Diversity in the Department of Medicine
It’s a dilemma that has plagued the U.S. healthcare system for decades: While the nation’s population is growing more diverse, its healthcare workforce is not.
Nearly one third of the population is now Latino, African American or Native American, according to U.S. census data. Yet only 8.5 percent of doctors share those ethnic backgrounds, according to the American Medical Association (AMA). The number of under-represented minorities entering medical schools nationwide hovers around 13.2 percent, up only slightly from 11.3 percent in 1980. Meanwhile, just 7.5 percent of medical school faculty are from minority background, based on data from the American Association of Medical Colleges (AAMC).
The good news: Thanks to a host of sweeping new initiatives at the School of Medicine and within the Department of Medicine (DOM), the University of Colorado is fast improving those numbers.
“We are taking a bold new approach and it is working,” says Rob Winn, M.D., former Associate Dean of Admissions for the School of Medicine (SOM). In his two years on the job (2010-12), the school’s minority enrollment soared to an unprecedented 39 percent of incoming students.
Under the direction of DOM Chair David Schwartz, M.D. who identified diversity as a top priority for the department, members of the DOM are working to spread that success throughout the academic pipeline.
“I think the opportunity to improve diversity in medicine at the University of Colorado is probably greater now than at any time since I have been here,” says Suzanne Brandenburg, M.D., who came to CU in 1986 and now directs the DOM’s Internal Medicine Residency Training Program.
Why diversity matters
Just as women often prefer being treated by women, patients from diverse ethnic backgrounds often find comfort in seeing a physician who shares, or is at least sympathetic to his or her cultural background, says Karen Villalon, M.D., who completed her residency in the DOM in 2007 and stayed on as a clinician researcher in geriatric medicine.
“I see a lot of older Hispanic women who are Spanish speaking, and they immediately make a connection with me because we have similar upbringing,” she says.
Noelle Northcutt, M.D., Chief Resident in the DOM, notes that just understanding certain cultural dynamics, like the fact that sons and husbands often play a strong role in a Hispanic woman’s care decisions, can go a long way in improving the patient/doctor relationship.
The more diversity that exists among faculty and housestaff, with each member sharing such subtle nuances with fellow residents and attending medical students, the more culturally competent everyone becomes. “It adds another layer to what everyone is able to learn,” says Northcutt.
Big picture, studies suggest that physicians from minority backgrounds are more likely to conduct research impacting those populations, practice medicine in underserved areas, and serve underinsured and uninsured patients. As the AAMC puts it: “A more diverse health profession workforce is key to eliminating health care disparities.”
And in the long run, a more diverse population of physicians begets a more diverse population of physicians. “The truth of the matter is, you are not going to inspire the next generation of African American or Latino physicians if young people don’t see them,” says Winn.
Real Progress at the School of Medicine
In the fall of 2012, the CU SOM welcomed its most diverse class in history, with 61 of its 160 incoming medical students coming from underrepresented minorities.
Winn stressed that as the numbers of diverse students have risen, average GPAs and MCAT test scores have remained the same, or risen slightly. “Diversity does not trump excellence,” he says. “These people are not here because of their skin color. They are here because based on their academic record and their experience; they are wonderful people that every medical school would want.”
The school recently earmarked $10 million over the course of five years to support scholarships for incoming students from under-represented communities, including rural and ethnically diverse communities (of the 61 incoming students of diverse backgrounds, 16 are on scholarship).
Winn noted that the school has also gotten more aggressive about recruiting, traveling to prestigious universities and elsewhere with a message that University of Colorado not only has top-notch facilities and divisions, and a diverse population of patients, but also a more “holistic” approach to medicine that goes beyond academics. “We believe in a humanistic approach to taking care of patients,” he says. “You don’t find that everywhere.”
Bold initiatives for Department of Medicine
Within the Department of Medicine, the numbers are also improving – albeit more slowly, with nearly 11 percent of internal medicine residents now coming from underrepresented minority backgrounds.
Several initiatives are underway to try to boost that number to closer to 20 percent within a few years.
The DOM developed a five-year diversity plan and amassed a group of faculty members and residents (including Brandenburg, Villalon, and Northcutt) to tackle the issue.
In hopes of boosting its pool of diverse residency applicants, the DOM is broadening its local and national recruitment efforts this year. To better welcome those applicants, diversity ambassadors now personally reach out to everyone to answer questions or offer advice.
Through its new DREAM Program, the DOM will provide stipends to connect medical students already on campus with DOM faculty and researchers. The hope is that they will form a relationship and stay on for their residency training and beyond.
To make incoming housestaff feel more comfortable once they get here, efforts are underway to create more social support for them on and off campus. “If we are going to say, ‘We understand you are coming from a diverse background and we want you here’ we need to provide a support net so when they need it, it exists,” says Northcutt.
Ultimately, Brandenburg would also like to see the DOM reach out to underrepresented middle and high school students, to show them what the path there might look like. “It’s all about the pipeline,” she says. “As diversity increases at the school of medicine, we are trying to attract more diverse students into the residency program, and then encourage some of them to stay on as faculty.” “At the end of the day,” she says, “the patients win.”