Community College Pathways: Improving the U.S. Physician Workforce Pipeline

Talamantes, Efrain MD, MBA; Mangione, Carol M. MD, MSPH; Gonzalez, Karla; Jimenez, Alejandro MD; Gonzalez, Fabio MA; Moreno, Gerardo MD, MSHS

doi: 10.1097/ACM.0000000000000438
Research Reports

Purpose: To examine the association between participation in a community college (CC) pathway, medical school admission, and intentions to practice in underserved communities or work with minority populations.

Method: The authors performed cross-sectional analyses of the 2012 Association of American Medical Colleges matriculant and applicant files and the Matriculating Student Questionnaire to assess associations between student characteristics and participation in a CC pathway. They used logistic regression to estimate the association among CC pathway and acceptance to medical school, intention to practice in underserved areas, or intention to work with minority populations.

Results: There were 40,491 applicants and 17,518 matriculants to U.S. MD-granting schools; about one-third used a CC. A higher proportion of underrepresented minority (URM) matriculants used CC pathways compared with whites. Applicants who attended a CC after high school and before a four-year university (First-CC) had lower odds of acceptance into medical school (adjusted odds ratio [AOR] = 0.68; 95% CI 0.61–0.75; P < .05). Compared with medical students who never attended a CC, First-CC matriculants were more likely to have parents without a college education (304/895 [34%] versus 1,683/12,598 [13%], P < .001) and higher odds of intentions to practice in underserved communities (AOR = 1.26; 95% CI 1.04–1.53; P < .05), after adjusting for covariates.

Conclusions: There is both high representation of URM students and higher prevalence of intention to work with underserved communities among CC pathway participants. These findings may be of interest to those seeking to enhance diversity in the physician workforce.

Dr. Talamantes is a Robert Wood Johnson Foundation Clinical Scholars Program Fellow, Department of Veterans Affairs, University of California, Los Angeles, Los Angeles, California.

Dr. Mangione is professor, Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, and Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California.

Ms. Gonzalez is a fourth-year medical student, David Geffen School of Medicine at UCLA, Los Angeles, California.

Dr. Jimenez was a fourth-year medical student, David Geffen School of Medicine at UCLA, Los Angeles, California, at the time of the study. He is now a first-year resident, Department of Internal Medicine, University of California, San Francisco, San Francisco, California.

Mr. Gonzalez is a community college counselor, San Jose City College, San Jose, California.

Dr. Moreno is assistant professor, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.

Editor’s Note : A Commentary on this article by A. Saguil and A.L. Kellerman appears on pages 1589–1592.

Funding/Support: Dr. Talamantes was supported by the Veterans Affairs (VA) Office of Academic Affiliations through the VA/Robert Wood Johnson Foundation Clinical Scholars Program, UCLA. Dr. Moreno received support from a National Institute on Aging (NIA) (K23 AG042961-01) Paul B. Beeson Career Development Award, the American Federation for Aging Research. Dr. Mangione received support from the Robert Wood Johnson Foundation Clinical Scholars Program, the UCLA Resource Centers for Minority Aging Research, Center for Health Improvement of Minority Elderly under National Institutes of Health (NIH)/NIA grant P30-AG021684, and from the NIH/National Center for Advancing Translational Sciences UCLA Clinical and Translational Science Institute Grant Number UL1TR000124. Dr. Mangione holds the Barbara A. Levey and Gerald S. Levey Endowed Chair in Medicine, which partially supported this work.

Other disclosures: None reported.

Ethical approval: This study was approved by the University of California, Los Angeles institutional review board.

Disclaimers: This material is based on data provided by the AAMC. The views expressed herein are those of the authors and do not necessarily reflect the position or policy of the AAMC.

Previous presentations: This work was presented at the Robert Wood Johnson Clinical Scholars National Conference on November 13, 2013, in Atlanta, Georgia.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A228.

Correspondence should be addressed to Dr. Talamantes, 10940 Wilshire Blvd., Suite 710, Los Angeles, CA 90025; telephone: (310) 794-2257; e-mail: etalamantes@mednet.ucla.edu.

© 2014 by the Association of American Medical Colleges