One of the most pressing health care challenges facing the nation is the critical need for more minority physicians. In the next 15 years, the nation is projected to confront an overall shortage of physicians, but the need is, and will continue to be, particularly great for minority physicians.
By 2050, racial and ethnic minorities are projected to account for half of the U.S. population. While Blacks represent roughly 13 percent of the U.S. population, less than 3 percent of the nation’s 1 million doctors and medical students are Black.
Studies also indicate that when minority patients can select a health care professional, they are more likely to choose someone of their own racial and ethnic background. Higher levels of trust, respect and the increased likelihood that patients will recommend their physician to others also characterize relationships between patients and physicians of the same race or ethnic background. Exposure to racial and ethnic diversity in medical school contributes importantly to the cultural competence of all of tomorrow’s doctors.
Black communities suffer greatly in the aspects of proper health care coverage as well as caring and quality health care providers. Potentially, there are many great Black doctors and other medical professionals untrained and waiting in the trenches due to lack of the economic resources necessary to penetrate the sturdily built walls of being enrolled in many U.S. medical schools.
The under-representation of Blacks in the health professions is a concern for reasons of social equality, but also because members of the Black community may have unique health care needs that may be better addressed and more successfully treated by Black health care professionals who are knowledgeable about cultural aspects of health and care. Blacks have significantly more health problems than other groups, including high rates of diabetes, heart disease, prostate cancer, HIV/AIDS, breast cancer and infant mortality, according to the U.S. Department of Health and Human Services.
If Black doctors possess some comparative advantage in treating Black patients, the under-representation of Black doctors would have a direct effect on health outcomes in the Black community and the racial gaps in health.
One of the many barriers preventing an increase in the number of Black doctors is the cost of going to medical school.
The fact that doctors in the U.S. now graduate owing more than $155,000 on average is why so many doctors shun primary care in favor of highly paid specialties, where there are incentives to give expensive treatments and order expensive tests, an important driver of rising health care costs.
Like I said, that’s the “average debt”. For most newly trained doctors in the U.S., this is usually a higher debt. For example, I went to Harvard Medical School’s website, out of curiosity, and was shocked by what I saw:
“An estimate of yearly expenses shows that the average cost for an unmarried first-year student will be approximately $73,000 for the 2011–2012 academic year. This estimate includes tuition, health service fee and insurance premium, room and board, books, travel, transportation to clinical sites, laundry, and incidentals. Students whose homes are outside the northeast region of the United States may experience travel costs beyond the scope of this estimate.”
Couple this with the depressing state of education for Blacks in the U.S., and you come up with a rather dismal outlook! The education of Blacks and some other minorities lags behind those of other U.S. ethnic groups, such as whites and Asian Americans, as reflected by test scores, grades, urban high school graduation rates, rates of disciplinary action and rates of conferral of undergraduate degrees.
The percentage of African-American physicians in the United States has remained constant over the last 30 years at 3.9 percent of all physicians, while the percentage of international medical school graduates (IMGs) providing medical care in the United States has increased dramatically over this same time-period to 23 percent.
Among the stunning differences between the U.S. and Cuban systems is the liberation many doctors there feel with the absence of a profit motive. Plus, patients can visit their doctors as often as they wish and there are no constraints upon the amount of time and attention a doctor is able to offer them.
With a life expectancy of 76.9 years, Cuba ranks 28th in the world, just behind the U.S. However, its spending per person on health care is one of the lowest in the world, at $186, or about 1/25 the spending of the United States.
In Cuba health care is considered a right, yet in this country it is a privilege with access and quality of service rationed according to a person's ability to pay.
This is not to say that the Cuban system is perfect. Not all of its physicians are delighted to have an income comparable to that of, say, a minimally skilled laborer, and perhaps less than a waiter or taxi driver who earns tips.
But Cuba has quelled most of the infectious and childhood diseases that plague Third World countries. Infant mortality is under 4.4 percent — better than in the U.S. — and the life expectancy of around 78 years compares favorably with this country, according to the CIA World Fact Book. I admit, it is ironic that Cubans die from the same causes as do those in wealthy countries, such as cancer and heart disease, rather than infection, malnutrition, early childhood diseases, accidents and other maladies associated with countries that have a similarly low per capita income.
Although there are more doctors and nurses, percentage-wise, than in the U.S., in Cuba clinical supplies like medications are in short supply largely due to the U.S. embargo, which has been in place since 1960. The country has incorporated inexpensive indigenous herbal medicines and alternative treatments such as acupuncture into the delivery of routine health care. Cuba's ubiquitous multi-service medical centers, or “polyclinics,” have technicians trained in the rudimentary applications of these treatments.
Recently, I attended a fundraiser, at Vivant Art Collection, for a young Black woman, Veronica Flake, preparing to return for her third year of medical school.
The relevance to this column you ask?
Born and raised in North Philadelphia, and educated in Philadelphia’s public school system, Veronica is a medical school at ELAM (Escuela Latinoamericana de Medicina).
Established in 1999 and operated by the Cuban government, ELAM has been described as possibly being the largest medical school in the world by enrollment, with approx. 10,000 or 12,000 students from 27 or 29 countries reported as enrolled. All those enrolled are international students from outside Cuba and mainly come from Latin America and the Caribbean as well as Africa. Tuition, accommodation and board are free!
What’s the catch?
ELAM's mission is dedicated to the training of general practitioners and primary health care providers for impoverished communities outside Cuba. It is preferred that ELAM students come from the poorest communities with the intent of returning to practice in those areas in their countries. Initially only enrolling students from Latin America and the Caribbean, the school has also become open to applicants from impoverished and/or medically underserved areas in the United States and Africa.
Preference is given to applicants who are financially needy and/or people of color who show the most commitment to working in their poor communities.
Cuba began to train U.S. medical students after members of the Congressional Black Caucus met with then President Fidel Castro in 2000.
Congressman Bennie Thompson of Mississippi told Castro about the problems in areas of his legislative district that suffered an acute shortage of doctors.
The leader of the Revolution responded by offering scholarships to 500 U.S. young people to attend the Latin American Medical School, founded in November 1999 to provide medical studies for youth of the region, an idea later extended to Africans and Asians.
Having lectured and presented at several symposiums many times over the years (legally, I should add), I have met scores of young, Black medical students from all over the U.S. who are preparing to become doctors so they can return home to serve the communities from which they come. Without this option, many of them would never realize their dream of practicing medicine.
Many of Veronica’s friends and family turned out to support her, and having never met her but understanding the path she was on, I attended to show my support and express my hope. She represents yet another effort to fundamentally address the inequities in healthcare and medicine, which disproportionately touch the lives of Blacks in the U.S.
A fundamental requirement of admission to ELAM is that students demonstrate a commitment to working in distressed communities. Another requirement is being able to document a history of commitment to social justice. While ELAM has 500 positions slotted for U.S. students, only 117 were filled as of April 2010. Want to go to medical school but don’t have the money? Here’s an opportunity…
Remember, I’m not a doctor. I just sound like one.
Take good care of yourself and live the best life possible!
Glenn Ellis is a health advocacy communications specialist. He is the author of “Which Doctor?” and is an active media contributor nationally and internationally on health related topics. His second book, “Information is the Best Medicine,” is due out in fall 2011. For more good health information, visit www.glennellis.com.