Why We Need Physicians and Dentists of Color

In Seen, Heard, Reflected: A Look Into CA’s Teacher of Color Shortage report, we shed light on the growing racial and ethnic disparities between California’s teaching workforce and its students. Continuing the troubling trend around underrepresentation in crucial fields, the racial and ethnic disparities presented in that report mirror what we’re also seeing in the medical profession.

For example, in California, despite being one of the most racially and ethnically diverse states in the country, our health workforce and student populations attending medical or dental school currently do not reflect the diversity of the state’s population (Figure 1). Overall, Black, Latinx, and Native American physicians, dentists, and other healthcare professionals are underrepresented.

In addition, the COVID-19 pandemic has taken a disproportionately heavy toll on Black, Latinx, Native American, and Asian communities– amplifying the long-standing racial and ethnic inequities that pervade our healthcare system and highlighting the urgent need for culturally and linguistically appropriate care. Racial and ethnic health-related inequities are further exacerbated by the lack of diversity in health professions. Research demonstrates that a diverse healthcare workforce leads to tangible benefits for patients. Patient trust, satisfaction, buy-in for preventative care, and overall health outcomes are improved when patients are seen by physicians of the same racial-ethnic group, culture, social status, and/or speak the same native language.¹ We see similar trends in education, where research shows numerous benefits to students who have a same-race teacher.²

3, 4, 5, 6
Note: “Other” includes the following racial-ethnic categories: Native Hawaiian or Pacific Islanders, Two or More Races, Nonresident, Unknown, or Other.

By the numbers:

• California’s population of Latinx people is 40% yet only 11% of CA medical students and 6% of CA physicians are Latinx.⁷
• If medical school enrollment and completion rates do not change, it will take nearly 500 years to close the gap between Latinx and White physician rates in California.⁹
• While 7% of Californians are Black, only 2% of the state’s dentists are Black.¹⁰
• Nationally, 17% of Black medical students and 50% of Black dental students graduate with over $300,000 in debt – more than any other racial group.¹¹
• 1.3% of the U.S. population is Native American. However, only 0.1% of the dental workforce is Native American.¹³
• While Native Americans make up 1.7% of Californians, only 0.1% of medical students in the state are Native American. Specifically, of the 6,629 medical school students across the state, only 7 identified as Native American in 2021-22.¹⁵
• 7 million Californians live in Health Professional Shortage Areas – areas that have a shortage of primary, dental, or mental health care providers. The vast majority of Californians in these areas are Black, Latinx, and Native American. Shortages are most severe in the San Joaquin Valley, the Inland Empire, Los Angeles, and many rural areas.¹⁶

Legend
Medically Underserved Areas

Map Source: Health Resources & Services Administration “Medically Underserved Areas/Populations”  The map has an option to “Show Table” for those interested in exporting the data.

Education-related challenges to diversifying the pipeline for medical and dental professionals

• Proposition 209 (1996), which banned affirmative action, contributed to decreases in racial/ethnic diversity among medical and dental school applicants and continuing students.
  ¹⁷
• Underrepresented students too often face challenges accessing experiences or resources valued in the medical or dental school admissions process such as quality K-12 STEM education, standardized test preparation (MCAT and DAT), medical or dental internship opportunities, and effective mentorship.^{17, 19}
• Aspiring physicians and dentists from underrepresented backgrounds lack access to holistic, sustained, pre-health advising pathways that are shown to be beneficial.^{20, 21}
• Underrepresented students oftentimes face psychosocial challenges that disrupt their entrance and persistence in the health professional pathways.^{22, 23} Psychosocial challenges can include fear of failure²⁴, stereotype threat – anxiety about perpetuating a negative stereotype ascribed to their racial/ethnic group²⁵ – or fixed mindsets – the belief that intelligence is innate rather than something that can grow and expand. ²⁶
• The high cost of a college education deters underrepresented students from otherwise being interested in medicine and oral health.^{27, 28}
• Too many (60 percent) of California’s medical students enroll at out-of-state schools. In fact, California has one of the lowest medical school enrollments per capita in the country.²⁹

Opportunities and recommendations for increasing diversity in the health professions

• In addition to consideration of academic records, medical schools should adopt holistic review processes in medical school admissions that better account for student context, perspectives, and non-cognitive attributes. ³⁰ Moreover, educational institutions should ensure that all admissions committee members, faculty, and pre-health advisors participate in training that addresses implicit bias and prepares them to partake in holistic review.
• Higher education leaders should uplift and adopt legal and evidence-based, race-conscious outreach and retention strategies so that more underrepresented groups gain access to health profession career pathways. Retention strategies should include student-centered, culturally sensitive, and holistic academic advising that provides students with the academic, career, and psychosocial supports necessary to effectively navigate and persist in rigorous health professional pathways.
• The state legislature should increase investments in and expand health workforce pipeline programs that effectively support underrepresented students with academic enrichment, career development, mentorship, and advising, such as the Health Career Opportunity Program (HCOP) and the CA Medicine Scholars Program.³¹ K-12 and postsecondary institutions should also develop innovative partnerships with healthcare organizations that provide underrepresented students access to career exposure, internships, enrichment activities, and professional mentors.
• Post baccalaureate programs prepare college graduates to pursue professional health education and are effective at increasing the admission rates for underrepresented students.³² Higher education leaders, state education agencies, and other pertinent stakeholders should collaborate to increase the number of affordable and accessible post baccalaureate positions, giving priority to underrepresented students.
• State education agencies and higher education leaders should develop and expand service-contingent scholarships and loan repayment programs that prioritize underrepresented students to reduce financial barriers and attract underrepresented students, particularly those in medically underserved areas.³³ These programs should empower underrepresented students to pursue careers in needed health professions and financially support them when they return to serve in their communities.
• Developing new medical schools in medically underserved communities – like efforts at UC Merced in the San Joaquin Valley and at Charles R. Drew University in South Los Angeles – could increase and diversify enrollment.³⁴ Educational institutions should also consider developing three-year medical education programs, like that at UC Davis, to reduce the cost of medical education and debt for underrepresented students while also supporting quicker entry into the medical workforce.

“Bright spot” increasing diversity in health professional pathways

The Aspiring Physicians Program (APP) is an undergraduate premedical career preparation program designed by the University of California, San Francisco School of Medicine Latinx Center of Excellence (LCOE) to increase the number of Latinx and Black physicians in California.³⁵ LCOE APP provides Latinx and Black undergraduate students at two public state universities, California State University, San Francisco and Fresno, with support and mentorship through an intensive summer program and ongoing support and advising during the academic year. In addition to a summer stipend, the program offers participating students the opportunity to engage in activities that build their academic, career, and psychosocial preparation for medical school, including medical school preparatory workshops, health policy workshops, MCAT preparation, individualized and long-term mentorship and advising, exposure to clinical career exploration, and training in stereotype threat, implicit bias, and imposter syndrome. As of December 2021, nearly 90% of the program’s students who applied to medical school were admitted.³⁶ Moreover, students note that their participation in the program has prepared them to better understand their pathways to, through and beyond medical school.

Sources

“Meeting the Demand for Health: Final Report of the California Future Health Workforce Commission.” California Future Health Workforce Commission, February 2019. https://futurehealthworkforce.org.

Carver-Thomas, D. (2018). Diversifying the teaching profession: How to recruit and retain teachers of color. Palo Alto, CA: Learning Policy Institute. https://learningpolicyinstitute.org/product/diversifying-teaching-profession-report

“Quick Facts: California.” US Census Bureau, 2021. https://www.census.gov/quickfacts/fact/table/CA/PST045221

Private Tabulation. “U.S. Dental School Applicants and Enrollees, 2021 Entering Class.” American Dental Education Association, 2021. https://www.adea.org/publications-and-data/data-analysis-and-research/applicants-enrollees-and-graduates.aspx

Private Tabulation. “Total Enrollment by U.S. Medical School and Race/Ethnicity (Alone), 2021-2022.” Association of American Medical Colleges, 2020. https://www.aamc.org/data-reports/students-residents/interactive-data/2020-facts-enrollment-graduates-and-md-phd-data  

Private Tabulation. “U.S. Dental School Applicants and Enrollees, 2021 Entering Class.” American Dental Education Association, 2021. https://www.adea.org/publications-and-data/data-analysis-and-research/applicants-enrollees-and-graduates.aspx

Private Tabulation. IPEDS 2019-2020 – selected 161 CA degree-granting institutions (primarily baccalaureate or above), included variables for: Graduation rate data for bachelor’s degree-seeking cohort, by race/ethnicity: Aug 31, 2020. https://nces.ed.gov/ipeds/SummaryTables/report/812?templateId=8120&year=2020&expand_by=0&number_or_percent=0&tt=aggregate&instType=

Coffman, Janet, Emmie Calimlim, and Margaret Fix. “California Physicians: A Portrait of Practice.” California Health are Foundation, March 2021. https://www.chcf.org/wp-content/uploads/2021/03/PhysiciansAlmanac2021.pdf

Hsu, Paul, Yohualli Balderas-Medina Anaya, and David E. Hayes-Bautista. “5 Centuries to Reach Parity: An Analysis of How Long It Will Take to Address California’s Latino Physician Shortage.” UCLA Latino Policy and Politics Initiative, October 2018. https://latino.ucla.edu/wp-content/uploads/2019/06/AltaMed-Policy-Brief-2.pdf.

“Oral Health Workforce and Education in California.” Healthforce Center at UCSF, 2020. https://healthforce.ucsf.edu/publications/oral-health-workforce-and-education-california

Toretsky, Christopher, Sunita Mutha, and Janet UC Coffman Healthforce Center at San Francisco. “Reducing Educational Debt Among Underrepresented Physicians and Dentists.” Healthforce Center at UCSF, 2019. https://healthforce.ucsf.edu/publications/reducing-educational-debt-among-underrepresented-physicians-and-dentists

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U.S. Census Bureau. (2021). Quick Facts: California, Race and Hispanic Origin. https://www.census.gov/quickfacts/fact/table/CA/PST045221

Private Tabulation. “B-5.1, Total Enrollment by U.S. Medical School and Race/Ethnicity (Alone), 2021-2022.” Association of American Medical Colleges, 2020. https://www.aamc.org/data-reports/students-residents/interactive-data/2020-facts-enrollment-graduates-and-md-phd-data

“Meeting the Demand for Health: Final Report of the California Future Health Workforce Commission.” https://futurehealthworkforce.org/wp-content/uploads/2019/03/MeetingDemandForHealthFinalReportCFHWC.pdf

Alana Pfeffinger, Alicia Fernández, Manuel Tapia, Francine Rios-Fetchko, and Janet Coffman. “Recovery with Limited Progress: Impact of California Proposition 209 on Racial/Ethnic Diversity in Medical Schools”, (Healthforce Center at UCSF, December 2020) https://healthforce.ucsf.edu/publications/recovery-limited-progress-impact-california-proposition-209-racialethnic-diversity

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