At Med Schools, a New Degree of Diversity
Friday, June 1, 2007
The six members of Medical Team 4 have a lot in common. Each wears a white coat, has a stethoscope for a necklace and has stayed up late this week. They can all start an IV and work up a solitary lung nodule.
They share something less obvious, too. With one exception, none has a grandparent born in the United States.
Med 4 at the Veterans Affairs Medical Center in Northwest Washington is the new face of American medicine. Its members happen to come from Georgetown and George Washington universities, but the team is indistinguishable from similar groups of young doctors and doctors-to-be at many of the country's 125 medical schools.
In the past 15 years, U.S. medicine has seen a huge influx of first- and second-generation immigrants. It follows and augments a different demographic trend that began 30 years ago with the acceptance of increasing numbers of women into medical schools. As a result of that earlier revolutionary change, half of new practitioners today are women.
The Norman Rockwell-Marcus Welby image of the American doctor -- an avuncular white man, often in a bow tie -- is rapidly disappearing.
From 1980 to 2004, the fraction of medical school graduates describing themselves as white fell from 85 percent to 64 percent. Over that same period, the percentage of Asians increased from 3 percent to 20 percent, with Indians and Chinese the two biggest ethnic groups.
Counted in the "white" category, moreover, are a moderate number of ethnic Persians whose families fled the 1979 Iranian revolution, and a smaller number of more recent arrivals from Eastern Europe and the former Soviet Union. In the "black" category is an unknown number of graduates whose families recently arrived from Africa, predominantly Nigerians and Ghanaians.
"We are seeing more and more kids of foreign-born parents, especially in the last eight to 10 years. I don't think there is any doubt about it," said Milford M. Foxwell, a physician and dean of admissions at the University of Maryland School of Medicine. In his 18 years on the job, he has reviewed about 75,000 applications.
Many forces are sketching this changing portrait of the American medical student. They include a general increase in immigration, a large influx of foreigners trained in scientific and technical professions, and a culture of educational achievement in communities of newly arrived immigrants that prepares their children for the competition and rigors of medical school.
How -- or whether -- this trend will change the practice of medicine in this country is uncertain.
There is a small amount of evidence that a diverse student body may be more attuned to disparities in medical care than a homogeneous one. A study published in 2004 found that black, Hispanic and Asian medical students (in descending order) are more likely than white ones to think that U.S. medicine often "treats people unfairly" based on race, ethnicity, insurance status, income or ability to speak English.
In general, though, few are eager to touch on the implications of the new ethnic mix in medical schools. Officials at institutions as different as the University of Vermont and Howard University declined multiple requests to discuss, even anecdotally, the evolution of their student makeup.