Questions from Government Agencies

and sources of info

1. Number of primary care physicians serving in medically underserved communities.

2. Number of primary care physicians completing Title VII funded programs who are serving in medically underserved communities.

Data on who is serving in high poverty level areas in some studies, the vague nature of medical underservice makes it difficult to determine.

3. Number of physicians who are underrepresented minorities and/or from disadvantaged backgrounds in the public at large. (I recognize that "disadvantaged backgrounds" is not defined – please do your best.)

Donald E. Pathman, MD MPH, Thomas R. Konrad, PhD, and Robert Schwartz, MA

This study assesses how local physician concentrations and distances to hospitals differ for rural communities of varying African American and Hispanic compositions. We used data at the town-area level (i.e., towns and their immediately surrounding minor civil divisions and census civil divisions) for nine Southern and six Western states, primarily for 1990. Data were from the US Census, American Medical Association, and American Hospital Association. Analyses compared nonmetropolitan town-areas with low, medium, and high proportions of African Americans and Hispanics on their local physician-to-population ratios and distances to nearest hospitals offering each of four levels of services. We found that Western town-areas having over 50% Hispanic populations had lower physician densities than other Western town-areas that were predominantly non-Hispanic white (24.2 vs. 31.2 physicians per 100,000 population). In Southern town-areas, physician densities did not co-vary meaningfully with the proportion of African Americans. Distances to the nearest hospitals offering basic, intermediate, and tertiary subspecialty services were generally 25% to 35% farther for Southern town-areas composed of over 60% African Americans and for Western town-areas composed of over 50% Hispanics, compared to communities with more than 80% non-Hispanic white populations within each region. These relationships were not due to confounding by extraneous state factors, but in some cases were explained by community socio-demographic differences other than race. Thus, we learned that rural communities with populations that are predominantly Hispanic but not those predominantly African American face longer travel distances to physicians; and both groups face longer distances to some types of hospital services than rural communities with few minorities.

An Issue Paper Prepared by the National Rural Health Association— April 2001

4. Number of physicians who are underrepresented minorities and/or from disadvantaged backgrounds in medical schools.

AAMC was pushing 3000 by 2000 or 3000 minority students admitted each year by the year 2000 or 3000 of the 16000 medical students graduating each year as URM. So far the numbers have only made it to 1700 and may fall if current litigation weighs.

5. Number of physicians who are underrepresented minorities and/or from disadvantaged backgrounds in faculty positions at the nation’s medical schools.

JAMA  issues have this kind of data at http://jama.ama-assn.org/issues/v284n9/rfull/joc91626.html

6. Number of primary care physicians who are underrepresented minorities and/or from disadvantaged backgrounds that have completed Title VII funded programs.

7. Any data or references on what the maximum potential of "proportion of persons who have a specific source of reliable, continuing healthcare". It is currently (2001 or 2002) at 86%. OMB sets a target at 96%. Is that realistic? What can it realistically advance to? What are the factors that would limit it?

More related items

COGME site regarding workforce at http://www.cogme.gov/resource_update.htm

COGME Tenth Report on Inner City and Rural http://www.cogme.gov/10.pdf

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 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.

Those who took 6 or more years to complete medical school had much higher debts.

More at site URL noted above

AAMC Files Brief in Support of University of Michigan Admissions Policy

Washington, D.C., February 17, 2003 - The Association of American Medical Colleges (AAMC), along with numerous healthcare-related organizations, will file a brief tomorrow in support of the University of Michigan in the Grutter v. Bollinger case, now before the Supreme Court of the United States. This case, one of two affirmative action cases being considered by the Court, challenges the University of Michigan's use of racial preferences in its law school's admissions policies.

As representatives of the nation's 126 medical schools, the AAMC argues in the brief that the medical profession must be able to consider race and ethnicity in selecting students in order to graduate a capable, effective physician workforce prepared to meet the needs of a diverse society. Without race-conscious admissions policies, medical schools would be unable to increase the number of minority physicians necessary to serve America and its ever-growing minority population, expand areas of academic research, and raise the general cultural competence of all physicians.

"A reasonable balance in the racial and ethnic composition of our nation's physician workforce is essential if we are to care for an increasingly diverse population. No alternative to affirmative action in medical school admissions exists for meeting that need," said AAMC President Jordan J. Cohen, M.D. "In ruling on the affirmative action cases now before it, the Supreme Court must provide a clear means for allowing the medical and health professions to fulfill their solemn societal obligation."

At present, virtually all medical schools take race and ethnicity into consideration during the competitive admissions process. The AAMC contends that if schools were to ignore the race of applicants the percent of students from underrepresented minority backgrounds would fall from the current level of 11 percent to no more than 3 percent of the student population of medical schools. This is at a time when African Americans, Native Americans, Mexican Americans and Mainland Puerto Ricans make up 23 percent of the United States' general population.

In its argument, the AAMC brief explains first why society has a critical need for more minority physicians. Some of the key reasons-

The brief goes on to point out how classroom diversity also helps to create physicians and health care managers who are both proficient and culturally competent.

"Only by encountering and interacting with others from different life experiences can students transcend their own viewpoint and see the world from a different perspective." (page 17, AAMC amicus brief, Grutter v. Bollinger)

Such awareness is an invaluable asset for physicians entering the workforce in the 21st century.

An additional key point examined in the AAMC brief is how reliance solely on academic credentials would dramatically decrease the number of minority medical students. Only very small percentages of underrepresented minority applicants score as well on the Medical College Admissions Test (MCAT®) and maintain as high a grade point average as the great majority of white and Asian applicants. The reasons for this are not clearly understood but may include: poorer quality schools available to many minority students; lower educational attainment of parents; and stereotypic attitudes that stifle academic achievement. Despite this reality, medical school admissions officers have been successful in identifying the qualities of mind and spirit minority applicants need to succeed as medical students and future doctors. Over 90 percent of the underrepresented minority students admitted to medical school graduate.