AAMC Reporter: July/August 2015

By Elena V. Rios, MD, MSPH, President and CEO, National Hispanic Medical Association

As the founder, president, and CEO of the National Hispanic Medical Association (NHMA), I have worked since 1994 with a core group of other founders and supporters who believe we can make a difference by building the leadership not only of NHMA but also of its foundation, the National Hispanic Health Foundation (NHHF), and our NHMA Fellows. For more than two decades we have supported federal health policy reform, including health care workforce policies that will increase the number of Hispanic physicians and other health care professionals to broaden access to health and wellness in our communities.

Fifty years of funding from the federal government, foundations, and academia have been critical to the diversity of the health care workforce, especially for medical schools’ underrepresented students (African-American, Hispanic American/Latino American, and Native American), but major challenges remain. There are many reasons for this, including poor academic preparation and counseling of students, lack of understanding that medical education can be a sound financial investment, and lack of minority role models in higher education and medical education. 

According to AAMC data, in 2014, 1,230 Hispanic, Latino, or Spanish students (6 percent of the total) matriculated to medical school while 928 had graduated in the previous class—a number that has basically stayed the same since 1987 when graduating Hispanic medical students numbered 975. In addition, studies show that Hispanic health professionals are more likely to care for Hispanic patients and those covered by Medicaid.

The U.S. Department of Health and Human Services (HHS) recently announced that the Affordable Care Act (ACA) has resulted in 16 million newly insured Americans, many of whom are poor and minority. Thus, one would think that Congress would have increased the investment in diversity health care workforce programs, but this did not happen.

The U.S. Census Bureau reports that Hispanics now comprise the largest minority group at 50 million or 17 percent of the population, projected to become 31 percent by 2060. African-American and Native American groups will remain about the same as today, at 15 and 2 percent, respectively. In addition, Census projections show that in 2018, the U.S. population under age 18 will be a majority non-white group, and by the year 2044, the total population will be majority non-white.

What many call the “new America” deserves renewed attention to developing policies for a larger health care workforce that culturally and linguistically can provide high-quality preventive health and wellness services as well as related research that can build knowledge for health programs targeted to Hispanic populations. Federal programs such as the Health Careers Opportunity Program (HCOP), Centers of Excellence (COE), and Area Health Education Centers (AHEC) have supported underrepresented undergraduate and younger students in health career pathways, while programs such as Primary Care Scholarships and the National Health Service Corps provide incentives for medical students to work in underserved communities.

In June 2009, the Josiah Macy Jr. Foundation supported the NHHF in convening a group of 25 African-American and Hispanic medical leaders and developing recommendations to strengthen Title VII diversity programs, such as HCOP and COE, and other programs. The group proposed:

•     Funding mentoring and support services that advise current minority K–12 and college students as a cohort

•     Funding collaborations between high schools community colleges, universities, and medical schools in a region and create health care professions pathways

•     Improving accountability at the highest levels of the university with boards of trustees, deans, and senior faculty taking on the diversity agenda

•     Developing a new metric to gauge community effectiveness and measure medical diversity’s impact on a community

•     Including the health workforce in the White House Executive Order establishing the Department of Education Programs for Educational Excellence for African-Americans and Hispanics

•     Including HCOP with the new ACA proposed primary care retraining of the health workforce

In November 2013, the Josiah Macy Jr. Foundation again supported the NHHF at the President’s STEM Initiative and Diversity in the Healthcare Workforce Summit. Speakers met with 40 African-American and Hispanic medical leaders to discuss the Obama administration’s development of a diversity agenda for STEM policies. The group recommended:

•     Increasing STEM education of underrepresented students and developing mentoring pathways to medicine

•     Supporting collaboration among Hispanic-serving institutions and historically black colleges and universities and their partner institutions and medical schools

•     Improving coordination of STEM initiatives to enhance efforts to build pre-medical student pathways at all education levels, with a national center to support and share models

As we respond to the president’s call to action to improve the STEM achievement of America’s students over the next decade, we must ensure that medicine and other health care professions are recognized as STEM disciplines. Moreover, programs and initiatives must reach groups that are underrepresented in the health professions.

The NHMA has advocated for these recommendations, as well as best practices in underserved communities.  Given the increased demand for health care services as more Americans become insured under the ACA, there is a critical need for training underrepresented students in medicine and other health professions. NHMA has been working with Rep. Ruben Hinojosa (D-Texas), who introduced the legislation that created the Department of Education HSI and HSI STEM program, to educate congressional staff as they debate higher education. Our fundamental message is that federal HSI STEM programs should be expanded to facilitate mentoring and scholarships to increase the pool of community college and state university students who will become matriculants to medical school.

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