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Diversity in medical students now means better health care later

American medical schools are suffering from a severe case of economic and racial homogeneity, which is fueling physician shortages in vulnerable communities. Doctors are most likely to work in areas that share their demographics. White medical students from wealthy backgrounds tend to return to well-off, predominantly white locales to practice. Conversely, communities that produce few medical students also tend to have few practicing physicians.

Take rural areas. Not only are there very few people from these communities training to be doctors; medical school pedagogy often ignores them entirely. Just 4 percent of family medicine training and 5 percent of internal medicine training occurs at rural, community-based health clinics.

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As a result, while about 20 percent of the American population lives in rural settings, only 10 percent of doctors practice there. Rural patients already have to travel greater distances for care. The comparative lack of doctors only exacerbates their inability to access care. Studies show that med students from rural areas are more likely to return there to practice. To address the shortage of rural doctors, med schools need to recruit rural students in the first place.

The story is similar for racial minorities. About 55 percent of medical school applicants are white (and 54 percent of them are male), while just 7 percent are black, and most of them are women (65 percent compared with 35 percent for African American men). Hispanic or Latino studnets make up 8 percent of applicants. Further, ethnic minorities comprise just 4 percent of medical school faculty and 8 percent of American doctors.

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Research suggests that black doctors are more likely to practice medicine in communities with higher proportions of black residents. Likewise, Hispanic doctors tend to work in areas that have, on average, double the share of Hispanic residents relative to populations served by non-Hispanic doctors.

Increasing the number of black and Hispanic doctors will surely increase access to care for their brethren. That's important. Thirty percent of blacks, and 42 percent of Hispanics never visit a doctor over the course of a year, compared to just 23 percent of whites.

Consequently, boosting the diversity of the physician workforce isn't just a feel-good mission. It's crucial to improving the quality of care, especially for at-risk Americans and can have tangible, positive consequences for patients and doctors.

Some prominent figures in the health care community agree and are trying to foster greater diversity at medical schools. Darrell Kirch, the CEO of the Association of American Medical Colleges, has made a direct link between student body diversity and quality of care. He explicitly urges his member institutions to "admit medical school classes that reflect the diversity of our communities."

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Some have taken up that charge. Consider Baltimore's own Johns Hopkins University School of Medicine. Nearly one-sixth of the most recent class of incoming students hailed from underrepresented groups. Thirteen percent were first-generation college students. The undergraduate campus also runs a program to mentor students from underrepresented populations who are interested in going into medicine.

The University of California-Riverside's med school provides admission preferences to students who are first-generation, speak English as a second language, come from economically disadvantaged communities, or reside in inland Southern California, a historically underserved area.

The University of Kansas recently opened a medical school in rural Salina, Kansas. KU is betting that MDs trained in a rural community are more likely to end up practicing in one.

At the institution I lead, St. George's University, all second-year students go through a 10-week rotation at a community hospital in Grenada, in the Caribbean. We've also made diversity the focus of our recruitment efforts. Our students come from 97 different countries; non-U.S. residents account for 35 percent of our enrollment.

Through our CityDoctors New York City HHC scholarship program, we fund the educations of students from New York City, including many who hail from poor or traditionally underserved neighborhoods. For each year of free tuition they receive, they promise to work for one year at NYC Health + Hospitals, the public hospital system in New York.

Today's medical schools don't reflect the ethnic, socioeconomic or geographic composition of the patient populations doctors serve. By boosting diversity, med schools can improve the quality of their training, help close the health care access gap and improve patient health.

Dr. G. Richard Olds is president of St. George's University in Grenada. His email is grolds@sgu.edu.

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