In honor of Hispanic Heritage Month, ACOFP member, AOA trustee and school of osteopathic medicine faculty members David E. Garza, DO, MS, MEdL, FACOFP, discusses the importance of increasing representation in medicine to better serve our patient populations—and where we can begin.
By David E. Garza, DO, MS, MEdL, FACOFP; AOA Trustee
Existe la necesidad de que más personas de origen Hispano sigan carreras como médicos.
Translation: There is a need for more people of Hispanic origin to pursue careers as physicians.
While more than 18% of people in the United States are Hispanic, less than 6% of U.S. doctors fit that description.1 For Hispanic patients, this lack of diversity in the physician workforce can result in decreased access to care, limited patient choices and suboptimal doctor-patient communication. The same can be said for any sector of society experiencing similar shortcomings in diversity and equity in the physician population.
It’s no secret that people who seek the attention of a physician very often prefer that person to be someone whom they can relate to—whether that be in terms of cultural awareness, or just being fluent in their native language. That’s not to say that physicians who don’t look and speak like a certain subgroup can’t provide excellent care to anyone who walks in the door, because physicians do that every day. Rather, my message is that the process of healing has a lot to do with the trust that patients have in the people taking care of them. So from a patient’s perspective, it’s important to have access to doctors who resemble and have similar experiences as them.
It’s also no secret that a disproportionate number of physicians who practice in areas with a high percentage of people from underrepresented racial and ethnic groups are members of those same minority groups. They also tend to practice in areas with larger numbers of uninsured residents. Hispanics, for example, are more often found living in rural and inner-city communities, so to address the problem of too few physicians of similar background serving these communities, it would make sense to simply recruit more young people with similar backgrounds to enter and graduate from medical school and then begin working in these underserved areas once formal training is complete.
But no such quick fix exists, and the explanation is multifactorial. Finding, starting and completing the path to medical school requires inspiration, perspiration, a proper educational foundation, strong family support, ample financial resources and, of course, an enormous commitment of time.
Unfortunately though, a disproportionate number of Hispanic students lack some or most of these resources. Many are required to work to support the family; are brought up in families where the children are simply discouraged from leaving the nest; live in communities where school district resources lag far behind those of wealthier districts; are from families lacking the resources needed for them to attend college; don’t have the grades to land generous scholarships; or haven’t been exposed to role models in the medical or academic community. When more than one critical piece is missing, steep walls are created that can discourage students from realistically pursuing a career in medicine. Our goal as a society, therefore, should be to find short- and long-term strategies to promote greater physician diversity.
Situated in the seventh-largest city in the nation and in a state where 40% of its population is Hispanic, San Antonio’s University of the Incarnate Word School of Osteopathic Medicine has honored its mission of helping address the shortage of minorities in medicine. Since opening our doors in 2017, we have aggressively recruited applicants from underrepresented ethnic groups, and now have the most diverse enrollment among all colleges of osteopathic medicine. Most notably, 28% of our student body is now Hispanic. Some of these students have taken advantage of our Direct Admit Program, while many others enrolled in our Master of Biomedical Sciences program to help ensure their transition to our DO degree curriculum. Both pathways are open to any qualified applicant.
Other ideas that could be considered by medical schools include visitation of local high schools and college pre-med groups by medical students, hosting groups of high school students on campus for a “medical student for the day” experience, and creating summer programs that include academic enrichment, clinical exposure and meaningful guidance. Perhaps the most effective influence, though, is mentorship of prospective medical school applicants by students, faculty and practicing physicians, which is a great segue to the issue of a lack of Hispanic and other minority representation among medical school faculty. For the same reason that people from certain groups are drawn to physicians who look and sound like them, having more minority faculty members and administrators could help medical schools attract more applicants with similar backgrounds.
If you’re interested in finding out what others are doing to help close the gap, please check out the Josiah Macy Foundation. You may want to read one of their commentaries entitled “Why We Need More Hispanic Doctors.”
In 2015, the University of Illinois College of Medicine at Chicago (UIC) was the top school in the United States top medical school—outside of Puerto Rico—in graduating the highest number of Hispanic physicians. They did this by developing three specific programs targeting Hispanic students early in their academic career. Read more here.
While UIC’s solution seems logical and has been quite effective, it takes vision, initiative, planning and some funding to develop programs such as this. As a college student, I attended two summer programs for pre-med students from underrepresented backgrounds. The first was at the Baylor College of Medicine, which was where I had my first taste of family medicine, and the second was at the Texas College of Osteopathic Medicine, where my course was set. I am certain that my career and life would not be what they are without those experiences.
While programs sponsored by medical schools can be effective, the spark of inspiration and meaningful academic support need to start much earlier, and some experts say that this needs to occur by the fifth grade. Texas Tech University Health Sciences Center in Lubbock, Texas certainly believes in this as is evident in their Doctor for a Day program.
We have some serious work to do to close this gap, but some very good examples of how it can be done.
- 2019 National Healthcare Quality and Disparities Report. Rockville, MD: Agency for Healthcare Research and Quality; December 2020. AHRQ Pub. No. 20(21)-0045-EF.