If medical schools truly want to create a diverse physician workforce, a new study in JAMA suggests they must account for structural barriers to education that underrepresented racial minorities in medicine face.
The study found that Black, Hispanic, and Indigenous students taking the Medical College Admission Test (MCAT) prior to applying to medical school face increased levels of educational and financial barriers, and experience increased discouragement from academic advisors compared with White students.
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Dr. Jessica Faiz, an emergency medicine physician, National Clinician Scholars Program Fellow at UCLA, and lead-author of the study, noted these barriers have clear implications on physician diversity.
“We also found that Black and Hispanic students taking the MCAT were less likely to apply to and attend medical school,” said Faiz. Another JAMA study found similar patterns for Indigenous students, noting that between 2002 and 2017, they were the only underrepresented racial group that did not experience an increase in medical school matriculation.
This trend is concerning given equitable representation of physicians from underrepresented communities in medicine has been shown to improve the quality of care for patients from those communities. As such, Dr. Utibe R. Essien, a physician-leader in the pharmacoequity movement, UCLA faculty, and co-author of the study, believes systemic solutions tailored to the magnitude of the crisis are needed.
“Despite years of research, funding, and attention to the issues of addressing medical workforce diversity, we still have significant gaps in achieving this goal. Our study suggests that those gaps cannot be addressed alone by medical school diversity deans or hospital chief diversity officers, we have to look much earlier to addressing barriers to higher education that exist outside of medicine as well,” noted Utibe.
Their study also comes at a time where systemic racism-conscious approaches to address minority underrepresentation in education are under increased scrutiny.
“Amidst an impending Supreme Court ruling that will potentially ban affirmative action, these findings are critical. It is important to remember that promoting socioeconomic diversity alone is not enough to address the sequelae and persistence of racism in medicine, and our study supports that,” said Faiz.
The findings, according to Faiz, are likely just the tip of the ice-berg.
“If we see that these barriers exist in those who are already taking the MCAT, we can only imagine how many students are really falling off before that. By studying these upstream factors and potential mechanisms for why we are behind in diversifying the physician workforce, we can come closer to solutions that will ultimately improve care for our patients,” she said.
Some solutions proposed in the paper are admission rubrics that account for structural barriers, working with underrepresented communities and bringing them to the decision-making table to develop solutions or even participate in selection committees, and stand behind race-conscious admissions processes.