By Joseph A. Flaherty and Jorge A. Girotti
A new report from the Association of American Medical Colleges contains a fact that should disturb anyone concerned about our health-care system and our country. Since 1978, while the number of African-American men graduating from college has gone up, the number going on to medical school has dropped.
This contradiction should serve as a wake-up call to educators and leaders across the country. Medical schools in particular need to look closely at what may be keeping away those African-American students who might otherwise aspire to become physicians.
The obvious rationale for recruiting African-Americans into medical school is to undo past societal wrongs – to provide opportunity that has previously been denied. But just as important is the need to produce minority physicians whose very presence in the health-care delivery system will help to address health-care disparities.
Studies have shown that the physicians most likely to practice in under-served African-American communities are African-American themselves. And those communities want and need them there.
One reason is that many people prefer to be treated and cared for by a doctor of their own background – health care, after all, is a deeply personal matter dependent on mutual trust. At the same time, many communities suffer from a deficit of strong role models and mentors.
And African-Americans who return to practice in settings familiar to them bring a unique perspective that goes beyond medical knowledge or clinical expertise – they often are intimate with the lifestyle factors affecting the community’s health or have first-hand experience in the difficulties one might face in navigating the healthcare system.
At one time, we seemed to be on our way to alleviating this gap. In the early 1980s, when I was at the University of Illinois College of Medicine, we revised the admissions guidelines and had high hopes that we could make meaningful progress in increasing the diversity of the student body.
And we did, growing minority enrollment to 25 percent of the student body, half African-American and half Latino. This had a major effect over time; three-quarters of Chicago’s African American physicians are University of Illinois graduates. However, overall in the U.S. we have seen a downward or flat trend in African-American admissions, while enrollment of Latino and Asian students has continued to grow.
The AAMC report notes that one of the obstacles to attracting more African-American men to medical school comes well before they are even at the point of applying.
Factors within some African-American communities dis-incentivize the pursuit of academic excellence, while those who do have high aspirations often have limited educational resources, or lack sufficient guidance into science programs that may lead them to interest in medicine.
However, a large part of the answer to African-American enrollment rests with medical schools themselves. Although some U.S. medical schools are beginning to explore a more holistic approach to evaluating candidates, by and large the Medical College Admissions Test (MCAT) is still the dominant selection tool.
The MCAT is a standardized test on physical and biological sciences, behavioral sciences, and critical reasoning. While it can predict the future success of some medical school applicants, it primarily measures one’s ability to perform well on tests (as well as one’s ability to procure test-prep resources or simply the time needed to adequately prepare).
Admissions committees that focus primarily on MCAT performance tend to overlook important qualifying criteria, like commitment, determination, and prior career experience.
So what needs to happen? We can speak to the part of an individual’s life where they have reached the possibility of going to medical school.
Simply put, we need to make the process fair.
We need to look at aspiring medical students from all different backgrounds and ask them who they are today and what drives them. We can look at their MCAT score and their GPA, but if we are going to raise the numbers of African-American doctors working in African-American neighborhoods bringing up and educating healthy African-American children and families, we have to look more closely at the candidates and understand what it is about them that will make a great doctor.
For African-American men, Ross University School of Medicine enrolls at nearly double the level of U.S. schools on average: In the past five years, 5.8 percent of our enrollees were black males. That level carries through to graduation. RUSM graduated 138 black men, 4.8% of all RUSM graduates, from 2011 to this year.
Outcomes like this show us one way to get more African-American male physicians – welcome them as students and give them a fair opportunity to show they have what it takes to become physicians.