medical Education” (PRIME) that is specifically designed to meet the needs of the medically underserved.
Other members of the study team are Kevin Grumbach, MD, professor and chair, Department of Family and Community Medicine, UCSF School of Medicine; Mary P. Sutphen, PhD, adjunct assistant professor, Department of Social and Behavioral Sciences, UCSF School of Nursing; and Nancy Rockafellar, PhD, former director, Oral History Program Department of History, Anthropology and Social Medicine, UCSF School of Medicine.
The study, which was conducted over the period from 2002 through 2009, was supported by the Josiah Macy, Jr. Foundation and the California HealthCare Foundation. Report recommendations are being shared with state and national health policy leaders as well as leaders within medical schools, universities, professional and trade associations, and foundations. The entire report is available online at http://escholarship.org/uc/item/0qt8d0j8.
UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. For further information, please visit www.ucsf.edu.
About the UCSF Philip R. Lee Institute for Health Policy Studies
The UCSF Philip R. Lee Institute for Health Policy Studies was founded in 1972 as the Health Policy Program within the School of Medicine on the UCSF campus. It was the first program to bring together on the campus of a major academic health sciences center a multidisciplinary group of faculty (medicine, law, ethics, and pharmacology) committed to developing an innovative unit with health policy as its focus. Today the Institute is one of the nation’s premier centers for health policy and health services research.