Boosting Diversity

Texas Medical Schools Need More Minority Students

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Medical Education Feature - December 2005  

By  Ken Ortolon
Senior Editor  

The number of African-Americans and Hispanics graduating from Texas colleges and universities jumped dramatically during the 1990s. Even so, there was only a modest gain in the number of underrepresented minorities in Texas medical schools during the decade.

In fact, the percentage of underrepresented minorities in entering classes at the state's eight medical schools declined between 1996, when a federal court ruled in the Hopwood case that Texas colleges and universities could not use race and ethnicity as a factor in admissions, and 2004, when the U.S. Supreme Court reached the opposite opinion in a Michigan case.

Today, medical school enrollment of African-Americans, Hispanics, and other underrepresented minorities in Texas is less than 20 percent. Medical educators say Texas must do better in attracting minority students to medicine to solve minorities' problems with access to care and health disparities.

"It's absolutely essential if we are going to have an effective health care system that we see the diversity among health care providers that we see in the population itself for a variety of reasons," said Kenneth Shine, MD, executive vice chancellor for health affairs at The University of Texas System. 

Number Crunching  

The Texas Higher Education Coordinating Board says the number of African-American baccalaureate graduates increased 64 percent between 1992 and 2000, while the number of Hispanic graduates increased 93 percent. During the same period, however, the number of African-American students entering medical school increased only 58 percent, from 48 in 1992 to 76 in 2000. The number of Hispanic students entering medical school grew by less than 3 percent, from 152 to 156.

African-American and Hispanic enrollment in Texas medical schools peaked in 1996, then fell precipitously following Hopwood. While the numbers have risen since 1997, underrepresented minorities - Hispanics, African-Americans, and Native Americans/Alaska Natives - accounted for only 232, or 17 percent, of matriculants in 2004, compared with 255, or 20 percent, in 1996.

Harlingen pediatrician Stanley Fisch, MD, chair of Texas Medical Association's Council on Medical Education, says minority enrollment rates must increase dramatically if Texas is to meet the demands of its growing minority population. African-Americans and Hispanics already make up a majority of the state's population, and demographic projections indicate Hispanics alone eventually will account for more than 50 percent of the population.

"We need to have diversity in the [physician] workforce that reflects the diversity in the population," he said. "Studies have shown that where there is not that kind of diversity there are disparities in health care access and health status, through no one's fault but from the fact that we're out of sync with our patient population." 

Increasing the Pipeline  

Low minority enrollment is not a problem faced only by Texas medical schools. Statistics from the Association of American Medical Colleges showed that nationally Hispanics accounted for only 7 percent of medical school matriculants in 2004, while African-Americans made up only 6.5 percent and Native Americans were only 0.3 percent. Those groups make up approximately 25 percent of the total U.S. population.

In April, the Council on Graduate Medical Education issued 21 recommendations for increasing the proportion of underrepresented minorities in medicine and strengthening cultural competency among physicians. The first step toward reaching those goals, it said, is to increase the number of underrepresented minorities in the academic pipeline.

James Phillips, MD, senior associate dean of medical education and professor of pediatrics at Baylor College of Medicine, says that is a huge challenge for Texas.

"The biggest problem is the inadequacy of the public school system in all the major cities," he said. "Not only are they not getting the same level of education, they're not getting the same exposure and encouragement to try to go into those [health] fields."

Texas medical schools are attempting to tackle the academic pipeline issue by establishing programs designed to help minority high school and college students prepare for medical school admission.

The University of Texas Southwestern Medical Center in Dallas sponsors a seven-week Health Professionals Recruitment Exposure Program with the Dallas Independent School District to expose ninth- and 10th-graders to science and health careers. Baylor has programs sponsored with the DeBakey High School for the Health Professions, the University of Houston, and UT Pan American that guarantee admission and scholarships to students who maintain the required grade point average and Medical College Admissions Test scores. Texas Tech University Health Sciences Center sponsors a Summer Pre-Medical Academy for socially and economically disadvantaged students. And, the Texas A&M University System Health Science Center College of Medicine partners with Prairie View A&M University to create an Undergraduate Medical Academy. 

Beating the Competition  

Still, progress has been slow. Dr. Fisch says Hopwood's impact is still being felt, even though the Supreme Court decision involving the University of Michigan has freed state-supported schools to again consider race and ethnicity, among other factors, in admissions decisions. And, many of the brightest minority students are leaving Texas to attend medical schools that can offer more financial aid.

"Harvard and Stanford are looking for the same bright minority students that Baylor and UT Southwestern are," said Dr. Fisch. "And Harvard and Stanford can put a lot more scholarship money on the table."

Dr. Shine, former member of the Harvard Alumni Council, says that institution makes "incredible offers" to minority medical school applicants, including full tuition, employment opportunities, and financial aid for housing.

Texas schools are having some success. Dr. Phillips says minorities in Baylor's 2005 entering class hit 24 percent for the first time. And, minority applicants there have increased from 240 in 1993 to 753 in 2005.

"We have a long way to go before we have an appropriate diversity in our medical school population," Dr. Shine said. "We have to have more resources for financial aid, not just scholarships but financial aid that's broader than that. We need more in the way of work-study programs, particularly for undergraduates who want to go to medical school. A work-study program on campus is much more effective in keeping youngsters on the campus and graduating in a reasonable period of time than if they have to take a semester off to earn money and then come back."

Ken Ortolon can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at  Ken Ortolon.   


TMA Council Reevaluating Minority Enrollment Policy

The Texas Medial Association Council on Medical Education is evaluating whether to renew existing policy in support of minority recruitment efforts by Texas medical schools.

The policy on physician distribution and health care access, adopted by the House of Delegates in 1995, reaffirmed TMA support for Texas medical school efforts to recruit, enroll, and retain qualified underrepresented minorities. That policy is up for review under TMA House of Delegates rules that require policies to be reevaluated every 10 years.

The same policy also calls on Texas medical schools to increase their efforts to encourage students to enter primary care specialties, including family practice, general internal medicine, and general pediatrics.

The council heard an extensive presentation of minority enrollment trends at its meeting in May and began discussions on the physician distribution policy in September. Stanley Fisch, MD, chair of the council, says that in light of increasing shortages in other specialties, some council members felt the emphasis on primary care was no longer appropriate.

"Recognizing the demographics of the state and the demographics of the physician workforce, we want to craft a policy that recognizes that we need physicians really across the board, not only in primary care fields," Dr. Fisch said. "And we also need to encourage minority representation in all these fields of medicine."

The council likely will revisit the issue at its meeting in February. It can recommend that the House of Delegate retain, amend, or delete the policy. 

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