Health Policy$ense

Diversity in the Health Professions: a 'Leaky Pipeline'

Undergraduate minority students identify barriers

Despite decades of calls for increased representation of minorities in the health professions workforce, we are very far away from a workforce that reflects this nation’s diversity. Underrepresented minorities make up 31% of the general population, but just 15% of medical school students and 13% of dental students. A new study helps us understand the barriers minority college students face in pursuing medical and dental careers.

In Academic Medicine, Brandi Freeman and colleagues, including LDI Senior Fellows Judy Shea and David Grande, report on focus groups they conducted with undergraduates from minority backgrounds that are underrepresented in medicine, including Blacks, Latinos, and Native Americans. The one-hour focus groups, involving 82 diverse students across 11 colleges, highlighted several challenges: inadequate institutional resources for academic success and clinical opportunities; strained personal resources such as lack of financial resources or familial pressure; inadequate guidance and mentoring to assist with key career decisions; and societal barriers such as work-life balance concerns or job uncertainty.

The quotes from the focus groups illustrate the challenges, insecurities and uncertainties that these students face:

...somebody else who never worked—had to work for anything and their parents paid for all their college, it’s their GPA is obviously going to be higher because all they had to focus on was school.

It’s kind of a disadvantage almost if you don’t have family that—or someone that will let you come into their workplace and follow them around. […] For people who don’t have that as an option, it makes us look bad.

I feel kind of lost. I know I want to be there, but I just don’t know how to get there.

What happens if you never get matched, I guess? Because that’s a possibility and you don’t go through residency, so you’re stuck with an MD who can’t practice medicine.

The focus groups were conducted as part of the Tour for Diversity in Medicine, an effort from underrepresented minority physicians and dentists to encourage students of diverse backgrounds to pursue careers in the health professions. The focus group approach to understanding root causes of the “leaky pipeline” is important, the authors say, since past studies have relied on quantitative data such as academic achievement, focused on a single institution, or captured perspectives from minority students who have already become health professionals. This new study is more qualitative, involves multiple institutions across the nation, and captures the undergraduate perspective.

The authors suggest that external programs, such as the Summer Medical Education Program (SMDEP), can strengthen support for students at resource-limited institutions. To address strained personal resources and familial barriers, the authors recommend educating families at the high school level to familiarize them with the medical training process at an earlier stage. At a higher level, the authors suggest that policy changes, such as regulation of medical resident work hours, can change perceptions of work-life balance.

Increasing the diversity of the workforce is important because health professionals from underrepresented backgrounds disproportionately serve minority and other medically underserved populations. In addition, minority patients tend to receive better care from practitioners of their own race or ethnicity, particularly in primary care and mental health settings. As part of a series on how the Affordable Care Act affected minority health last January, we wrote about workforce diversity. The ACA invested $100 million to expand scholarships and loan repayments for disadvantaged and minority students; provided large grants to historically Black Colleges and Universities for academic support, faculty development, and research surrounding health issues; and created $67 million in Health Profession Opportunity Grants (HPOG) for low-income families.

The authors of the focus group study point out that the perceived and actual barriers for minority students in the health professions pipeline are similar to those for other science degrees and fields, and that interventions can affect diversity across a broader set of careers. One closely related field is health services research, which the Leonard Davis Institute and other Penn institutions support through the Summer Undergraduate Minority Research (SUMR) program. Now in its 16th year, SUMR provides stipends for students to conduct research with Penn faculty on a topic of their choice. These programs are an important step in addressing barriers for minorities who want to help advance the nation’s health.