Delivering care to Delivering care to the underserved:the underserved:

Increasing the Numbers of Increasing the Numbers of Minority PhysiciansMinority Physicians

Ruben Gonzalez MDRuben Gonzalez MD

CCRMCCCRMC

ObjectivesObjectives

1)1) Barriers to providing health care to the Barriers to providing health care to the underserved underserved

2)2) Barriers to recruiting underrepresented Barriers to recruiting underrepresented minorities into medicineminorities into medicine

3)3) What we can learn about successful What we can learn about successful college-bound programscollege-bound programs

4)4) How we at CCRMC can helpHow we at CCRMC can help

Racial and Ethnic Racial and Ethnic Disparities in HealthcareDisparities in Healthcare

Institute of Medicine 2003Institute of Medicine 2003 Racial and ethnic disparities remain even after Racial and ethnic disparities remain even after

adjustment for socioeconomic differences and adjustment for socioeconomic differences and other healthcare access related factorsother healthcare access related factors

Differences in treatment are not due to clinical Differences in treatment are not due to clinical factors such as racial differences in severity of factors such as racial differences in severity of disease or overuse of services by whitesdisease or overuse of services by whites

Racial and ethnic minority patients are more Racial and ethnic minority patients are more likely to refuse treatments but this difference is likely to refuse treatments but this difference is small and do not fully explain healthcare small and do not fully explain healthcare disparitiesdisparities

Findings of Institute of Findings of Institute of Medicine continued…Medicine continued…

Many sources-including health systems, Many sources-including health systems, healthcare providers, patients and utilization healthcare providers, patients and utilization managers– may contribute to racial and managers– may contribute to racial and ethnic disparities in healthcareethnic disparities in healthcare

Bias, stereotyping, prejudice, and clinical Bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare uncertainty on the part of healthcare providers may contribute to racial and ethnic providers may contribute to racial and ethnic disparitiesdisparities

Summary of Summary of RecommendationsRecommendations

General RecommendationsGeneral Recommendations Increase awareness to general public and providersIncrease awareness to general public and providers

Legal, Regulatory and Policy InterventionsLegal, Regulatory and Policy Interventions Increase the proportion of underrepresented U.S racial Increase the proportion of underrepresented U.S racial

and ethnic minorities among health professionalsand ethnic minorities among health professionals Strengthen the stability of patient-provider relationships Strengthen the stability of patient-provider relationships

in publicly funded health plansin publicly funded health plans Health Systems InterventionsHealth Systems Interventions

Use of evidence-based guidelines, support community Use of evidence-based guidelines, support community health workers, support the use of interpretation health workers, support the use of interpretation services, structure payment systems to ensure adequate services, structure payment systems to ensure adequate supply of services to minority patientssupply of services to minority patients

Patient Education and empowermentPatient Education and empowerment Cross-Cultural Education in Health ProfessionsCross-Cultural Education in Health Professions

Importance of Importance of Underrepresented Minority Underrepresented Minority

ProvidersProviders 25% are underrepresented racial and ethnic 25% are underrepresented racial and ethnic

minorities (URM)minorities (URM)

Minority medical graduates represent 9% of the Minority medical graduates represent 9% of the country’s physicianscountry’s physicians 33.3% are African American, 40.1% are Asian 33.3% are African American, 40.1% are Asian

American, 24.9% are Hispanic, 1.8% are American American, 24.9% are Hispanic, 1.8% are American IndianIndian

Between 1990 and 1994 increase to 12% of total of Between 1990 and 1994 increase to 12% of total of URM due to Project 3000 by 2000.URM due to Project 3000 by 2000. Since then there has been a dramatic decline due Since then there has been a dramatic decline due

significant policy shifts regarding affirmative action significant policy shifts regarding affirmative action and higher education admissions proceduresand higher education admissions procedures

Importance of Importance of Underrepresented Minority Underrepresented Minority

ProvidersProviders

Racial concordance of patient and provider is Racial concordance of patient and provider is associated with greater patient participation in associated with greater patient participation in care processes, higher patient satisfaction and care processes, higher patient satisfaction and greater adherence to treatmentgreater adherence to treatment

Racial and ethnic minority providers are more Racial and ethnic minority providers are more likely than their non-minority colleagues to likely than their non-minority colleagues to Serve in minority and medically underserved Serve in minority and medically underserved

communitiescommunities Work in hospital-based practicesWork in hospital-based practices Work in FAMILY PRACTICE, ob/gyn, and Work in FAMILY PRACTICE, ob/gyn, and

pediatricspediatrics

Barriers to Recruiting Barriers to Recruiting URMURM

2005 Carrasquillo et al identified perceived 2005 Carrasquillo et al identified perceived barriers to enrollment of URM studentsbarriers to enrollment of URM students

1)1) Educational Preparation (e.g. MCAT scores)Educational Preparation (e.g. MCAT scores)2)2) Lack of Minority FacultyLack of Minority Faculty3)3) Lack of Minority Role ModelsLack of Minority Role Models

2007 Davidson et al found that for dental 2007 Davidson et al found that for dental students URM recruitment was enhanced bystudents URM recruitment was enhanced by

1)1) higher proportion of URM clinical facultyhigher proportion of URM clinical faculty2)2) ability to care for diverse groups ability to care for diverse groups

URM students suggest that summer enrichment URM students suggest that summer enrichment programs were the most effective tools used by programs were the most effective tools used by Medical schools to recruit studentsMedical schools to recruit students

College Success College Success ProgramsPrograms

Only 54% of recent high school graduates from low-Only 54% of recent high school graduates from low-income families pursue postsecondary education, income families pursue postsecondary education, compared to 88% of upper-income graduates.compared to 88% of upper-income graduates.

For Latino students, in 1976 they made up 36% of For Latino students, in 1976 they made up 36% of college-age students. In 1997 it was 35.8%, however college-age students. In 1997 it was 35.8%, however the Latino population had increased 200%.the Latino population had increased 200%.

Minority students today have a lower persistence, Minority students today have a lower persistence, graduation rates and levels of academic graduation rates and levels of academic preparednesspreparedness

College Success College Success ProgramsPrograms

Different theories of retentionDifferent theories of retention1)1) Tinto’s Student Departure TheoryTinto’s Student Departure Theory : academic integration and : academic integration and

societal integrations are key. “college as a rites of passage”societal integrations are key. “college as a rites of passage”

2)2) Culture integrity modelCulture integrity model: One develops ways of affirming, : One develops ways of affirming, honoring and incorporating the individual’s identity into the honoring and incorporating the individual’s identity into the organization’s culture organization’s culture

Different approaches used to increase acceptance and Different approaches used to increase acceptance and retention for URM.retention for URM.

1)1) Summer Bridge ProgramsSummer Bridge Programs

2)2) Developmental Education ProgramsDevelopmental Education Programs

3)3) Supplemental instruction ProgramsSupplemental instruction Programs

4)4) Mentoring ProgramsMentoring Programs

5)5) Culturally Conscious ProgramsCulturally Conscious Programs

Puente ProgramPuente 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 ProgramPuente Program

More likely to be eligible for the University of California More likely to be eligible for the University of California (19% vs. 6%)(19% vs. 6%)

83% rate of acceptance to 2 and 4 year college compared 83% rate of acceptance to 2 and 4 year college compared to 49% of all graduating high school seniorsto 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 Acceptance to UC increased 234% between 1999 and 20032003

Passage rate of exit examPassage rate of exit exam English: 96% vs. 69%English: 96% vs. 69% Math: 81% vs. 56%Math: 81% vs. 56%

Puente - CCRMC Puente - CCRMC Health PathwayHealth Pathway

Short term projectShort term project Creation of shadowing opportunities and Creation of shadowing opportunities and

volunteering opportunities for those interested in volunteering opportunities for those interested in health scienceshealth sciences

Long term projectLong term project Creation of a Puente-CCRMC health careers Creation of a Puente-CCRMC health careers

pathwaypathway Longitudinal program throughout four yearsLongitudinal program throughout four years of High schoolof High school Allow for exposures to different careersAllow for exposures to different careers in Health Carein Health Care Student Community Outreach Projects to Student Community Outreach Projects to encourage awareness of minority health issuesencourage awareness of minority health issues Resident/Faculty mentorsResident/Faculty mentors

THANK YOUTHANK YOU