Delivering care to the underserved: Increasing the Numbers of Minority Physicians Ruben Gonzalez MD CCRMC

Objectives 1) Barriers to providing health care to the underserved 2) Barriers to recruiting underrepresented minorities into medicine 3) What we can learn about successful college-bound programs 4) How we at CCRMC can help

Racial and Ethnic Disparities in Healthcare Institute of Medicine 2003 Institute of Medicine 2003 Racial and ethnic disparities remain even after adjustment for socioeconomic differences and other healthcare access related factors Racial and ethnic disparities remain even after adjustment for socioeconomic differences and other healthcare access related factors Differences in treatment are not due to clinical factors such as racial differences in severity of disease or overuse of services by whites Differences in treatment are not due to clinical factors such as racial differences in severity of disease or overuse of services by whites Racial and ethnic minority patients are more likely to refuse treatments but this difference is small and do not fully explain healthcare disparities Racial and ethnic minority patients are more likely to refuse treatments but this difference is small and do not fully explain healthcare disparities

Findings of Institute of Medicine continued… Many sources-including health systems, healthcare providers, patients and utilization managers– may contribute to racial and ethnic disparities in healthcare Many sources-including health systems, healthcare providers, patients and utilization managers– may contribute to racial and ethnic disparities in healthcare Bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare providers may contribute to racial and ethnic disparities Bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare providers may contribute to racial and ethnic disparities

Summary of Recommendations General Recommendations General Recommendations Increase awareness to general public and providers Increase awareness to general public and providers Legal, Regulatory and Policy Interventions Legal, Regulatory and Policy Interventions Increase the proportion of underrepresented U.S racial and ethnic minorities among health professionals Increase the proportion of underrepresented U.S racial and ethnic minorities among health professionals Strengthen the stability of patient-provider relationships in publicly funded health plans Strengthen the stability of patient-provider relationships in publicly funded health plans Health Systems Interventions Health Systems Interventions Use of evidence-based guidelines, support community health workers, support the use of interpretation services, structure payment systems to ensure adequate supply of services to minority patients Use of evidence-based guidelines, support community health workers, support the use of interpretation services, structure payment systems to ensure adequate supply of services to minority patients Patient Education and empowerment Patient Education and empowerment Cross-Cultural Education in Health Professions Cross-Cultural Education in Health Professions

Importance of Underrepresented Minority Providers 25% are underrepresented racial and ethnic minorities (URM) 25% are underrepresented racial and ethnic minorities (URM) Minority medical graduates represent 9% of the country’s physicians Minority medical graduates represent 9% of the country’s physicians 33.3% are African American, 40.1% are Asian American, 24.9% are Hispanic, 1.8% are American Indian 33.3% are African American, 40.1% are Asian American, 24.9% are Hispanic, 1.8% are American Indian Between 1990 and 1994 increase to 12% of total of URM due to Project 3000 by Between 1990 and 1994 increase to 12% of total of URM due to Project 3000 by Since then there has been a dramatic decline due significant policy shifts regarding affirmative action and higher education admissions procedures Since then there has been a dramatic decline due significant policy shifts regarding affirmative action and higher education admissions procedures

Importance of Underrepresented Minority Providers Racial concordance of patient and provider is associated with greater patient participation in care processes, higher patient satisfaction and greater adherence to treatment Racial concordance of patient and provider is associated with greater patient participation in care processes, higher patient satisfaction and greater adherence to treatment Racial and ethnic minority providers are more likely than their non-minority colleagues to Racial and ethnic minority providers are more likely than their non-minority colleagues to Serve in minority and medically underserved communities Serve in minority and medically underserved communities Work in hospital-based practices Work in hospital-based practices Work in FAMILY PRACTICE, ob/gyn, and pediatrics Work in FAMILY PRACTICE, ob/gyn, and pediatrics

Barriers to Recruiting URM 2005 Carrasquillo et al identified perceived barriers to enrollment of URM students 2005 Carrasquillo et al identified perceived barriers to enrollment of URM students 1) Educational Preparation (e.g. MCAT scores) 2) Lack of Minority Faculty 3) Lack of Minority Role Models 2007 Davidson et al found that for dental students URM recruitment was enhanced by 2007 Davidson et al found that for dental students URM recruitment was enhanced by 1) higher proportion of URM clinical faculty 2) ability to care for diverse groups URM students suggest that summer enrichment programs were the most effective tools used by Medical schools to recruit students URM students suggest that summer enrichment programs were the most effective tools used by Medical schools to recruit students

College Success Programs Only 54% of recent high school graduates from low-income families pursue postsecondary education, compared to 88% of upper-income graduates. Only 54% of recent high school graduates from low-income families pursue postsecondary education, compared to 88% of upper-income graduates. For Latino students, in 1976 they made up 36% of college-age students. In 1997 it was 35.8%, however the Latino population had increased 200%. For Latino students, in 1976 they made up 36% of college-age students. In 1997 it was 35.8%, however the Latino population had increased 200%. Minority students today have a lower persistence, graduation rates and levels of academic preparedness Minority students today have a lower persistence, graduation rates and levels of academic preparedness

College Success Programs Different theories of retention Different theories of retention 1) Tinto’s Student Departure Theory : academic integration and societal integrations are key. “college as a rites of passage” 2) Culture integrity model: One develops ways of affirming, honoring and incorporating the individual’s identity into the organization’s culture Different approaches used to increase acceptance and retention for URM. Different approaches used to increase acceptance and retention for URM. 1) Summer Bridge Programs 2) Developmental Education Programs 3) Supplemental instruction Programs 4) Mentoring Programs 5) Culturally Conscious Programs

Puente Program Writing Counseling Mentoring Methodologies Puente has pioneered include: 1)Linking an academic program to the local community; 2)Integrating culturally relevant literature into the core curriculum; 3)Creating small learning communities that foster academic success; 4)Working in cross-disciplinary teams; 5)Successfully teaching students reading and writing in untracked, mixed-skills classes.

Puente Program More likely to be eligible for the University of California (19% vs. 6%) More likely to be eligible for the University of California (19% vs. 6%) 83% rate of acceptance to 2 and 4 year college compared to 49% of all graduating high school seniors 83% rate of acceptance to 2 and 4 year college compared to 49% of all graduating high school seniors More likely to enroll in four year college (43% vs. 24%) More likely to enroll in four year college (43% vs. 24%) Acceptance to UC increased 234% between 1999 and 2003 Acceptance to UC increased 234% between 1999 and 2003 Passage rate of exit exam Passage rate of exit exam English: 96% vs. 69% English: 96% vs. 69% Math: 81% vs. 56% Math: 81% vs. 56%

Puente - CCRMC Health Pathway Short term project Short term project Creation of shadowing opportunities and volunteering opportunities for those interested in health sciences Creation of shadowing opportunities and volunteering opportunities for those interested in health sciences Long term project Long term project Creation of a Puente-CCRMC health careers pathway Creation of a Puente-CCRMC health careers pathway Longitudinal program throughout four years Longitudinal program throughout four years of High school of High school Allow for exposures to different careers Allow for exposures to different careers in Health Care in Health Care Student Community Outreach Projects to Student Community Outreach Projects to encourage awareness of minority health issues encourage awareness of minority health issues Resident/Faculty mentors Resident/Faculty mentors

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