The medical work force must become more diverse. UCSF program aims toward that goal
As rising second-year medical students in the UCSF San Joaquin Valley (SJV) program for medical education (PRIME), we spent time during our first year learning how structural racism propagates health-care inequities. Now, we’re seeing structural racism in action with the confluence of the COVID-19 pandemic and unjust murders of Black individuals.
The more than 3.4 million COVID-19 infections in the U.S. are disproportionately affecting Black, indigenous, and people of color (BIPOC). Black and Latinx individuals comprise 45% of the California population, but account for 59% of COVID-19 cases and 53% deaths. The chronic conditions that worsen COVID-19 outcomes and essential worker status, and increase infection risk, are more prominent among BIPOC due to limited health care access, poverty, and environmental racism.
We are at a breaking point for change to reduce health-care inequities by diversifying the health-care workforce. A Black female physician can best understand the racism, mistrust, and fear faced by a Black pregnant mother seeking prenatal care. A Latinx physician can best understand and mitigate the cultural dynamics when suggesting it may be time for a Latinx family to put their loved one in a nursing home. Equitable care is best given by providers who look like and may have shared experiences with their patients.
In California, having racial, ethnic, and/or language concordant providers is difficult for Black and Latinx patients, where practicing physicians identify as white 32%, Asian/Pacific Islander 28%, Latinx 5%, and Black 3%, in contrast to the state’s makeup of white 39%, Asian/Pacific Islander 14%, Latinx 38%, and Black 6% individuals.
To increase health-care workforce diversity, we can ensure that BIPOC children, beginning in elementary school, have safe and nurturing learning environments. Students cannot be subjected to racial biases, especially when BIPOC students already face increased barriers.
Alejandro Alejandrez, who grew up in Madera, was deemed unmotivated by teachers for not completing homework. No one inquired about his difficulties with a 180-minute round-trip commute to school. Additionally, there was no one to assist with homework, as his parents were monolingual Spanish speaking, worked full-time, and had little educational opportunities.
Like Alejandrez, many BIPOC students don’t have the privilege of parents mentoring their scholastic journey. In the Fresno Unified School District, only 20% of Blacks are at grade level in English and math, compared to 30% of Latinx and 52% of white students. Additionally, only 18% of Black students graduating from Fresno Unified are college/career ready. Our educational system is failing BIPOC students and actively contributing to the leaky pipeline that results in even fewer BIPOC students enrolling in medical school.
The University of California public school system sponsors PRIME, of which we are participants, to train medical students dedicated to caring for marginalized communities. The UC PRIME program is a glimmer of hope for those of us from underserved backgrounds. For Alejandrez, “it was clear PRIME was looking for diverse students, which encouraged me to apply.” For Rey Berry, “growing up within the Central Valley walls, I wasn’t sure there was a place for LGBTQ providers in medicine. However, I felt a sense of belonging in PRIME.” While programs like PRIME are not the be-all, end-all to solving medicine’s disparities, PRIME is one example of a public institution making headway in the right direction.
For changes in patient outcomes, interventions to diversify the health-care workforce must occur early in childrens’ scholastic journeys. Pipeline programs within the Central Valley, including “Doctors Academy,” are dedicated to increasing the number of economically and educationally disadvantaged minority students graduating from high school and college, and supporting them to become health professional school applicants.
“Doctor’s Academy was essential in preparing me to flourish in higher education and without it, I wouldn’t have received admission to UCLA for college and UCSF for medical school” said Amitoj Singh. The Health Careers Opportunity Program (HCOP), in college campuses across California, is another program dedicated to serving students from economically and/or educationally disadvantaged backgrounds.
Programs like Doctors Academy and HCOP have supported us in getting to medical school and are necessary to patch the leaky pipeline to medicine. With the COVID-19 related budget cuts, these programs, among others in the Central Valley, are under threat as they are funded by local school districts, state agencies, and private organizations.
Supporting early education, pipeline programs, and efforts like UCSF SJV PRIME must remain priorities amidst COVID-19. We can reduce inequities that result in worsened BIPOC health-care outcomes by making deliberate choices to diversity our workforce. As medical students and future physicians, we ask for continued funding of existing pipeline programs, investment in de novo programs, and re-evaluation and accountability of our educational system to create a more equitable health-care system for all.