After ban on affirmative action, focus on economic disparities can increase diversity
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Key takeaways:
- Black, Hispanic/Latino and other populations are underrepresented in health care, starting at the medical school level.
- A focus on economic disparities can reduce racial/ethnic disparities.
When Mark C. Henderson, MD, MACP, takes a Black medical student with him to see a Black patient, he often receives the same request.
“Can he or she be my doctor?” the patient asks Henderson. “I’m like, ‘Yeah, in 5 years when they actually become a doctor.”
The interaction highlights the lack of trust some individuals have about the health care system and the need for more racial and ethnic representation, Henderson told Healio.
“Medicine, in general, isn’t very reflective of society,” said Henderson, professor of internal medicine and associate dean for admissions at UC Davis School of Medicine.
Diversifying the workforce became more difficult after the U.S. Supreme Court ruled in 2023 that affirmative action programs colleges and universities used to admit students are illegal.
However, if institutions and medical centers make it their goal to reduce racial and ethnic health disparities, they can accomplish that objective through other means, Henderson said during a presentation at ASCO Annual Meeting.
This effort can include focusing on economic disparities and community work.
“If your mission is to meet the health care needs of your community or the broader U.S., you have to start off by saying, ‘We’re not doing that now,’” he said.
Background
White and Asian individuals account for 64% of the U.S. population but 85% of medical providers in the country, according to data Henderson presented at ASCO.
Conversely, Black and Hispanic individuals account for 32% of the population but only 13% of physicians.
Diversity trends have worsened over time, as well.
Medical school slots increased 54% from 1997 to2017, but the rate of students from underrepresented groups decreased from 15% to 13%.
“Oncology is lagging behind in a lot of ways,” Henderson said. “About 9% to 10% of the trainees [in U.S. oncology training programs] are African American or Latino compared with one in three Americans. Fellows in oncology over the last 5 years have also dropped, from [about] 12% from underrepresented groups to around 9%. Overall, it’s not good.”
Focus on economic disparities
Medical schools no longer can use race or ethnicity to bridge these gaps.
However, focusing on financial disparities could produce the same result, Henderson said. Fifty percent of current medical students come from homes from the top 20% of family income while 5% come from the lowest quintile, he said.
At UC Davis, a public institution founded to meet the healthcare needs of California, median family income is $68,000 and 75% of students receive financial assistance.
Focusing on students from across the economic spectrum has resulted in a much more diverse student population.
Hispanic/Latino, Black and Native American individuals accounted for a combined 10% of the UC Davis medical student population in 2006.
The class of 2027 includes 24.1% Hispanic/Latinx students, 13.1% Black/African American and 5.1% American Indian/Alaska Native, Henderson said.
“There are economic disparities that cut across racial and ethnic backgrounds,” he said. “We don’t choose on the basis of identity. We have many low-income rural white students, too, because we’re trying to look at their socioeconomic background and lived experiences of health care — or sometimes lack of it — when we choose them.”
Family income is only one part of the UC Davis scale, which admissions uses to provide context to traditional measures like grade point average and test scores.
“There’s such a heavy emphasis on test scores, but we realize test scores are influenced dramatically by resources and wealth,” Henderson said. “We wanted to incorporate a metric to help interpret other scores like grades and MCATS in proper context of the wealth and educational opportunities afforded each applicant.”
Other factors considered include parental education, receipt of family assistance, growing up in an underserved area and personal experiences.
“A lot of Americans have trouble accessing health care,” Henderson said. “Maybe they’re on Medicaid and it’s harder to see a physician. Maybe they’re from a rural area and can’t get to a physician, especially a specialist. When students and residents understand those experiences, they have a greater understanding of what patients go through. Those physicians, ultimately, are more able to connect with patients and advocate for patients to get better care.”
Henderson compared UC Davis’ approach to the “Moneyball” method — explored in the best-selling book and motion picture of the same name — that former Oakland As general manager Billy Beane used to make his baseball team competitive in the 2000s. They rejected conventional statistics and advice of long-time scouts, and instead relied on other innovative metrics to achieve their mission.
“Winning the game [in health care] means reducing health disparities, improving the care of patients who are left out or get less quality care,” Henderson said. “To that end, we must have greater representation. We have to produce physicians more like the populations that we’re supposed to serve.”
As an example, Henderson said institutions could take a closer look at students from community colleges instead of giving legacy preferences.
“Many of the students have to work to make ends meet, thus community colleges are much more representative of the United States than Ivy League schools,” he said.
‘Work toward the change’
Reducing disparities beyond medical school can be more difficult as residency applications do not include financial information.
However, hospitals, medical centers and other practices can utilize similar equalizing methods to diversify.
For example, they can partner with universities that have shown a commitment to reducing disparities.
Henderson likened it to a Major League Baseball team investing in their farm systems or other countries.
“A lot of times, training programs focus on getting people from the Ivy Leagues,” Henderson said. “Everyone wants Ivy Leaguers. ... My daughter went to Harvard and works for a magazine that basically only hires graduates from Harvard. It’s not just medicine. This is a bias. This is one reason we don't have greater representation from local communities.”
Instead, training programs can reward applicants who have shown a propensity to serve underserved communities.
UC Davis has a program dedicated to tribal and indigenous communities. To qualify, students must have demonstrated work in those communities.
“Our medical students teach,” Henderson said. “[Sacramento High School is] across the street. It is the most diverse high school in Northern California in terms of race and ethnicity. I think 85% of the students are Black or Latino. Our medical students go into that high school and teach these high schoolers about lung cancer, and what tobacco products do to one’s health. These are busy medical students. Why do they do it? They do it because they’re from those communities. They know there’s a change that needs to happen, and to them it’s personal. So they’re going to work toward the change.”
References:
- Henderson MC, et al. JAMA. 2023;doi:10.1001/jama.2023.15872.
- Henderson MC. How do we create a diverse workforce in oncology when affirmative action has ended? Presented at: ASCO Annual Meeting; May 31-June 4, 2024; Chicago.
- UC Davis Class of 2027 Matriculant Demographics. Available at: https://health.ucdavis.edu/mdprogram/admissions/pdfs/Matriculant-Demographics.pdf. Accessed Aug. 22,2024.
For more information:
Mark C. Henderson, MD, MACP, can be reached at mchenderson@ucdavis.edu.
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Henderson MC, et al. How do we create a diverse workforce in oncology when affirmative action has ended? Presented at: ASCO Annual Meeting; May 31-June 4, 2024; Chicago.
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