Relationship of Diversity to Outcomes UCLA INTERNATIONAL MEDICAL GRADUATE PROGRAM: At the Crossroads of Education & Health Michelle Anne Bholat, MD, MPH Professor & Vice Chair UCLA Dept. of Family Medicine Executive Director UCLA International Medical Graduate Program Patrick T. Dowling MD, MPH Associate Director UCLA International Medical Graduate Program Diversity Research Conference UCLA Law School June 22, 2012

Why UCLA IMG?  Need + Limited Resources  Trade-Offs & Tensions  UCLA IMG Model & Outcomes

Shortage of Doctors Proves Obstacle to Obama Goals USA currently short 16,000 Primary Care Physicians California Short 17,000 physicians by 2015! Robert Pear; NY Times pg A1 April UC Vice President for Health Affairs 2006

Distribution of U.S. Population by Race/Ethnicity, 2010 and 2050 Pop. 310 million 2010 Pop. 439 million 2050 SOURCE: Kaiser Family Foundation, based on U.S. Census Bureau, 2008

Diversity – LA County Country of Origin, Foreign Born Country% Pop.Country%Pop Mexico 43 Korea 4.4 America,C 12 Iran 3.0 China 6.3 Vietnam 2.7 Philippines 6.1 Taiwan 1.9 Armenia 1.6

A Case for Diversity in the Physician Workforce  Increases access to underserved  Advances cultural competence among all  Increases patient satisfaction/trust  Broadens research agenda with respect to racial/ethnic disparities. -IOM“In the Nation’s Compelling Interest”, 2004

Barriers Linguistic Barriers (LEP)= Risk  Among LEP Hispanics + an interpreter, only 70% fully understood what the doctor was saying  61% LEP Hispanics uninsured compared to 36% EP Hispanics, 30% African Americans and 20 % NH Whites  LEP + Uninsured = ‘double burden’ as 2/3rds lack a usual source of health care Doty, MM Commonwealth Fund

Leaks in the Educational Pipeline: Percent Obtaining College Degree by Race/Ethnicity, 2009 Level of Education WhiteBlackHispanicAsian High School BA/BS U.S Census, Educational Attainment, 2009 * Excludes NA and PI

U.S. Medical School Graduates Race/Ethnicity, Medical School Class Source: American Association of Medical Colleges

Hispanic Graduates California Medical Schools, 2011 Medical SchoolsHispanic Graduates Total Graduates Allopathic - MD Private (3) 44 (10.5%)420 Allopathic-MD UC (5) 70 (11%)635 Ostepathic - DO Private (2) 18 (4.5%)404 1 TOTAL(10) 132 (9.7%)1,459 AAMC: Data Warehouse: Student file 1/9/ DO 2007data

Migration of Physicians to the U.S. National Geographic Dec. 2008

The Global Physician Pipeline: International Medical Graduates (IMGs)  1,950 medical schools and 350,000 graduates/year  US has relied on IMGs for 40+ years  Staff safety net hospitals/waivers to serve in underserved communities

IMGs as a percentage of the U.S. physician workforce

America’s IMG Physicians Country of Origin

Why so Few IMGs from Latin America?  Language of instruction is rarely English  Unfamiliar with U.S. physician training process  Bias against F-1 (Student Visas) despite J-1 waivers  U.S. Medical Licensing Exams (3) + Prep. Courses  Cost of living

Race/Ethnicity of Practicing Physicians Compared to Population California, 2010, N= 94,631 Sources: AMA Physician Masterfile, 2010; Medical Board of California, 2010

Why UCLA IMG?  Need + Limited Resources  Trade-Offs & Tensions  UCLA IMG Model & Outcomes

Trade-Offs & Tensions  Latinos – not an undifferentiated population  All UCLA IMGS share a common language but differences exist in class, country and experiences.

 External Brain Drain?  Internal Brain Waste?  Internal Tension? Trade-Offs & Tensions

 Borders & Loans  State Medical Boards

Why UCLA IMG?  Need + Limited Resources  Trade-Offs & Tensions  UCLA IMG Model & Outcomes

Identify & recruit bilingual/bicultural IMGs The UCLA IMG Model 1

Identify & recruit bilingual/bicultural IMGs 2 Provide intensive instruction and clinical observership The UCLA IMG Model

Identify & recruit bilingual/bicultural IMGs Provide intensive instruction and clinical observership Standardized, competency- based curriculum

Identify & recruit bilingual/bicultural IMGs Provide intensive instruction and clinical observership Standardized, competency-based curriculum Scalable & Replicable

Identify & recruit bilingual/bicultural IMGs Provide intensive instruction and clinical observership Standardized, competency-based curriculum Scalable & Replicable Targeted to Family Medicine

Identify & recruit bilingual/bicultural IMGs Provide intensive instruction and clinical observership Standardized, competency-based curriculum Scalable & Replicable Targeted to Family Medicine Integrated with UCLA medical graduate education

Identify & recruit bilingual/bicultural IMGs Provide intensive instruction and clinical observership Standardized, competency-based curriculum Scalable & Replicable Targeted to Family Medicine Integrated with UCLA medical graduate education Tailored for Family Medicine Residency Programs

Identify & recruit bilingual/bicultural IMGs Provide intensive instruction and clinical observership Standardized, competency-based curriculum Scalable & Replicable Targeted to Family Medicine Integrated with UCLA medical graduate education Tailored for Family Medicine Residency Programs Acculturation to US healthcare system and medical care culture

Identify & recruit bilingual/bicultural IMGs Provide intensive instruction and clinical observership Standardized, competency-based curriculum Scalable & Replicable Targeted to Family Medicine Integrated with UCLA medical graduate education Tailored for Family Medicine Residency Programs Acculturation to US healthcare system and medical care culture Place IMG grads into Family Medicine Residencies 3

Secure contractual commitment Identify & recruit bilingual/bicultural IMGs Provide intensive instruction and clinical observership Standardized, competency-based curriculum Scalable & Replicable Targeted to Family Medicine Integrated with UCLA medical graduate education Tailored for Family Medicine Residency Programs Acculturation to US healthcare system and medical care culture Match IMG grads into Family Medicine Residencies 4

California’s Future Physician Workforce Needs  Only 16 of California’s 54 Counties meet minimum population to PCP ratio  In 2014, 4.2 million out of a total of 7 million uninsured Californians will receive health insurance

Hispanics are under- represented in the physician workforce in California

54 and Counting: UCLA IMG graduates placed in Family Medicine Residencies in underserved California communities,

IMG Graduate Matches, Natividad/Salinas2 Stanislaus/Modesto2 Kern/Baskersfield2 Hanford/Loma Linda4 UCSF/Fresno6 San Joaquin1 Kaiser/Fontana1 Riverside County7 Glendale Adventist2 Presbyterian/Whittier2 UCLA Family Medicine8 USC/CA Hospital8 Pomona Valley4 Northridge Hospital1 UCSD2 Naval Hospital1 JM/Miami1 TOTAL 54

Health Disparities “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” -Dr. Martin Luther King, Jr.

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