The crisis the American people confronted on Oct. 4, 1957, seems almost quaint by current standards: Our Cold War nemesis, the Soviet Union, had launched an artificial satellite into low-earth orbit. The beach ball-sized object, known as Sputnik 1, exposed a purported technology gap between the Western powers and our Communist adversary.
The U.S. responded neither with despair nor confrontation. Rather, the event proved a mainspring for an extraordinary investment in science and technology, transforming school curricula and leading to low-cost loans for STEM students through the National Defense Education Act.
Sputnik I also inspired a generation of young men and women to pursue careers in space technology and related fields. Watching the satellite cross the West Virginia sky propelled future Rocket Boys author Homer Hickam to a job as a NASA engineer; the event drove Alan Shepard, the first American in space, to become an astronaut.
Americans today face a grave crisis in COVID-19. Yet as thousands of healthcare workers serve on the front lines, fighting the virus and caring for their fellow citizens, we have an opportunity to make this pandemic our Sputnik I.
Despite increases in medical school applications and leaps in therapeutic offerings, perceptions of the medical profession have been in decline for some time. A 2014 study by Robert Blendon and colleagues found that only 58% of Americans agreed with the statement, "All things considered, doctors in the United States can be trusted." That compared with 76% in Great Britain and 75% in France. Increasingly, the burdens of electronic documentation and lost autonomy have thinned the ranks of physicians and scared away would-be replacements. If that were not deterrent enough, the average medical school graduate now carries more than $200,000 in debt.
COVID-19 may change some of those perceptions. In New York City, physicians have been cheered the way first responders were hailed after 9/11. Should we be fortunate, this newfound appreciation will prove the first step toward recruiting a future generation of passionate researchers and clinicians.
But inspiration is not enough. If our society is to make the most of this challenging moment, we must re-envision the healthcare workforce. Community buy-in for public health measures is essential during a crisis. Having a physician to whom one can relate is just as crucial for optimal care in non-pandemic times. This is best achieved through a diverse corps of physicians whose backgrounds and experiences reflect those of the broader population.
We are not there yet. For example, Black men have suffered disproportionate mortality during the COVID-19 pandemic, yet the total number of self-identified Black males entering U.S. medical schools last year was 604. Other underrepresented groups include first-generation college students, those from low-income backgrounds, Latinos, Native Americans and veterans. Children of blue-collar workers, single parents, and the disabled still face counterproductive barriers to entry.
Several marquee medical schools now offer free tuition, while others cap debt. That is a step toward equity. However, this approach largely helps candidates already in the pipeline.
What is needed are free post-baccalaureate programs for highly talented individuals who did not have a meaningful chance to pursue science education in high school or college so they can complete the preliminary coursework necessary to apply. Alternative pathways to entry are also essential: linkage programs that guarantee admission to "career changers" as long as they meet certain academic benchmarks. Low-income students giving up stable jobs to pursue pre-med courses should know that there is place for them in a medical school class if they succeed.
Finally, the country desperately needs more medical schools. At present, the number of seats for students is set artificially low, which in turn generates higher reimbursement for doctors. Yet the patient demand, especially in primary care, continues to grow. In essence, in a world of markets, doctors belong to a medieval guild. Why not let anyone capable of practicing first-class medicine join the field?
Much as Sputnik I transformed American science—ultimately leading to the first human steps on the moon—medicine is ready for its own moon landing. Let us make this the positive legacy of the current tragedy.