Paving the way to a diverse medical workforce starts with med schools

When the medical workforce is reflective of the patients it treats, everyone wins. But getting there isn’t going to be an overnight process; instead, leaders in medical education need to start focusing on creating pathways to a career in healthcare.

Indeed, a diverse medical workforce is ideal for medicine, experts are increasingly recognizing, in large part because it increases the odds for racially concordant care. Data have shown that racial concordance can improve the patient experience as well as improve clinical outcomes.

That push for medical workforce diversity, plus the looming specter of a significant provider shortage, are among healthcare’s biggest problems right now, according to Leon Clark, vice president and chief academic affairs officer at Northern California’s Sutter Health.

“The big problem, one that I think affects all of us in healthcare, is that we have a growing and relatively unabated physician shortage,” he told PatientEngagementHIT in an interview. “We can't have good quality care, and we can't address health equity without access. Access to care impacts those who are under resourced in profound ways, and it is really important that we, in order to address health equity, address issues of access.”

The healthcare industry needs to increase the medical workforce in general, Clark explained, but as it also seeks to improve health equity, industry leaders need to consider doing so by building a diverse medical workforce.

But getting to racial concordance isn’t realistic right now, with the data showing that a diverse medical workforce is still rare at most hospitals and health systems. After all, health systems can only hire from the resumes they receive.

And although the American Academy of Family Physicians has reported the racial composition of medical school is showing signs of leveling out, 51 percent of applicants still identify as White, representing a disproportionate share of medical school applicants. Another 26 percent identify as Asian, while 12.7 percent identify as Hispanic, and 11.3 percent identify as Black.

Those numbers aren’t entirely shocking considering that applying to and completing medical school isn’t exactly easy, especially for people from traditionally underserved backgrounds. Getting into medical school is a rich person’s game, data has suggested, with a 2022 JAMA Network Open research letter showing that, regardless of race, medical school matriculations were largely among those with high family incomes. This study corroborated that medical school matriculants are also more likely to be White.

Income can sway interest in medical schools for a lot of reasons. Perhaps most obvious is the question of medical school debt. Bankrate says that the average medical school debt is over $200,000. That’s a huge burden to carry for anyone and nearly impossible for someone whose family nets only $50,000 a year.

But income can influence medical school access in more discrete ways, as well. Take, for example, public school funding. Public schools in low-income areas are not as likely to have sophisticated STEM programming and lab space as their counterparts in high-income towns. And that is not to mention the gulf in STEM exposure in public versus private school settings.

All of those forces come together to create a Whiter, richer medical school student body and dampen potential diversity efforts for health systems seeking to build a workforce that’s more reflective of the community it serves, Clark suggested.

That’s where a partnership with Charles R. Drew University of Medicine and Science (CDU) comes into play.

In a deal with CDU, the only federally designated Historically Black Institution west of Texas which opened its doors to medical students a year ago, Sutter plans to create a pipeline for medical students from traditionally underserved backgrounds to complete their medical educations and begin careers at Sutter serving the very communities they come from.

“You don't just one day wake up as a college student and decide you're going to medical school,” Clark pointed out. “I really believe that that decision is made early. So, part of what we're trying to do is to create pipelines early on, so we have to reach high school students.”

“The more that we can expose young people, young people of color, to science and medicine and technology, getting them interested and exposed to healthcare professionals, I think we'll start to see more of them enter into the field,” he added.

CDU’s been doing this pathway work for decades, according to Deborah Prothrow-Stith, MD, dean and professor of medicine at CDU. CDU’s Saturday Science Academy has been in operation for 25 years, long before CDU had a medical school, and offers an eight-week program three times a year for kids pre-K through 12th grade.

“It's just this amazing exposure to science and lab science and biological sciences,” Prothrow-Stith explained in the phone interview. “And if a student in a year goes through all three of the eight-week sessions, then they have a little graduation where they get a white coat, and it's so cute.”

What can be a precious moment to be photographed and hung on the fridge can, ultimately, turn into serious gains for the medical industry, Prothrow-Stith said, outlining anecdotes about Saturday Science Academy kids growing up to be full-fledged doctors.

“We like to say, if you can see it, you can be it,” she said. “In opening the medical school and getting the support of some place like the Sutter Health System, we have an opportunity to not only have children see it and therefore know that they can become physicians, but it's also an economic engine in a neighborhood and in an area to open a medical school.”

Sutter and CDU’s partnership will extend beyond the pathways work CDU has been doing and help chip away at the financial barriers to medical school. Starting in the academic year 2024 and continuing for the next five years, Sutter will invest $7.5 million to provide five tuition-free scholarships. That’s a total of 25 scholarships.

“The offer is not just scholarships, but it's mentorship,” Clark added. “It is an opportunity to learn with us. We'll do that by offering clinical rotations and research opportunities. In other words, we're going to stay connected with every student throughout the life of their education.”

Ideally, those scholarships and mentorships will continue the pathway into medical residency, Clark suggested, although that’s not a requirement of the scholarships.

“My hope then is that they would come into one of our residency programs,” he noted. “It's their choice, but I think if we create a relationship with them, if we partner with them, I think the chances are higher that they'll choose to do their residency with us.”

Sutter knows its role in cultivating a diverse medical workforce extends way beyond that of benefactor. It also has to create a culture of safety and equity within its facilities to stem the tide of high residency attrition rates among racial/ethnic minorities.

In 2020, survey data showed that around a quarter of residents experienced some sort of discrimination based on their race or ethnicity. Black residents were the most likely to report as much. That level of discrimination may contribute to resident physicians leaving the field and not continuing their careers.

“We have to train more of our own, but it also means we have to retain them, too,” Clark acknowledged. “We recognize residents are not going to stay if they're not treated well or if they feel like they're working in an environment that isn't fair and just where they can't be themselves. And so, we're working even today to address those factors and reinforce fair and just culture in our environment.”

Sutter has started by hiring a chief diversity, equity, and inclusion officer. This person is in charge of creating a safer and more culturally competent environment that will ideally make for a better workplace for all staff members. The DEI efforts will also center on flagging issues of discrimination and developing corrective action plans.

Although this program is centered on the workforce, the ultimate goal is better patient care, Prothrow-Stith explained.

“This is a diversity that America needs in order to have authentic services for people, solutions that are achievable when a doctor is seeing a patient,” she said. “And the scholarship from Sutter is just an amazing boost for our students. They will be students from areas where Sutter serves. They will be students who are from families without a lot of resources, and they are students without a lot of resources.”

And, ideally, the program is going to outlast both of their tenures, Clark said.

“One of the things that I believe in is measuring success,” he concluded. “All of the students will graduate. They're all going to be doctors serving the patients who need us most, who need care the most. And so I am super excited and thrilled to be part of it, but we're just laying a foundation. Others will build on top of it.”