Juan Jose Guerra is now an obstetrician and gynecologist at Kaiser Permanente in Oakland, Calif. But when he was going to medical school in the 1980s, he got little encouragement to do so.
“I battled through college, I did not have the highest grade point average. On one occasion I was told not to go to medical school by my pre-med advisers,” he says, adding: “I would not be here if I listened to them.”
Guerra wanted to be a doctor not because of an interest in science but because he wanted there to be more Spanish-speaking physicians. As a seven-year-old, he accompanied his grandfather, an alcoholic with a host of medical problems, to the doctor where he had to serve as an interpreter.
Now a new report by the Greenlining Institute looking at who’s going to medical school in the University of California system suggests that future generations of Californians will be facing the same kind of problems Guerra faced as a boy. The doctors of tomorrow don’t match up to the diversity of the state today.
Even if the universities start accepting only Latinos, African Americans and Native Americans, it would take 38 years to just match the population trends says Hector Javier Preciado, the director of health policy of Greenlining Institute which issued the report.
“The report looks at underrepresented minorities of California’s population — Latinos, African Americans and native Americans. That group combined (represents) 40 percent of the population of the state of California and it is only 20 percent of the student population of the University of California’s medical school system,” says Preciado. While Asians as a whole are not underrepresented in the system, Preciado says it’s important to realize that the aggregated number for Asians might mask under representation among certain Asian groups such as Hmongs and other Southeast Asians.
While underrepresented minority enrollment has been increasing steadily since 2001, the representation gap still persists, say researchers. The disparity between the representation of African Americans, Latinos, and Native Americans in the U.C. student body and their representation at U.C. medical schools is growing, because their rate of increase in the population outstrips their increase in medical school enrollment, researchers say. For example, in 2007 only 9.6 percent of the applicants in a U.C. medical school were Latinos, and 14 percent who were accepted were also Latinos. Only 4.6 percent of the applicants were African American, the same as the percentage of the African American enrollees. As for Native Americans, the percentages were 0.2 percent and 0.3 percent only.
Preciado denies that universities were filtering out candidates from these groups. He points out that until 1996, minority representation on U.C. campuses was a lot higher. But with the passage of Proposition 209, a ballot initiative that effectively ended affirmative action programs in the state, U.C. schools also ended affirmative action on their campuses.
“What happened is the steep decline in the number of the minorities getting into the medical school. Prop 209 punched the major hole in that pipeline,” says Preciado. “And a lot of people did not get to the point where they could be physicians, or where they could enter the medical school.”
The problem is that the pipeline leading up to medical education is very constricted. Changes should begin at the elementary school level and continue into high school.
Of course, there is no guarantee that increasing the number of underrepresented minorities in medical school will mean those doctors are bilingual. But Preciado says language isn’t the only issue when it comes to wanting diversity in a body of doctors. At the core of the issue is what has been referred to as cultural competency and quality care.
“The physician and patient relation is a very intimate one and as you would imagine one would feel more comfortable and more inclined to be honest about one’s health if there was a rapport, and we know that cultural similarities help establish that,” Preciado says.
He adds that it has also been well-documented that like Dr. Guerra, medical students from underserved groups, once they become doctors, are more likely than anyone else to be willing to serve in areas with higher minority populations where the need is the greatest.