Delivering care to the underserved: Increasing the Numbers of Minority Physicians

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Delivering care to the underserved Increasing
the Numbers of Minority Physicians

• Ruben Gonzalez MD
• CCRMC

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Objectives

1. Barriers to providing health care to the
   underserved
2. Barriers to recruiting underrepresented
   minorities into medicine
3. What we can learn about successful college-bound
   programs
4. How we at CCRMC can help

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Racial and Ethnic Disparities in Healthcare

• Institute of Medicine 2003
• Racial and ethnic disparities remain even after
  adjustment for socioeconomic differences and
  other healthcare access related factors
• Differences in treatment are not due to clinical
  factors such as racial differences in severity of
  disease or overuse of services by whites
• Racial and ethnic minority patients are more
  likely to refuse treatments but this difference
  is small and do not fully explain healthcare
  disparities

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Findings of Institute of Medicine continued

• Many sources-including health systems, healthcare
  providers, patients and utilization managers may
  contribute to racial and ethnic disparities in
  healthcare
• Bias, stereotyping, prejudice, and clinical
  uncertainty on the part of healthcare providers
  may contribute to racial and ethnic disparities

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Summary of Recommendations

• General Recommendations
• Increase awareness to general public and
  providers
• Legal, Regulatory and Policy Interventions
• Increase the proportion of underrepresented U.S
  racial and ethnic minorities among health
  professionals
• Strengthen the stability of patient-provider
  relationships in publicly funded health plans
• Health Systems Interventions
• Use of evidence-based guidelines, support
  community health workers, support the use of
  interpretation services, structure payment
  systems to ensure adequate supply of services to
  minority patients
• Patient Education and empowerment
• Cross-Cultural Education in Health Professions

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Importance of Underrepresented Minority Providers

• 25 are underrepresented racial and ethnic
  minorities (URM)
• Minority medical graduates represent 9 of the
  countrys physicians
• 33.3 are African American, 40.1 are Asian
  American, 24.9 are Hispanic, 1.8 are American
  Indian
• Between 1990 and 1994 increase to 12 of total of
  URM due to Project 3000 by 2000.
• Since then there has been a dramatic decline due
  significant policy shifts regarding affirmative
  action and higher education admissions procedures

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Importance of Underrepresented Minority Providers

• Racial concordance of patient and provider is
  associated with greater patient participation in
  care processes, higher patient satisfaction and
  greater adherence to treatment
• Racial and ethnic minority providers are more
  likely than their non-minority colleagues to
• Serve in minority and medically underserved
  communities
• Work in hospital-based practices
• Work in FAMILY PRACTICE, ob/gyn, and pediatrics

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Barriers to Recruiting URM

• 2005 Carrasquillo et al identified perceived
  barriers to enrollment of URM students
• Educational Preparation (e.g. MCAT scores)
• Lack of Minority Faculty
• Lack of Minority Role Models
• 2007 Davidson et al found that for dental
  students URM recruitment was enhanced by
• higher proportion of URM clinical faculty
• ability to care for diverse groups
• URM students suggest that summer enrichment
  programs were the most effective tools used by
  Medical schools to recruit students

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College Success Programs

• Only 54 of recent high school graduates from
  low-income families pursue postsecondary
  education, compared to 88 of upper-income
  graduates.
• For Latino students, in 1976 they made up 36 of
  college-age students. In 1997 it was 35.8,
  however the Latino population had increased 200.
• Minority students today have a lower persistence,
  graduation rates and levels of academic
  preparedness

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College Success Programs

• Different theories of retention
• Tintos Student Departure Theory academic
  integration and societal integrations are key.
  college as a rites of passage
• Culture integrity model One develops ways of
  affirming, honoring and incorporating the
  individuals identity into the organizations
  culture
• Different approaches used to increase acceptance
  and retention for URM.
• Summer Bridge Programs
• Developmental Education Programs
• Supplemental instruction Programs
• Mentoring Programs
• Culturally Conscious Programs

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Puente Program

• Methodologies Puente has pioneered include
• Linking an academic program to the local
  community
• Integrating culturally relevant literature into
  the core curriculum
• Creating small learning communities that foster
  academic success
• Working in cross-disciplinary teams
• Successfully teaching students reading and
  writing in untracked, mixed-skills classes.

Mentoring
Counseling
Writing
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Puente Program

• More likely to be eligible for the University of
  California (19 vs. 6)
• 83 rate of acceptance to 2 and 4 year college
  compared to 49 of all graduating high school
  seniors
• More likely to enroll in four year college (43
  vs. 24)
• Acceptance to UC increased 234 between 1999 and
  2003
• Passage rate of exit exam
• English 96 vs. 69
• Math 81 vs. 56

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Puente - CCRMC Health Pathway

• Short term project
• Creation of shadowing opportunities and
  volunteering opportunities for those interested
  in health sciences
• Long term project
• Creation of a Puente-CCRMC health careers pathway
• Longitudinal program throughout four years
• of High school
• Allow for exposures to different careers
• in Health Care
• Student Community Outreach Projects to
• encourage awareness of minority health issues
• Resident/Faculty mentors

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THANK YOU