Annals of Family Medicine Research

Community Colleges Hold Key to Family Medicine Diversity

July 18, 2018 08:43 am Sheri Porter

Health care leaders and policymakers across the country have long maintained that a robust primary care workforce is the best way to provide high-quality, continuous and affordable health care to a growing and diverse U.S. population.

[group of young college students]

It's also no secret that family medicine owns a bigger chunk of the primary care pie than any other specialty.

When combined, those factors provide an enticing backdrop for newly published research in which authors make the case for utilizing America's community college system to help fill the primary care pipeline with future family physicians.

Authors of the article -- titled "Community College Pathways to Medical School and Family Medicine Residency Training"(www.annfammed.org) and published in the July/August Annals of Family Medicine -- began by acknowledging that prior research showed community college attendance "provides a viable pathway for students to pursue a career in medicine and ultimately become primary care physicians," and that "strengthening the community college pathway may increase the diversity and supply of the U.S. primary care physician workforce."

Story Highlights
  • Authors of new research published in Annals of Family Medicine conclude that U.S. medical school graduates who attend community college are more likely to train in family medicine than in any other specialty.
  • A good percentage of community college students are black, Latino or Asian /Pacific Islander.
  • Promoting the community college pathway to medical school could create a more culturally diverse physician workforce, particularly in family medicine, that more closely matches the U.S. population.

But authors took those positive associations one step further when, after evaluating their research findings, they concluded that U.S. medical school graduates who attended community college were more likely to train in family medicine than in any other specialty.

Authors point out that more than 7 million -- about 40 percent -- of all undergraduate college students attend community college, and a good proportion of those attendees are black, Latino or Asian/Pacific Islander -- the same ethnic groups most underrepresented in the demographic makeup of U.S. physicians.

That's an important point, because recognizing and promoting the community college pathway to medical school will, in time, create a more culturally diverse physician workforce that more closely matches the U.S. population.

Author Insight

Lead author Efrain Talamantes, M.D., M.B.A., M.Sc., is associate director of the Internal Medicine Residency Program and associate director of the Center for Reducing Health Disparities at the University of California, Davis, School of Medicine in Sacramento.

Editorial Stresses Importance of Diverse Physician Workforce

Research findings(www.annfammed.org) recently published in Annals of Family Medicine suggest that America's community colleges already serve as a pathway for students to enter medical school and to continue on to training in family medicine residency programs. An accompanying editorial titled "Building a Pipeline to Equity,"(www.annfammed.org) discusses the importance of these findings to the U.S. health care system.

In an interview with AAFP News, Talamantes attributed his passion for the topic in part to his work as co-director of the UC Davis Center for a Diverse Healthcare Workforce. "We were interested in investigating the contributions that community college pathways to medical school make to the health care workforce, and specifically to primary care," he said.

"Family physicians make up the largest percentage of primary care physicians," said Talamantes. That, coupled with the fact that medical students with community college experience are more likely to come from underrepresented backgrounds and more likely to enter family medicine when compared to students without such experience," should make this topic particularly insightful to AAFP members, he added.

Findings indicate that the community college setting "represents an important yet undervalued asset to promote health equity for our patients," said Talamantes.

In fact, he added, "after adjusting for known demographic confounders, attending community college made it more likely for a medical graduate to enter family medicine residency -- and this finding did not hold for any other specialty."

Study Methods

Researchers analyzed data gathered from Association of American Medical Colleges files on 50,791 residents who graduated from M.D.-granting medical schools between 2010 and 2012. The final cohort consisted of 43,382 U.S. medical school graduates (USMSGs).

Authors defined undergraduate college pathways as attended community college during high school, attended community college before transferring to a four-year university, attended community college after graduating from a four-year university or post-baccalaureate, and never attended community college.

The primary outcome measure was graduate medical education residency training -- family medicine versus other residency specialty programs.

Researchers identified residency selection during the second postgraduate year to avoid including physicians who changed their specialty after the first year of residency.

Additional Research Highlights

Of the 43,382 USMGs from 2010-2012, 25.9 percent attended community college at some point in time.

A total of 3,787, or 8.7 percent, of those 43,000-plus USMGs trained in family medicine, and of that group, 1,298, or 34.3 percent, attended community college.

Regarding race/ethnicity among the 3,787 USMGs trained in family medicine,

  • 12.6 percent identified as black,
  • 11.4 percent as Latino,
  • 10.3 percent as multiple race,
  • 9.2 percent as white, and
  • 5 percent as Asian.

In addition, 59.3 percent of family medicine residents were female; 13.2 percent were first-generation college students.

Authors noted that among family medicine residents, 32.7 percent of whites, 35.2 percent of Asians, 50.8 percent of Latinos and 32.7 percent of blacks who were first-generation college graduates attended community college.

"Nurturing early interest in family medicine during high school and community college may be a strategy to increase the supply and diversity of the primary care physician workforce in the United States," they added.

"Our study's findings highlight the need to reassess the the importance of community college attendance in the medical school admissions processes as a potential means to ameliorate the primary care shortage" authors concluded.

Author and family physician Amanda Kost, M.D., M.Ed., of Seattle, summarized the content of her editorial for AAFP News. "Medical schools must do more to produce a physician workforce that reflects the patients we serve, and reaching back into the pipeline to partner with community colleges to help increase diversity among physicians is one way of meeting that obligation," said Kost.

She added that doing so would make an impact on both students and patients. "Medical school must be accessible regardless of student background, just as we aspire to have health care be accessible to patients of all backgrounds."

Related AAFP News Coverage
Family Medicine Reaches New High in 2018 NRMP Match
Target Set for 25 Percent by 2030

(3/16/2018)

GME System Not Meeting Nation's Physician Workforce Needs
AAFP Researchers Crunch the Numbers

(10/4/2017)

Additional Resource
Annals of Family Medicine: Estimating the Residency Expansion Required to Avoid Projected Primary Care Physician Shortages by 2035(www.annfammed.org)
(March/April 2015)