Clearly AAMC minority studies are revealing. In many ways I consider rural students to face some of the same challenges, but the differences in intact families and neighborhoods are obvious differences. The following is taken from AAMC books X and XI taken from 1996 matriculants and 1997 graduates. These are comparisons of under-represented minorities (URM) compared to non-URM.
4 times as many URM took a magnet high school, 50% more did a summer lab, 38% (compared with 8% non-URM) did a summer academic program, and almost twice as many did post-Bacc for academic strengthening. Over recent years these figures show falling admissions for minorities, clearly a concern for the Black Caucus and for underserved urban communities. When compared to non-urm, reasons for a medical career were similar except 78% wanted to educate patients about health compared to 59% of non-URM. Regarding the place they selected, more were concerned regarding teaching methods, ability to place students in residency, availability of community experiences, financial support, and diversity of student body. Only 21% had no debt compared to 57% Non-urm. 50% of URM wanted to locate in an underserved area (compared to 20% although only 12% desired rural (compared to 20% of non-URM). Blacks with generalist career choices desired underserved areas 70% of the time (1997 graduates). 61% graduated in four years compared to 84 % non-URM (1996 grads) 98% still in school compared to 99% non-URM. 84% had a scholarship or grant compared to 50% non-URM
| Perceptions of medicine | URM | NonURM |
| Specialists are less important than primary care physicians | 49% | 40% |
| Access to care is still a problem | 78% | 56% |
| Everyone is entitled to adequate care | 83% | 66% |
| Physicians can influence health promotion/dis prevent | 67% | 56% |
| Physicians are obligated to care for the poor | 55% | 45% |
Those who took 6 or more years to complete medical school had much higher debts.
Personal reflection on East TN and UTMB Galveston - both had outstanding numbers compared to their competitors. East TN where I was for 4 years had a great but small black community in Johnson City that was incredibly supportive. This in the middle of white Appalachia. UTMB has had feeder enrichment programs for years that have stood the test of loss of affirmative action.
Overall, we clearly need more minority students for many reasons. There are costs and risks however.
Clearly we need more preparation programs for rural applicants.
Native Americans and other minority plus rural folks are in incredible need!
I always reflect on the tough match areas for FP, especially the south and feel that their is much ground to make up with programs that encourage black and rural students.
There are certainly concerns about getting the type of students that are likely to serve the underserved admitted to medical school. One concern may be that they may not be able to graduate. This is obviously difficult for them, given the debt they incur, but there are solutions. For example, those advising potential medical missionaries tell students to only take out half or less of the cost of living dollars. This is good advice since missionaries must be debt free before leaving for overseas. Public med school tuition plus $5000 debt with failure after a year is not insurmountable (private school debt is another thing and the cost of living at these locations is often higher, but in general private allopathic schools graduate fewer to underserved areas – WAMI study, upcoming Title VII studies). Medical schools who really want the right students could eat their tuition portion. Others could help students with payment plans. Another solution is convincing medical schools that graduating the right students that serve patients in underserved communities may protect them from future problems. Touting the few that graduated with the right stuff (as our medical school just did repeatedly with their 4 minority graduates) is worthless compared to a track record of physicians graduating and changing environments in communities in need.
I still feel that the real reason for failure to admit students at academic risk (rural, minority, etc.) is the potential to take up extra faculty time on
1. Admissions evaluations – really takes time to look over these students and verify service ethic, career potential, potential problem areas
2. Remedial time – takes time to advise and tutor, counsel etc., our FP dean of admissions takes significant hits here
3. Accreditation – more risky students mean more suspect accreditation, I doubt LCME looks at what the students were like before medical school,
just the results and not the progress.
4. Pressures for MD/PhD built by NIH and dean pressure, increasing rapidly
5. Extra time and stress for admissions chair and committee members to defend low GPA and MCAT number choices from high pressure parents – doctor and political figure’s kids who’s kids did not get in
There are ways to adapt again
1. Allow students more at risk to take the more challenging classes first as a prep to medical school. If they make it, then they are fully admitted and have one or two less courses to take the next year. Some combined BA/MD programs decompress the first year.
2. I still like the concept of a family medicine medical school where you admit 3 or 4 smaller classes a year. Who needs a match deadline if you are doing all of the training. Competence is the focus. If students have a problem (personal, educational), they just drop back 3 months and don’t lose a year.
3. Major support from all of department to get and keep good people on admissions committees.
I have learned something from the Health Professions List Serve that is similar to Mitch Jacques’ response. Several health advisors were incensed that students would be deceived and go down to Cuba (via Castro offer and Black Caucus response) for years with little chance of fulfilling their dreams. They cited lack of good health advising, the challenge of adapting to Cuba and Spanish, and then adapting back to the US ECFMG, etc. Nonetheless some of these students will make it and we will see lots of press about their success.
I guess my main concern is with people that say it cannot be done and don’t explore options. Admissions is the most important priority in Family Medicine right now. We must have the right kind of students for us and for medicine as we know it. Problem-solving complex situations is the heart of family medicine and this is so important to us that we cannot afford to give up easy. Some of these students should be in US medical schools, but are not. Our recent chief resident who was chief of all of the chief residents at UNMC was told that he should stay a paramedic. He did med school in Grenada. Others are like him and many are serving rural and underserved areas. Another like him turned an entire residency program around. Another was the best producing resident in terms of patients. In fact all of these were the top producing residents at their residency locations. Perhaps service and dedication is a characteristic that medical schools in the US do not value.
Another concern that I have is that medical school is increasingly not an option for those from the bottom levels of income. Studies in Canada have noted this and I would love to see similar studies in the US. Those coming from the lowest economic fraction were cut in half and debt is a major concern. Perhaps these studies in the US would reveal why those representing underserved populations are growing frustrated.
It would also be interesting to hear what people think about the teaching of the first two years. My thoughts are that they are poorly taught and students survive based on their intellectual capacities and ability to test well.
Robert C. Bowman, M.D, Interim Chairman
Rural Medical Educators Special Interest Group of the National Rural Health Association
UNMC Department of Family Medicine Director of Rural Health Education and Research
983075 Nebraska Medical Center Omaha, NE 68198-3075
(402) 559-8873 or fax at –8118 Email: rbowman@unmc.edu
http://www.unmc.edu/Community/ruralmeded/
Character, Color, Admissions, and Physicians
Minorities, Admissions, and Underserved
Characteristics of Rural Interested Medical Students