If the United States is serious about diversifying its health care workforce, then medical schools can't afford to overlook campuses where many students from underrepresented minorities and low-income families get their start in higher education.
Welcome to America's community colleges.
That was the overall conclusion from authors of a study titled "Community College Pathways: Improving the U.S. Physician Workforce Pipeline." The study recently was published online(journals.lww.com) ahead of print by the journal Academic Medicine.
Lead author Efrain Talamantes, M.D., M.B.A., told AAFP News that he and his co-authors set out to discover the role community colleges play as a pathway to medical school admission. The primary outcome measure was acceptance to a U.S. allopathic medical school or medical scientist training program (MSTP). Additional outcome measures were students' plans to practice in an underserved community or to work primarily with minority populations.
Understanding that learners use community colleges in a variety of ways, researchers defined four community college pathways:
- attendance during high school,
- attendance before moving to a four-year university,
- attendance after graduating from a four-year university and
- no community college classwork.
In this setting, students who attended community college after high-school graduation were considered "traditional" students.
- Students who attended community college after high school were less likely to gain entrance into medical school than students who studied at a community college during high school, after college graduation or never at all.
- Researchers found that those same students were more likely to say they intended to practice in underserved communities or focus on minority populations.
- As a group, Latinos led other ethnic groups in community college attendance, and given population projections, authors noted the need to increase Latino representation within the physician workforce.
Talamantes, an internal medicine physician, is a National Research Service Award Scholar in the Division of Internal Medicine and Health Service's Research at the University of California, Los Angeles. He said the community college research was done with the blessing of the Association of American Medical Colleges (AAMC), which administers the Medical College Admission Test.
"This study shows that students are getting into medical school from the community college pathway and that is hugely important. Many of those who are getting in are minority students and the first in their families to go to college," Talamantes added.
However, researchers also found that students in one particular pathway -- those who graduated from high school and then attended community college before they transferred to a four-year university -- were less likely to be accepted into medical school when compared with those in the other pathways.
Specifically, authors noted that 17,518 students (out of 40,491 applicants) matriculated into medical school in 2012; of that total, 4,920 used one of the community college pathways. So overall, 11 percent of those who matriculated attended community college during high school, and 12 percent attended community college after graduating from a four-year university.
However, only 5 percent of those accepted into medical school attended community college after high-school graduation. Importantly, researchers discovered that those same students were more likely to say they intended to practice in underserved communities.
For purposes of the study, the research team analyzed the AAMC's 2012 matriculant and applicant files, as well as the Matriculating Student Questionnaire, to find associations between student characteristics and participation in a community college pathway. Students who attended community college after high school "likely grew up in underserved communities, and their exposure to a more resource-limited environment may have reinforced their future practice intentions," wrote the researchers.
They concluded that it could be more difficult for those students to get into medical school or an MSTP because of "limited premedical opportunities at nonresearch institutions, other socioeconomic status-related challenges, or a perception, whether it is accurate or not, they are not as academically well-prepared as students who only attend four-year colleges or universities."
Study authors noted that in 2010, 44 percent of U.S. undergraduate students -- some 8 million learners -- were enrolled in one of the country's 1,600 community colleges.
And a majority of those students came from low-income families.
That same year, community college enrollment broke down as 52 percent white, 17 percent Latino, 15 percent black, 5 percent Asian and 11 percent unreported. Notably, the percentage of Latinos attending community colleges had almost doubled since 1992.
Community colleges "serve as a principal higher education attainment pathway for many low-income and underrepresented minority students," wrote the authors.
On the other hand, they noted, the majority of U.S. medical students "have parents with graduate levels of education and incomes in the top quintile of all America families," with a median parental income of $115,000 reported in 2012.
The researchers called medical school cost a "strong deterrent for potential applicants with lower parental income." They also pointed to "disparities in educational attainment and academic preparedness" as possible explanations for demographic trends among medical school matriculants.
As for the ethnic composition of medical school applicants between 1977 and 2012, data show that
- Asians increased from 2.6 percent to 23 percent,
- Latinos increased from 2.6 percent to 8.7 percent,
- blacks increased from 6.4 percent to 8.1 percent,
- American Indians and Alaska Natives decreased from 0.33 percent to 0.25 percent, and
- whites decreased from 88 percent to 60 percent.
"Today, blacks and Latinos make up 13 percent and 17 percent of the U.S. population and constitute 6 percent and 5.5 percent of the physician workforce, respectively," wrote the authors.
Looking to the Future
The authors noted that more Latinos used community college pathways to matriculate to medical school in 2012 than any other ethnic group. "Given the population projections, there is a huge need to increase the pool of qualified Latino medical school applicants to ensure adequate representation within the physician workforce," they wrote.
The authors pointed out that in the past three decades, the U.S. community college sector had accounted for nearly all the growth in the country's higher education system. They suggested that community colleges would continue to be an affordable option for millions of Americans.
"Although many medical school recruitment and outreach efforts are strictly targeted at four-year universities, ample opportunities may exist to support CC (community college) students pursuing careers in medicine," wrote the authors.
Talamantes said the AAMC had responded positively to the research. "The AAMC is developing a task force specifically to ensure that medical schools have more formal relationship with their community colleges," he said.
Family Physician Connection
Personal experience drives Talamantes' interest in this topic. He took community college classes while in high school to help satisfy the requirements he needed to get into a four-year university.
Talamantes had this message for family physicians who have a passion for mentoring and are invested in helping to fill the primary care workforce pipeline.
"If you are a family physician thinking about succession planning or leaving a legacy behind, what better way than to help train a student who is already is in the community and committed to serving that community?" said Talamantes.
One final note: Talamantes revealed the name of his mentor, family physician Gerardo Moreno, M.D., of Los Angeles, who also served as the anchor author for this study.
Related AAFP News Coverage
'Four Pillars' Blueprint Charts Course for Physician Workforce Reform
Academic Medicine: "The Community College Pathway to Medical School: A Road Less Traveled"(journals.lww.com)
(July 29, 2014)