Federal cuts gut programs for minority med school students

Experts say underserved patients will face additional access problems as fewer minority physicians move through the pipeline.

By Myrle Croasdale — Posted Sept. 25, 2006

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Tomas Acuna is among the last group of minority medical students to benefit from a federally funded program at the University of Arizona College of Medicine aimed to help minorities excel.

"It's taken me from being a questionable student, as far as my ability to survive in this competitive, fast-paced environment, to being a resource for other students," he said.

Cuts to Title VII funding have gutted Centers for Excellence grants sponsored by the Health Resources and Services Administration. The money supports programs that give financial support, guidance and academic tutoring to minority and disadvantaged students. The goal is to improve health care access in underserved communities by increasing the number of minority professionals qualified to provide care.

But by 2007, the grants will no longer exist, and leaders within medicine are concerned that the number of minority physicians, already tiny, will plummet further. In 2004 blacks made up 2.3% of total physicians, Hispanics 3.2%, Asians 8.3% and Native Americans and Alaska Natives 0.6%, according to the American Medical Association.

"As underrepresented minorities become a larger percentage of the population, if we don't find a way to bring them into the health care professions, we'll have a health care shortage," said Francisco García, MD, MPH, an ob-gyn and director of the Arizona Hispanic Center of Excellence at the university.

The cuts to end these grants came after the government had already reduced spending on pipeline programs. For example, it put $33.6 million into Centers for Excellence grants for 34 medical schools in 2005, dropping to $11.8 million for four centers in 2006. In a statement, HRSA said "other sources of funding through partnership linkages with private and corporate entities are available to provide support for health professions training. ... Analyses found that eight of every 10 providers that benefited from the ... program's long-term training support did not practice in shortage areas."

New research, however, shows postbaccalaureate programs, like the one Acuna attended, have been effective in getting underrepresented minorities and disadvantaged students into and through medical school.

A study in the Sept. 6 Journal of the American Medical Association looked at five, one-year postbac pipeline programs in the University of California system and found three times as many minority students from the programs entered medical school between 1999 and 2005 than did minority students in a control group.

"This is real hard evidence of the effectiveness of these programs," said study lead author Kevin Grumbach, MD, who is chief of Family and Community Medicine at San Francisco General Hospital and research director for the UCSF Center for the Health Professions.

Dr. Garcia certainly considered the University of Arizona's program a success.

Part of the HRSA grant funded a program where six to eight minority students were accepted into the medical school contingent on completing a year of intensive study to learn better test taking, studying and writing skills. The program also gave students more exposure to the sciences.

"It helped them get acclimated into the world of medical academia, so when they started [medical school] their likelihood of success was as good as anyone else's," Dr. Garcia said.

Out of a class of 110, these students made up a significant number of the minorities enrolled, he said.

Without the $500,000 grant, the postbaccalaureate program has closed. No other funding has been found to resurrect it or the other programs the grant supported, including a minority faculty development program and a pipeline program for high school and middle school students, Dr. Garcia said.

First-year University of Arizona medical student Rosalie Zhine attributes her entry into medical school to the postbaccalaureate program.

"I worked the entire time while I went to [undergraduate] school, and I couldn't pour my energy into my education and attain the scores I would have liked," Zhine said.

Programs like the one at Arizona are designed for students like Zhine, who've shown potential but don't have the scores typically needed to enter medical school.

She's disappointed that this door is now closed.

"There are so few Native American physicians out there," said Zhine, who is Navajo. "There are so many minority cultures that don't have enough medical professionals."

Dr. Grumbach said closure of such pipeline programs was discouraging for the future diversity of the physician work force.

"Without targeted programs like these, we will continue to slide farther and farther behind any hope of achieving a work force that resembles the ethnic and economic diversity of our population," Dr. Grumbach said. "The evidence is clear that minority physicians are much more likely to practice in high minority communities."

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Teach a student to study

Give underrepresented minorities and disadvantaged students a year of intensive training on how to take tests and study high volumes of material, along with clinical and research experiences, and they'll improve their chances of getting into and thriving in medical school. A study examining postbaccalaureate programs at the University of California's five campuses for the 1999-2000 to 2002-03 school years confirms what's been known anecdotally:

Postbac Controls
Number of students 265 396
Applied to med school by 2005 82.0% 65.0%
Accepted to med school by 2005 67.6% 22.5%

Source: "Effectiveness of University of California Postbaccalaureate Premedical Programs in Increasing Medical School Matriculation for Minority and Disadvantaged Students," Journal of the American Medical Association, Sept. 6.

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