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A bill would spend $1 billion on diversifying medical schools to close the racial health gap

"There simply are not enough doctors who look like the patients in the underserved communities."
Image: Dr. Yvonne Fry-Johnson
Dr. Yvonne Fry-Johnson of the National Center for Primary Care at the Morehouse School of Medicine checks the blood pressure of Terrell L. Slayton Jr. in Atlanta in August 2005.Ric Feld / AP file

Black doctors make up less than 6 percent of the physicians in America, and a recently introduced bill seeks to help encourage more young doctors of color through a $1 billion grant to several medical schools.

The Expanding Medical Education Act, introduced in the Senate last week by Tim Kaine, D-Va., was drafted to offer a pathway to "tackle the lack of representation of rural students, underserved students, and students of color in the physician pipeline," it says. The goal would be to reduce mistrust in doctors and health care institutions among marginalized communities, thus narrowing the gap in health care.

The legislation would encourage recruiting, enrolling and retaining Black students in medical schools and help fund programs for schools that mostly serve students from marginalized backgrounds.

The ultimate goal, Kaine said, is to increase the talent pool by making the path to medical school less arduous and more affordable. The idea is that if there are more Black doctors, more of them could tend to underserved communities.

"If this bill will add to the number of brown and Black doctors, then that's a good thing," said Donald Alcendor, an associate professor of microbiology and immunology at Meharry Medical College, a historically Black institution in Nashville, Tennessee. "There simply are not enough doctors who look like the patients in the underserved communities. And this systemic distrust [these] communities have for the medical system is something that is long-standing and has at least a chance of being overcome with Black doctors' presence to create a better patient-doctor relationship."

As a 2006 study cited by the National Institutes of Health outlines, Black populations say they distrust medical providers because of factors like perceived racism or greed. More broadly, systemic racial segregation cultivated a gap in health care, and several high-profile cases through American history were found to have used Black people for medical experimentation against their will or without their consent.

Black doctors agree that the need for more physicians of color is critical, for many reasons, and that funneling money and attention to historically Black colleges and universities, or HBCUs, is "a start," said Dr. Pierre Vigilance, an adjunct professor of health policy and management at George Washington University's Milken Institute School of Public Health.

"There's almost no choice but to diversify the pool," Vigilance said. "Teams that are diverse create better results. If you have only one type of demographic in physicians, you will get a certain set of outcomes. But if you have a diverse team that is willing to go into distressed areas, you can address some of these concerns. You can break barriers and you can improve outcomes."

The Expanding Medical Education Act would:

  • Prioritize grants to minority-serving institutions, including HBCUs, that propose to use the funds to establish medical schools or branch campuses in areas where no other such schools are based and that are medically underserved communities or health professional shortage areas,
  • Allow grant funds to be used to plan and build new medical schools in areas where no other school or branch campus is based. Other requirements include activities to meet the accreditation criteria for a medical school; hiring diverse faculty and other staff members; recruitment, enrollment and retention of students, including those from disadvantaged backgrounds, underrepresented racial and ethnic minorities, students from rural and underserved areas, low-income students and first-generation college students; supporting educational programs; modernizing and expanding infrastructure; and other activities determined by the secretary of health and human services.
  • Require reporting to Congress on activities conducted under the grants.

The House version of the bill was introduced in January by Jim Costa, D-Calif., and was incorporated into the Heroes Act, which the House passed in May.

Javaune Adams-Gaston, president of Norfolk State University, the largest HBCU in Virginia, which boasts a renowned nursing program, said in a statement that she supports the bill and that it "will help to address these disparities and diversify the physician pipeline by providing the financial resources."

The four historically Black medical colleges — Meharry, Morehouse School of Medicine, Howard University College of Medicine and Charles R. Drew University of Medicine and Science — pride themselves on serving Black communities. Morehouse recently received a $40 million grant from the Department of Health and Human Services to work with communities of color in relation to the coronavirus pandemic.

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Vigilance, who led the District of Columbia's response to the H1N1 swine flu virus in distressed areas in 2009, however, warned against assuming Black doctors will want to work in poor or underserved areas.

"The assertion often made that these providers will go back to the community they serve also makes the assumption that they come from low-income communities," he said. "That's true for some but not all."

In the end, he said, the two goals remain to "make opportunities for more doctors of color and to build teams that are diverse because teams that are diverse create better solutions to challenges or problems. If you diversify that health care provider group or health system, and if you're truly about this notion of population health and community wellness. . . now have no choice but to diversify the provider pool."

Medical school enrollment was up by 31 percent last year, according to the Association of American Medical Colleges. But Blacks made up about 7 percent of medical college students in 2017 and Hispanics made up 6 percent. Enrollment in rural medical programs is also on the decline, which is a concern since the existing doctors in more remote areas are aging and retiring, and not being replaced fast enough.

The cost of medical school — averaging at about $60,000 a year at a private college — could also deter prospective Black students.

"Just applying for medical schools can be cost-prohibitive, let alone the interviewing process, pre-COVID-19, flying around the country," Vigilance said. He added that a typical student would apply to at least 10 medical colleges at $170 per application, with a second fee of around $41 for a secondary application. "So you're already well into the thousands of dollars just to apply."

Alcendor agrees. "If this bill can reduce some of the medical school debt that you incur going to medical school, this could be very helpful," he said. "To increase the possibility of people who don't have the means but have the talent to go to medical school is important. We had a student making straight As but couldn't pay for medical school and had to sit out."

As for Black doctors helping build trust in the medical system, it will always be a tough hurdle with African Americans people. "This bill is a start to perhaps making some inroads on a lot of areas," Vigilance said. "It doesn't have all the answers but it's a good piece. And that would be better than where we are."

CORRECTION (Aug. 12, 2020, 1:05 p.m. ET): A previous version of this article misstated the status of the Expanding Medical Education Act in the House. While the bill did not move after it was introduced in January, the language of the bill was incorporated into the HEROES Act, which passed the House in May.