For the Nation’s Health, Medical Schools Must Become More Diverse
In September 1976, I donned a white coat for the first time and began my studies in medicine at Cornell Medical College, as it was then known. Though I am a black man, I did not find myself alone: Nearly 20 percent of my fellow medical students were black or Hispanic. This is remarkable, given that only a decade earlier, there was very little racial or ethnic diversity in medical schools.
But today, a full 40 years later, we’ve fallen behind. As the Association of American Medical Colleges recently reported, the number of black men applying to and enrolling in medical school in 2014 was lower than in 1978. Some 1,337 black men applied and 515 enrolled in 2014, while 1,410 applied and 542 enrolled in 1978. Meanwhile, the black population in the United States has increased.
The lack of diversity in medical schools extends beyond black men. While 13 percent ofthe nation’s population identifies as black or African-American, only 4 percent ofphysicians do, according to the association.Latinos, American Indians, and Alaskan Natives are also significantly underrepresented in medicine. The numbers for black or African-American and Hispanic women, while they outpace those of black male applicants and matriculants to American medical schools, are also small.
We are clearly not doing enough to ensure there is a path for talented students from underrepresented backgrounds to become doctors. I believe those of us who work at all levels of education and health care have a collective responsibility to help more students find that path.
As a student, I was a beneficiary of the legislation and policies that came out of the civil-rights movement. Formal academic-enrichment programs similar to Prep for Prep, which helps place promising New York City students in private schools and prepare them for college, further opened doors for me — as far back as junior high school — so that I could join other high-achieving students.
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Beyond the general programs that supported students of color back then, specific programs to encourage diversity in medicine began to sprout. By the 1970s, there were several pipeline programs to diversify medical schools, including the Summer Research Fellowship Program at Cornell, where I enrolled in 1975. Without the formal programs that provided me with opportunities and opened up new doors, I would not be where I am today.
Over the last four decades, diversity programs for medicine have continued to expand. The Associated Medical Schools of New York, which represents the state’s 16 medical schools, developed its first postbaccalaureate program 25 years ago. (I serve as chairman of the group’s Committee on Diversity and Multicultural Affairs.) That program, funded by the state, has offered more than 400 students from groups traditionally underrepresented in medicine the opportunity to attend medical school in New York. The consortium also created three master’s-degree programs with the same goal. Some 93 percent of graduates of those programs have become physicians. In addition, the consortium has offered numerous pipeline programs for students in middle school, high school, and college.
Despite those successful programs, diversity in medicine has not kept up with the growing diversity of our population. We must do more. How?
First, we need a better understanding ofthe barriers. For example, we know that almost half of black men who take the MCAT do not apply to medical school — a share twice as large as that among the general population of test takers — but we don’t know why.
Next, we need to create a national, comprehensive, and sustainable strategy to bridge those barriers. Medical schools, which have traditionally shouldered much of the work ofdiversifying the medical field, cannot do it alone. Elementary and secondary schools and community leadership must be part of the conversation and the solution. The increased emphasis on STEM programming in our elementary schools is a great start, but more students need to better understand careers in medicine, and more elementary and secondary educators need to know how to help students navigate the path toward a medical degree. For example, the Associated Medical Schools of New York has found that many high-school and college advisers still have misconceptions about the medical-school application process and the availability of financial support. Those misconceptions deter students.
Finally, medical schools need to continue their efforts to recruit more minority students. At the Icahn School of Medicine at Mount Sinai and the Mount Sinai Health System, where I work, we are making systemwide interventions to further advance diversity, with a particular focus on minority men. Every unit across the school and system has been asked to take part in coordinating improved, measurable, and sustainable efforts. Our IT department, for example, is developing an IT pipeline track for students interested in health-technology careers. An important next step is to identify mentors among our medical-school leaders who will commit to mentoring an underrepresented student in high school, college, or medical school.
Diversity in medicine is not just a social-equality issue; it is also about improving the health of our patients. People who have doctors from their own backgrounds express better satisfaction and are positioned to have better health than those who do not. For those reasons among many others, we all share a collective responsibility to train doctors from more-diverse backgrounds.
Gary Butts is chairman of the Committee on Diversity and Multicultural Affairs of the Associated Medical Schools of New York. A physician, he is also dean of diversity programs and policy at the Icahn School of Medicine at Mount Sinai.