In the coming weeks, nearly 17,000 medical school students will graduate across the US and begin their career in medicine. While this seems like a large number, it does not nearly meet the demand in our country. It is estimated that by the end of the decade there will be a shortage of over 90,000 physicians. But the profile of those receiving their degrees is increasingly homogenous and exclusive, particularly when it comes to Hispanic and Latino doctors.
Despite the fact that Hispanics make up 17% of the US population, they only represent a fraction of the physician workforce. Between 1978 and 2008, only 5.5% of graduating physicians in the US were Hispanic. While the number of Hispanic applicants to medical school has tripled over the past 30 years, the percentage who matriculate or graduate from medical school has remained relatively stable over the past few years. The problem is multifaceted: Talented Hispanic students may be choosing not to pursue a career in medicine, applicants to medical school are not competitive enough to be admitted, and once in medical school, a percentage of Hispanic students choose to leave, thus, creating a workforce gap.
In the past few years, the number of minority students applying to medical school has been increasing. In 2012, there was a 7% increase in the number of Hispanic applicants compared to 2011. The number of applicants from other minority groups, such as African Americans and American Indians, increased as well—yet these three groups made up less than 20% of all applicants to medical school. One reason why more minority students may not be choosing to enter medicine is the cost of medical education. The Association of American Medical Colleges estimated the cost of medical education to be $56,000 for a public institution and $74,000 for a private medical school in 2013. The cost of medical education is the leading reason why minority students choose not to pursue a career in medicine.
Ensuring that Hispanic medical students succeed once in medical school is also crucial. While the dropout rate is low (<4%), Hispanic students are more likely to leave medical school for academic reasons than non-Hispanic white students. If Hispanic students do not graduate, they will not become the needed doctors in our communities, because minority physicians have a greater likelihood of serving minority patients. That factor likely improves patient’s access to healthcare due not only to language compatibility, but also cultural competence. More than 37.6 million people speak Spanish at home it’s is the most widely spoken non-English language in the US.
Furthermore, minority patients are more likely to choose a minority physician, and to report greater satisfaction with their care. This may be in part because physicians who are of the same race and ethnicity as their patient have better communication with minority patients than physicians who are not of the same racial/ethnic group. Better communication between patients and their physicians has been linked to better outcomes in several diseases prevalent in the Hispanic community, such as diabetes and hypertension.
Increasing diversity in the medical workforce is crucial. A classic report from the Institute of Medicine a decade ago stated that improved workforce diversity is key for addressing disparities in care. This is especially relevant as millions of newly-insured enter the medical system due to the Affordable Care Act.
In 2013, more than 15 million non-elderly Hispanics did not have health insurance. While millions of Hispanics may have enrolled in healthcare under the Affordable Care Act, they will not realize the benefits of the system if they do not see their doctors. A study published this February surveyed 387 young Latinos in Oregon and found that more than 25% were not satisfied with their healthcare. Medical mistrust and perceived discrimination were two factors associated with dissatisfaction.
There are policies in place to achieve diversity among students, faculty, staff and other members at universities. They’re overseen by the Liaison Committee on Medical Education, the organization that accredits medical education programs. Close to half, or 13 of the 25 schools reviewed by the LCME between October 2011 and June 2012, received citations for a lack of diversity. What’s more, these are the most common citations given to medical schools. Institutional diversity matters since a lack of faculty diversity is one of the perceived barriers to minority student’s success in medical school.
Recently, I celebrated my 10-year reunion from medical school. I remember that four of us were Hispanic in a class of nearly 180. During my three years of residency, I was the only Hispanic anesthesia resident and was asked to translate or care for patients because I spoke Spanish. While the diversity in my medical school has improved, in the residency match that occurred this March, no Hispanic medical student matched into our anesthesiology program.
The health of the Hispanic community depends on not only policy change at the institutional-level to ensure a diverse workforce, but also at the individual-level by both encouraging promising students to enter a career in medicine, but also in ensuring that Hispanic students succeed once in medical school.