|November 8, 2001
Finds Underrepresented Minority Physicians More Likely To Practice In California Following
School And Residency In State
A UCSF study of the migration patterns of
Californians in medicine found that those who attend medical schools in the
state are more likely to enter residency programs in California and remain in
the state to practice. However, a decreasing number of California minorities
who attend medical school are entering medical schools in California. The
report was issued November 1 by the California Policy and Research
Center/Program on Access to Care.
"California needs to hold onto more of our own when it comes to
underrepresented minorities enrolling in US medical schools," according to
Kevin Grumbach, MD, UCSF professor of family and community medicine and
Director of the Center for California Health Workforce Studies at UCSF. "We
need to implement policies to reverse the exodus of qualified minority medical
students from California. Increasing the number of minorities educated in
California and practicing in the state is critical if we are to meet the health
care needs of an increasingly diverse California population."
Some studies of underrepresented minority students have suggested that
anti-affirmative action policies in California have contributed to the
decreasing enrollment of minorities in California medical schools. Another
roadblock to representation is that the capacity of the state medical schools
is far less than the number of applicants.
"There are fewer underrepresented minority Californians entering medical
schools anywhere in the nation," said Grumbach, "and in recent years, those who
do get accepted into medical school are less likely to stay in the state for
their medical education. Minorities seem to consider California a less
hospitable place for their medical education."
Latinos, African-Americans and Native Americans are underrepresented in
California's physician workforce, and this is a serious problem in California,
the study found, because many medically underserved areas in the state have
large Latino and African-American populations. Previous studies have shown
that African American and Latino physicians in California are more likely to
practice in underserved communities and care for uninsured and Medi-Cal
The study assessed the relationship between practice location and location of
medical school and residency. Data on location of medical school and
residency were analyzed for 3,007 Californians who graduated from medical
school between 1985 and 1999. For location of practice, data were analyzed for
Californians who graduated from medical school between 1985 and 1992. More
recent graduates were excluded from the analysis of practice location because
many of them have not yet finished residency.
Major findings of the report include the following:
--The number of Californians attending medical school far exceeds the capacity
of the state's medical schools. In 1999, a total of 1,868 Californians
enrolled in medical school as first-year students. Forty-four percent entered
California medical schools and 56 percent entered medical schools in other
states. California exports more medical students to out-of-state schools than
any other state.
--In addition to location of medical school, location of residency training is
an important predictor of practice location. Approximately 70 percent of
physicians who complete residency training in California remain in the state to
--Among underrepresented minority Californians practicing in the state, more
than half (57 percent) completed both medical school and residency in
California. Approximately one-third (31 percent) attended medical school in
other states, but returned to California for residency. Underrepresented
minority Californians who completed residency in other states accounted for
only 12 percent of those practicing in the state. These findings reinforce the
conclusion that increasing the number of underrepresented minority California
completing medical school and residency training in the state would increase
the number who practice in California.
The study had several recommendations to increase the number of
underrepresented minority Californians attending in-state medical schools and
-- Strengthen specific strategies to increase the number of underrepresented
minorities, including expansion of outreach programs, more extensive
recruitment activities and provision of financial aid packages comparable to
those offered by medical schools in other states.
-- Expand the Charles Drew/UCLA Undergraduate Medical Education Program
established in 1978. The mission at Drew is to educate health professionals
who intend to practice in medically underserved communities and to provide care
to disadvantaged populations.
-- Develop a new University of California program in the Central Valley to
prepare additional medical students dedicated to practicing in California's
underserved communities. At present there are no medical schools in the
Central Valley, but there is an existing residency training program at UCSF
Fresno which trains more than 200 US medical students per year at the clinical
"It's a very exciting prospect to consider adding a medical school to our
successful residency training program," said Deborah Stewart, MD, associate
dean, UCSF Fresno Medical Education Program. "It would be a perfect complement
to our UCSF Fresno pipeline programs which currently helps prepare Central
Valley junior high, high school and college students for future careers in the
health professions," Stewart added. Medical education programs in the valley
would emphasize preparation of physicians who intend to practice in underserved
areas. "Currently more than 50 percent of the UCSF Fresno graduates remain in
the valley to practice," Stewart said. Latinos constitute at least one-third
of the population of most counties in this region, and recent immigrants from
Southeast Asia are a growing population in the area.
-- Develop a voluntary registry of underrepresented minority Californians
enrolled in medical schools throughout the US for use by California residency
training programs to recruit applicants. Because underrepresented minority
Californians who complete residency in California are much more likely to
practice in the state, the study encourages state policymakers to assist
California's residency programs in recruiting minority Californians.
-- Provide funding to residency training programs in California to increase
information to underrepresented minority physicians about opportunities in the
state and to encourage them to apply. The state should establish a grant
program to support focused recruitment efforts, including production of
materials, travel and other communication methods.
Collaborators for the study include Rebecca Levin, research associate,
Association of American Medical Colleges (AAMC); and Lois Colburn, assistant
vice president, Community and Minority Programs, AAMC.
Funding for the research was provided by CPRC's California Program on Access to
Care and the Center for Health Workforce Information and Analysis, U.S. Bureau
of Health Professions, HRSA.
Source: Twink Stern