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November 2002 Home Poll Shows Continued Support for Academic Medicine NRMP Update: AAMC Seeks to Dismiss Suit; Some Groups Seek Arbitration Caring for the Underserved: The Art and Science of Community-Based Medicine Restoring the Balance: Fostering the Medical Education of Native American Students Physician Novelists: At the Intersection of Writing and Healing "A Day in the Life of a Medical Student" A Word From the President
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ViewpointTime Is Critical for a More Diverse Health Work Force
The time is ripe for a serious, coordinated effort to create a health professions work force that reflects our country's rich diversity. The 2000 census demonstrated that in many respects, the United States is more diverse than it has ever been. For example, over the past 10 years there has been enormous growth in Latino and Asian-Pacific Islander American populations - 61 and 49 percent, respectively. This unprecedented racial and ethnic diversity means not only that health professionals must be prepared to serve, interact, and communicate with patients from a wide range of backgrounds, but also that the pool of potential health professionals is also increasingly diverse. Recently, the AAMC reiterated its commitment to increasing diversity in the medical professions by demonstrating leadership on the issue. In 1991, the organization launched "Project 3000 by 2000," which was intended to increase the number of underrepresented minority (URM) students enrolling in U.S. medical schools. Despite a promising start between 1991 and 1994, when the number of URM matriculants to U.S. medical schools increased almost 30 percent with admissions peaking in 1994, these numbers have remained flat ever since. What happened? At least two things: In 1996, the U.S. Court of Appeals for the Fifth Circuit ruled that universities in Texas, Mississippi, and Louisiana could not use race and ethnicity as factors in admission decisions. That same year, California passed Proposition 209, which eliminated consideration of race, ethnicity, or gender in all government-based programs, including universities and professional schools. The combined effect of these two policy decisions was chilling, with drops of 30 to 50 percent in the number of African-American and Latino students matriculating at certain schools in Texas and California. Today, African Americans, Latinos, and Native Americans account for more than 25 percent of our population, but represent only 14 percent of medical school matriculants. While URM matriculation rates for medicine have remained stagnant over the past several years, those for dentistry have actually dropped from 14 percent in 1989 to less than 10 percent in 1999.
In fact, the only major clinical health profession that has made sustained gains in diversity is nursing. URM enrollment in baccalaureate nursing programs increased 48 percent between 1991 and 1999, rising to 16 percent of nursing program matriculants - which still represents a significant gap. The issue of work force diversity has more serious implications in its ability to address racial and ethnic disparities in health. In the Institute of Medicine's March 2002 report Unequal Treatment: Confronting Racial and Ethnic Health Disparities in Health Care, a key recommendation is to strengthen patient- provider relationships by increasing the racial and ethnic diversity of the healthcare work force. The likelihood that a provider understands a patient's cultural framework - or speaks a patient's primary language - is increased when their backgrounds are similar. Research has shown that a diverse healthcare work force increases patient trust, adherence, and participation in health decisions, and that URM providers are more likely to practice in underserved or predominantly minority communities. We must be more proactive in engaging public opinion around the importance and role of diversity in our society. We need to be ready to commit resources and time commensurate with the enormity of the issue, create sustainable programs, and formulate thoughtful policy. Partnerships across sectors and collaboration with communities will be critical to our success. The power of philanthropy is equally important to raise the level of awareness and commitment to the issue, and several foundations are stepping up to the plate. The Endowment's Work Force Diversity Program is aimed at developing a work force that is reflective of California's racial/ ethnic and geographic diversity and focuses on the areas of medicine, nursing, oral health, and mental health. This summer, the W.K. Kellogg Foundation announced a $3.6 million initiative to increase diversity in America's health professions education programs at all levels of preparation. And this fall, the Robert Wood Johnson Foundation funded dental schools to link their schools to communities in need of dental care and to boost their underrepresented minority and low income student enrollment numbers. Our hope is the momentum generated by these foundations will engage government, business, communities, and private and public educational institutions to ensure that the healthcare work force of the 21st century can respond to the health needs of 21st century Americans. |
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