Can minority students change medicine's racial imbalance?
WINSTON-SALEM, N.C. — Eight of Melissa Cornett’s 10 children want to be doctors.
The oldest, at 29, hopes to become a family physician; the youngest, who’s “almost 9,” wants to be an ER doctor.
Although they all have endured the typical bumps, bruises, and medical crises of childhood, they’ve only ever met two doctors who were black, like them.So this past Tuesday, Cornett, a certified nursing assistant, brought six of her children to Winston-Salem State University to hear from the Tour for Diversity in Medicine, an initiative started by a group of black and Latino doctors, dentists, pharmacists, podiatrists, and students to help minority students navigate the graduate school application process.
For five days, members of the tour travel between US cities and try to help others follow in their footsteps.
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The Cornett children came out feeling encouraged. It’s unfortunate that there aren’t more black doctors, said Sean, 23. But at the same time, he said, “I know it is possible.”
Other young African-Americans might not share his optimism. Just 5 percent of US doctors are black, even though African-Americans account for 12 percent of the US population. Hispanics and Native Americans are even more underrepresented, research shows.
That may mark more than a simple failure to diversify the ranks of medical professionals; it could also be bad for public health.
Studies have repeatedly shown that underrepresented minorities are more likely to follow medical recommendations when their doctor looks like them. A diverse workforce also improves medical care for people who are traditionally underserved, including the elderly, those who live in rural areas, and minorities.
The challenge is figuring out how to get more minorities into the field.
“I really think it’s a leaky pipeline from the very beginning, all the way until the very end,” said Dr. Joseph L. Wright, a professor and chair of pediatrics at Howard University College of Medicine. Minority children don’t see many doctors, dentists, or pharmacists who look like them. In school, they often miss out on learning test-taking skills, he said.
“I have become convinced that we really must ratchet back to a much earlier stage of trying to fix the leaky pipeline,” Wright said.
That’s what brought Melissa Cornett and her family to Winston-Salem the other day. She said she’s always encouraged her kids to “aim high.” The path to becoming doctors might not be easy for them. But, she added, “It is definitely a doable path.”
On a state-by-state basis, the numbers can be staggering.
In Texas, for instance, Hispanics make up 38 percent of the population but only 8 percent of doctors. In Georgia, one of every three residents is African-American, and yet African-Americans make up only 13 percent of doctors there.
Experts say the situation for aspiring doctors is likely to get worse before it gets better.
While medical schools have increased their enrollments to forestall an impending shortage of doctors, the number of residency slots hasn’t grown at the same pace — meaning an increasing number of medical school graduates won’t get the training they need to advance their careers.
Students with less traditional backgrounds, underrepresented minorities often among them, could face even steeper odds as competition tightens.
The racial and ethnic imbalance is even more acute in academic medicine, research shows, and minorities are vastly underrepresented in research studies — potentially compromising their results.
Experts say the only medical schools that have succeeded at expanding their diversity are the ones that expressly work at it, taking steps like paying to bring interviewees to campus, instead of requiring them to pick up their own travel costs.
John Matsui, who runs the University of California at Berkeley’s Biology Scholars Program, which helps underrepresented minorities thrive in college science majors, said students of color drop out of entry-level undergraduate science courses like chemistry and organic chemistry at higher rates that whites.
“We spend so much time getting them to college and then they get blown up that first year,” Matsui said.
Advisers at schools like Berkeley will look at the transcripts of students who got a C in chemistry and tell them to give up on their dream of medicine — which Matsui thinks is the wrong approach. Instead, he said, with tutoring and mentoring, many of those same students can go on to thrive in higher-level courses.
“A lot of the barriers are attitudinal, and they’re structural in terms of how we grade, what we expect from students from the get-go,” said Matsui.
Where are all the men?
The Tour for Diversity runs two five-day bus tours a year. The aim is to bring minorities who have successfully navigated the process of applying to medical, dental, pharmacy, and podiatry schools to meet with young people in places such as Winston-Salem, where drive and talent far outstrip role models and concrete advice.
Audiences always skew largely female. Tour members have noticed it since their first talk, five years ago. At Hampton University in Hampton, Va., on Monday, there were at least 20 females for every male. Tuesday’s smaller audience at Winston-Salem State included a handful of men and a few dozen women and girls.
Fewer black men applied to medical school in 2014 than in 1978, according to the Association of American Medical Colleges. Blacks are the only racial or ethnic group where women vastly outnumber men in medical schools, according to a recent report by the same organization.
Wright, the Howard University professor, said he spoke last weekend to a group of high school freshman interested in the health professions — and even at that age, the group was 75 percent female. “The gender gap is evident early on,” he said, suggesting that programs need to start reaching black boys in middle school, if not earlier.
Tour members talk about this gender gap on their bus rides between cities. Why aren’t there more black men showing up? What can they do to change the situation?
The men on the tour make a particular point to reach out to those who do attend.
Dr. Brandon Henry, the tour’s assistant director, said he had no idea how to proceed once he decided he wanted to become a doctor. As an athlete, he was always taught to get by on the least amount of schoolwork. “I didn’t read a book until I was 25,” he said. It took him seven years to graduate college.
In July, Henry, now 35 and a graduate of Howard University College of Medicine, will start a one-year “dream” sports medicine fellowship at Baylor University in Waco, Texas. He will serve as the team doctor for Baylor, as well as a local community college and high school. He practically bounces with enthusiasm describing the post.
He said he has to believe that his own small steps — volunteering for the tour, being a role model outside of entertainment and sports — make at least a little difference.
“We’ll get there, I’m hoping,” he said, breaking into a grin. “Days like these, these are momentum. They can be wasted if you don’t capitalize on them, but we try to capitalize on them.”
Keep bouncing back
Italo Brown was determined to get into medical school. Unfortunately, for a long time it seemed that medical schools were determined not to accept him.
The first year, Brown sent applications to 63 medical schools (the fees for some of which run as high as $188) and got 63 rejections. A year later, he sent out another 63 applications and got another 63 rejections.
The following year, something clicked and he boosted his Medical College Admission Test (MCAT) scores by 10 points. He also earned a master’s degree from the Boston University School of Public Health and took science classes at Harvard University to boost his GPA.
More focused, he sent out 13 applications. He got 13 rejections.
He called his parents for solace and his dad, a firefighter, answered the phone. “I ran into burning buildings for 30 years. All you’ve got to do is read,” Brown recalls his father saying. “I said, ‘let me talk to mom.’”
Shortly after that, Brown got a call from Meharry Medical College in Nashville, Tenn. Someone there had noticed his persistence. Would he like to attend their post-baccalaureate program that nearly guaranteed entrance into their medical school? He got the offer on a Thursday. By the following Monday, Brown had moved to Nashville to start classes.
Now, he’s an emergency room physician.
He’s also part of the Tour for Diversity. Last week, during a lunch break, he talked with two young men in the audience. “It’s going to be rough,” he warned them. “You’re going to see more women than men in every room you’re in.” But perseverance pays off. Now that he’s made it, Brown said, his experience gives him more credibility. People respect him.
He still has to work at it, though, Brown added later. He neatly pulls back his dreadlocks and controls his tone of voice to ensure he doesn’t come across as what he described as a stereotypical “angry black man.” As with many doctors of color, Brown said he struggles with imposter syndrome — they’ve gotten so many messages that they don’t belong in medicine that it’s sometimes hard to convince themselves that they do.
Brown said he doesn’t view these extra demands as a burden. He sees them as his “superpower.” He’s overcome challenges that his white counterparts haven’t had to face. He’s become stronger.
'We are so conservative'
As part of the tour, professionals who have been through the interviewing process at medical schools coach students on how to best sell themselves. Everyone needs a 30-second pitch about themselves and what makes them special, they said. If you don’t have one yet, ask someone who loves you to “brag on you,” suggested Dr. Love Anani, an emergency room physician in Tennessee.
The tour guides talked to students about how to write a compelling personal statement, manage their time well, improve their study skills, and find ways to fund their education.
They also talked about physical appearance.
Dr. Tyree Winters, a quiet-spoken osteopathic pediatrician, who comes from a family of academics and medical professionals, said there’s bias even among African-Americans about what a doctor should look and dress like.
“We are so conservative when it comes to certain things,” he told the group.
Winters, now on the admissions committee at Rowan University School of Osteopathic Medicine in New Jersey, said he’s always willing to argue on behalf of a student who looks neat and presentable, and doesn’t think students should straighten or change their hair to meet someone else’s standards of acceptability. But he asked the students to meet him halfway, by not dying their hair crazy colors or dressing too fashion-forward.
“We need you to be our partners in this,” he explained.
Dr. Ciera Sears, now an internal medicine specialist in Dayton, Ohio, recalled wearing long sleeves to cover the tattoos snaking up her right arm, and her smallest nose ring, for her medical school interview. Though she’s proud of how she looks, Sears didn’t want those ornaments to define her.
But Sears said that even after she thought she’d “made it,” life hasn’t been as easy as she would have hoped. Her first day working as a doctor, carrying $340,000 in debt from medical school, “somebody confused me for the help,” she told the audience in the final question and answer session of the day.
“I wish somebody had told me that you put in all this hard work, but once you get to residency it’s going to be even harder, and you’ve got to prove to people that you deserve to be there, despite the fact that you’ve got these letters behind your name.”Blacks are accepted to medical school at lower rates than whites or other minorities. Research by the AAMC shows that 44 percent of white medical school applicants are accepted, compared with 42 percent of Asian and Latino applicants and just 34 percent of black applicants.
That’s why the tour aims to reach those students. Some of the schools the tour visits are historically black, like Hampton, Winston-Salem State, and Tougaloo College in Mississippi, where the tour wound up last Friday.
“There’s something to be said for meeting students where they are,” said tour cofounder Dr. Alden Landry, an emergency room physician and assistant professor at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston. “These are students who are often overlooked.”
Landry said he knows that a one-day visit won’t solve medicine’s diversity problem. But at least he hopes to provide a road map for students who might otherwise be lost.
Oscar Reyes drove two hours from Boone, N.C., to Winston-Salem to attend Tuesday’s session. By the end of the day, the Appalachian State senior said he was feeling more confident about his chances of getting into medical school. He works at an outpatient clinic at a correctional facility in his spare time and hopes to go into correctional medicine, so he realized he has a good story to tell about himself to the admissions committees.
“I definitely feel more sure of my application,” he said as the one-day program wound down. “It’s definitely lit a fire.”
(Photo courtesy Tour For Diversity in Medicine)