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Tuesday Sep 01, 2015

Key to Boosting Access Is Expanding the Pipeline

The University of California, Los Angeles’ softball team scored a verbal commitment last winter from a talented pitcher and power hitter. Recruiting success isn't anything out of the ordinary for such an elite program, but this particular story made national news because the athlete in question won't be joining the Bruins until 2019.

Why? She’s 13.

Aggressive and early recruiting is a growing phenomenon in college sports. The motives are multifactorial, but result in students who receive mentoring and generous scholarship offers to competitive colleges. That children need resources early in their lives to succeed is no surprise. Yet the level of zeal seen in athletics is missing when it comes to encouraging children to pursue an academic field.

© Errol Dunlap/Tour for Diversity in Medicine
Family physician Kameron Matthews, M.D., talks to students about careers in medicine during a Tour for Diversity in Medicine event. The initiative promotes medicine and dentistry to undergraduate students from racial and ethnic groups that are underrepresented in health care.

The Physician Shortage
Medicine, in particular, is facing a crushing doctor shortage that is expected to total as many as 90,000 physicians by 2025(www.aamc.org), according to the Association of American Medical Colleges. The Robert Graham Center for Policy Studies in Family Medicine and Primary Care estimates that by that time, there will be a shortage of 52,000 primary care physicians. The implications of this shortage pose a real health risk to patients who can’t get timely care, but it also threatens to drive up already astronomical health care costs as hospitals absorb patients who don’t have a primary care physician.

The overall dearth of physicians must be addressed, but it's also true that there are compelling reasons for the physician workforce to grow in diversity as well as overall size. Minority physicians are more likely to become primary care physicians who practice in rural and underserved areas(www.nejm.org), where physicians are desperately needed. Closing care gaps for underserved groups is a key to reducing prevalent health disparities. Infant mortality among black infants is still twice as high as among white infants. Hispanics are three time more likely to die from asthma than any other demographic group. Lesbian, gay, bisexual and transgender Americans have disproportionately higher rates of later-stage cancer diagnoses. Access to care is a factor in these health disparities -- as are implicit biases. A more diverse physician workforce could help address both issues.

The Road to Becoming a Physician
For many, the journey to becoming a physician consciously begins at the college level. But the opportunities for success -- advanced-level classes, ambitious after-school programs, and a knowledgeable team of teachers, parents and guidance counselors -- start much earlier. Academically rigorous classes teach core content but also critical thinking skills, writing, problem-solving and oral communication, which are leveraged in the medical school application process. Yet according to the U.S. Department of Education, a quarter of the public high schools with the highest percentage of black and Hispanic students do not have any algebra II courses and a third are without chemistry classes.

The financial barriers to attending medical school also start well before college. All too often, it's the students who are the most underprepared for standardized tests (because of inferior schools, low socioeconomic status, etc.) and who need help the most who can’t afford costly test prep courses. The extracurricular activities that cultivate skills colleges find so appealing also come with extra costs many families can’t afford, such as sports uniforms, music lessons or theater costumes.

Financial burdens also limit students’ abilities to participate in extracurricular activities and shadowing experiences that college and medical school admissions processes prioritize and require -- especially once those students hit working age -- because they may have to contribute to their family's income rather than spending time volunteering in a lab or shadowing a physician.

In addition to educational and financial inequality, students from lower socioeconomic backgrounds face a social capital gap. They often don’t know college graduates who can give them advice about writing a personal statement. They aren’t connected to medical students who can provide interviewing tips and guidance in developing the all-important curriculum vitae. And they certainly don’t have doctors in their social circle who can share with them the joys, pitfalls and intricacies of a career in medicine. They also are less likely to have their own primary care physician.

All told, it’s no wonder that 75 percent of medical students come from families who are in the top 40 percent of U.S. incomes.

The Potential in Pipeline Programs
The path to medical school is daunting. Medical organizations have taken note; already, various pipeline programs -- ranging from the middle-school level to colleges -- encourage the pursuit of medicine. Their focus tends to be on underrepresented minorities in medicine who face the biggest hurdles in becoming physicians. Programs such as the AMA's Doctors Back to School(www.ama-assn.org) use mentoring and role modeling as the foundation for success. The AAFP has developed its own version of this program, with a focus on primary care.

The Tour for Diversity in Medicine(tour4diversity.org) kicks off its round of fall tours in October. That initiative -- which is directed by a family physician and an emergency medicine physician and is supported by the AAFP -- promotes careers in medicine and dentistry to undergraduate students of racial and ethnic minorities who are underrepresented in health care.

I served as a counselor for a summer program, Phoenix Med-Start(diversity.medicine.arizona.edu), that connects high-school students to health care professionals and university-level classes. We spent weeks in medical workshops, learned anatomy with skeleton models, participated in interactive labs and engaged in global discussions about health care ethics, disparities and systems. Three of my students from that program are now completing residency, including two in primary care.

But as ambitious as they are, few pipeline programs can offer generous scholarships or guarantee a coveted admissions spot (unlike the world of sports recruiting). Given the many barriers, the Medical Schools Council, which represents medical schools in the U.K., said children should actually learn about the medical field far earlier, at age 7, to plant the seeds of interest and start overcoming the social hurdles into medicine.

Pipeline programs are growing, becoming longitudinal and targeting children earlier, and a key component of their success is physician involvement. Although it takes years to realize the impact of pipeline programs, they are the first step to solving the physician shortage.

So what can you do? Family physicians can talk to their young patients about what they’re interested in and follow up with those interested in medicine and related topics. We can offer to let them shadow in the office, serve as a role model and encourage them in general. Physicians can also seek out opportunities to talk to kids in our communities by offering to do a presentation at a school or youth organization.

The AAFP’s Doctors Back to School program includes a PowerPoint presentation that members can use and modify. It also has tips for reaching out to schools, news release templates to promote their visit and other resources.

The qualities patients cite in a good physician -- compassion, excellent listening skills, clear communication -- aren’t gained from a linear or easy path to medicine. It’s the tangents that can’t be taught that eventually lead to a great physician. We need people in medicine who have experiences that prompt them to be better advocates for their patients. Let’s find those people and give them a good head start.

Natasha Bhuyan, M.D., is a family physician in Phoenix. You can follow her on Twitter @NatashaBhuyan(twitter.com).

Posted at 02:00PM Sep 01, 2015 by Natasha Bhuyan, M.D.

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