One way to grow the healthcare workforce is to recruit more minorities to help care for an increasingly diverse patient population. Everyone in the industry has talked for years about doing just that. Why then has the industry failed so miserably in meeting this goal?
"We've had 90 different organizations doing their own thing for a long, long time, and it hasn't been effective," says Randall Maxey, a Los Angeles nephrologist who is president of the National Medical Association, or the NMA, a Washington group that represents black physicians. "And the current situation isn't positive."
Although blacks, Hispanics and American Indians make up more than 25% of the U.S. population, they represent about 6% of physicians, 9% of nurses and 5% of dentists, according to HHS' Bureau of Health Professions. First-year enrollment of underrepresented minorities in America's 126 medical schools, which grew to a high of about 12.5% in 1995, has fallen steadily nearly every year since then, dropping to about 11% in 2001, according to the Association of American Medical Colleges, or the AAMC, which, like Maxey, places at least part of the blame on court rulings against affirmative-action programs.
Despite the lack of success so far, Maxey sees progress toward a strategic plan. "You must have some coordination of effort. And I think that's what's finally happening."
Two months ago, a task force co-sponsored by the NMA and the American Medical Association brought together about 40 organizations to discuss ways to increase workforce diversity, identify and train underrepresented minorities, and help raise awareness of racial and ethnic inequalities in healthcare. That gathering took place just about three months after the influential Institute of Medicine called racial diversity in healthcare a "compelling interest" and recommended a sweeping review of everything from medical-school admissions policies to national accreditation standards to help ensure better access to care for minorities.
"I think we've got a motivated core of people who recognize-especially after the IOM report-that healthcare in America is unequal," Maxey says. "Many people want to put their head in the sand and not recognize this."
On June 24, the Sullivan Commission on Diversity in the Healthcare Workforce, named after Chairman Louis Sullivan, the former HHS secretary, will hold a news conference in the nation's capital to release the results of an exhaustive study examining many of these same issues. "I think it's fair to say the report is going to point out the fact that we can-and should-be doing better in having a more diverse health-professions workforce," Sullivan says.
After some improvement during the late 1960s through the mid-1980s, he says, the progress appeared to come to a screeching halt in the late 1980s. "For whatever reason," he says, "we took our eye off the ball by the end of the 1980s. In the 1990s, we have made very little progress, and, in some areas, we're sliding back. That's the reality. And that is one of the things we're pointing out-I see this as a national call to action."
Officials with the 15-member commission, which was formed in April 2003, say blacks, Hispanics and American Indians tend to receive less healthcare-and of lower quality-than whites, leading to higher mortality rates for everything from cancer and heart disease to HIV/AIDS and diabetes.
At the AAMC, which has focused on diversity for years without much success, officials are busy promoting partnerships with colleges and high schools, summer internships for prospective medical students and initiatives to boost minority faculty numbers. For instance, the 16-year-old summer medical education program helps prepare about 1,200 undergraduate or post-baccalaureate students for the rigorous medical-school admissions process over a six-week period. About 63% of students who have gone through the program have been accepted to medical school.
Despite these and other efforts, the AAMC fell far short in its ambitious Project 3000 by 2000-an initiative aimed at having 3,000 underrepresented minorities in U.S. medical schools by the turn of the century. In the year 2000, just 1,741 underrepresented minorities were entering medical school. By 2004, the number had reached 2,026, an indication that the goal may not be reached for many years.
"Certainly, the numbers have been disappointing," says Charles Terrell, vice president of the AAMC's division of community and minority programs. "But we're hopeful that (existing) programs will continue to make a difference." And the AAMC has learned, he says, that it must work in coordination with other organizations on the issue.
The outlook isn't any more positive among medical school faculty. Of the 98,802 total faculty members at 125 U.S. medical schools in 2002, only 4,507 were black, Hispanic, American Indian or mainland Puerto Rican.
The renewed focus on diversity spans the spectrum of healthcare, touching on issues such as disease prevention and the dearth of minority doctors. It all comes down to the most vital concern of all: access to healthcare for the tens of millions of underrepresented minorities who have significantly higher risk of some of the most serious diseases.
In a 2002 study in the Journal of the American Medical Association that examined racial disparities in treatment for patients in Medicare managed-care plans, researchers found that whites received higher levels of service in four key areas-breast-cancer screening, diabetic eye exams, beta-blocker use and mental illness follow-ups. A Commonwealth Fund study in 2001 found that blacks and Hispanics have a far greater difficulty communicating with physicians than their white counterparts.
For his part, Maxey outlined a long list of problems and concerns that have contributed to what he describes as a growing racial and ethnic disparity in the U.S. healthcare system for minorities. Among the principal worries: Minority enrollment in U.S. medical schools has declined in recent years, partly because of adverse decisions in affirmative-action cases; there is little mentoring or tutoring of minority students, which adds to the problem of low admission rates in medical schools; and the fact that a lack of minority physicians to treat diverse populations only adds to problems involving education, disease management and health-tracking. Little improvement has been seen in the numbers of minority nurses, either.
Maxey says his group is now in discussions with groups like the NAACP and the Urban League to promote healthcare diversity. In April, the Alliance of Minority Medical Associations was formed as a collaboration between the NMA, the National Hispanic Medical Association, the Asian and Pacific Physicians Association and the Association of American Indian Physicians.