A strong commitment to addressing health disparities and health inequities has helped elevate the University of Miami Miller School of Medicine to the top ranks nationally when it comes to the diversity of its student body.
“Does it mean our work is done?” asked Henri R. Ford, M.D., M.H.A., Dean and Chief Academic Officer. “Absolutely not. We can always do better. But this institution has been at the forefront of this struggle.”
An aging population, significant health disparities between underrepresented minorities and whites, and a shortage of minority physicians have contributed to a crisis in American medicine, Dean Ford said at a recent town hall meeting.
At the Miller School, which is working on many fronts to address the crisis, 25 percent of this year’s new students are Hispanic, and 11 percent are African American. That’s 52 Hispanics compared with 22 in the entering class in 2015, and 23 African Americans compared with 10 in the 2015 freshman class.
The Miller School numbers are much higher than the national total of 6 percent Hispanic freshman medical students in 2018, and 7 percent black or African American students, according to the Association of American Medical Colleges (AAMC).
“This really puts us at the top of medical schools that are not historically black colleges and universities,” Dr. Ford said.
The importance of keeping those numbers growing is well documented. The Institute of Medicine issued a seminal report showing that even after adjusting for education and economic status, unequal treatment due to racial prejudice underlies health disparities despite equal access. Additionally, underrepresented minority physicians are much more likely to work in impoverished or underserved areas than their white counterparts.
Given these realities, “we must develop a culturally competent and diverse work force if we are going to meet the health needs of our nation,” Dr. Ford said. And that means developing a diverse pipeline of future physicians – which requires intervention well before the third grade.
Why so early? “It takes a bachelor’s degree to make a medical student, and it takes reading proficiency at age 8 (third grade) to make a doctor at age 28,” Dr. Ford said. “It takes resources to make all that happen.”
If a child fails reading comprehension in the third grade, there is a 60 percent chance they will spend one or two nights in jail by the time they’re 30 years old. “So if we are going to have an opportunity to develop future doctors, we need to make sure they can read and write in the third grade,” Dr. Ford said.
Research has also shown that poverty is linked to poor education, leading to low levels of proficiency in math and science among underrepresented minorities.
“This is an indictment of our educational system,” Dr. Ford said. The AAMC projects that by 2032, the U.S. population will increase from 328 million to 359 million, and 37 percent of the college-age population will be black or Hispanic. Underrepresented minorities will need to play a significant role in the medical workforce.
Under the leadership of Roderick King, M.D., M.P.H., senior associate dean for diversity, inclusion, and community engagement, the Miller School has several programs focused on developing the pipeline of future medical professionals. Stephen Symes, M.D., who served as associate dean for diversity and inclusion, led the creation of these programs along with Nanette Vega, Ed.D., executive director of the Office of Diversity, Inclusion, and Community Engagement.
The Medical Scholars Fellowship Program is a summer initiative that provides academic enrichment and career exploration for minority students who are preparing for a career in the health professions. The goal of the program, which had 75 participants this year and has trained 365 students overall, is to ensure that the physician population is more representative of the diverse communities the Miller School serves.
The school is also expanding its pipeline of diverse future physicians by launching a visiting clerkship program so that underrepresented medical students can spend time in University of Miami residency programs and consider them for their own training.
“Due to the phenomenal work of our talented staff,” Dr. Ford said, the Miller School was named a winner of Insight Into Diversity’s Health Professions Higher Education Excellence in Diversity (HEED) Award last year.
Optimizing the learning environment for all medical students inspired the creation of a new diversity and inclusion student space, an oasis where people can get together, study, and support each other.
Diversifying the faculty is also a high priority, Dr. Ford said. Though the Miller School’s 3 percent African American faculty matches the national average, the Dean said, “Obviously this is an area of serious interest to me, and we are going to go out and get the talent.” Thirty percent of the faculty is Hispanic.
Diversity is not just important for preparing the workforce that will meet the health needs of the nation, it is also critical to research into health disparities. Dr. Ford quoted Dr. Jordan Cohen, former president of the AAMC, who said, “What people see as problems depends greatly on their particular cultural and ethnic filters.”
That means “the solutions to disparities will require a racially, ethnically, and culturally more diverse research workforce,” Dr. Ford said.
The dean opened his presentation with widely quoted words from Dr. Martin Luther King Jr.: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
That injustice remains “a very vexing problem in contemporary American society,” Dr. Ford said. Underrepresented minorities have a shorter life expectancy and they experience a disproportionately higher incidence of cancer, birth defects, cardiovascular disease, diabetes, stroke, and other disorders.
Addressing these disparities will require much more diversity in future classes of medical students and the faculty who will train them. “Diversity is something the Miller School is serious about,” Dr. Ford said. “Just like Dr. King, many scholars say the issue of health disparities is really tantamount to moral failure. We will work tirelessly to reverse that failure and advance the health and well-being of everyone in our communities.”