Addressing the Needs for Rural Minority Health Providers

I would encourage you and other health advisors to develop programs that work with all types of minority students; not just the more easily accessed urban group, the gifted intellectuals, or those from upper socioeconomic groups. Across the south (and other regions) there is a great need for minority docs in rural areas. We know from the literature that medical students from lower socioeconomic groups and those that have a service orientation are more likely to become generalists (Madison, study at UNC Chapel Hill). We also know that you must recruit students from small towns to get rural outcomes after graduation. Whether this research applies to minority students is unknown. Appropriate studies to guide your efforts are not readily available, but I implore you to ask the AAMC for help in your effort. I hope that your project can shed some light in these areas.

If you want references for such a program, they do not exist. No one has attempted rural plus minority or done it long enough to publish. My research on family practice programs demonstrates that the programs most likely to graduate rural physicians are the ones with the least % of minority residents in the program. AAMC data shows that minorities are more likely to choose underserved practice locations (40% vs 10%). AAFP data shows that more FP graduates are choosing urban poverty locations (from 2% to over 6% of graduates over a decade). These changes may be a reflection of more minorities and more females in the programs. Rural numbers are steady or declining in FP graduates.

Society's primary reasons for prioritizing minorities involve issues of socioeconomic equality and culturally-sensitive care. It does not make sense to recruit for such a program as you propose from a pool that may be upper income or distanced from the underserved cultures that we all hope to serve better. We should also not fall into the trap of recommending this approach for minorities alone. Upper income students from mainstream cultures are less likely to go into specialties and locations where they are needed.

Studies are needed to demonstrate that minorities from upper socioeconomic groups are more culturally sensitive than graduates who are not minority or a different minority.

Clearly the combination of rural and minority is a challenge, but why develop a program that is likely to crowd more practitioners into physician-rich urban settings?

I challenge you to go past the easily accessible urban students and those from parents in higher socioeconomic situations to choose students who are more likely to become generalists, choose serving careers, and relocate to small towns.

Points to ponder:

Why should a Native American spend 11 years away from the tribe to learn about traditional American Medicine, only to come back to the tribal culture where healers that do not deal with the spiritual realm are regarded as the lowest class of health care or healing?

What if the State of Texas (or any state) had required fluency in Spanish as a requirement for medical school entrance? How would that have impacted relationships between ethnic groups, secondary education, individual students, the admissions pool, and health care in the state for generations?