Cohen, Jordan J. MD
Nine years ago in this journal, I discussed academic medicine’s responsibility to help finish building the bridge to diversity and the instrumental role of local partnerships.1 Imagine, if you will, the educational journey since that time of many junior high school students from disadvantaged neighborhoods, all with solid academic records and all with high hopes for rewarding careers.
Beginning in 1997, their path was likely to have been buffeted by school funding cutbacks affecting science education, teacher layoffs, and stagnant Federal Financial Aid dollars. Without the continuous support needed to help them stay on their path, it is likely many dropped out of high school. For some, however, a Health Professions Partnership Initiative (HPPI) project was there, and it made a world of difference to their future.
As the articles in this supplement demonstrate, HPPI’s 26 programs have provided needed continuity for an entire generation of future physicians and scientists. The projects described on these pages—as well as the many other projects nationwide—have been essential to moving us toward a physician workforce that looks more like the United States, improving the quality of care available for underserved Americans, and helping to close medicine’s diversity gap. Additionally, HPPI’s numerous success stories are testimony to how far underrepresented minority students can go when provided both the opportunity and necessary resources.
By increasing the racial and ethnic diversity of the physician workforce, we provide a powerful antidote to the racial and ethnic disparities still blighting our health care system. As research continues to show us, medical students from underrepresented minority backgrounds choose disproportionately to practice in underserved communities and to care for uninsured patients.2 Research also shows that racial concordance between patients and their physicians improves communication and compliance with medical advice.3 Additionally, we can reasonably surmise that minority physicians and scientists tend to select research topics of relevance to minority health concerns. Therefore, when you consider the number of lives just one doctor touches, or one researcher affects, the enormity of HPPI’s collective contribution becomes evident.
Over the past nine years, HPPI has produced several successful models for strengthening the educational pipeline through close relationships between academic medical centers and regional K–16 collaborators. Projects have been conducted at all educational levels, from elementary school to high school, college, medical school, and other health professional schools. In addition to helping students progress from grade to grade, HPPI partners have created teacher institutes, health curricula, parent groups, after-school programs, and Saturday Academies, among many other programs. The individuals behind these pipeline programs have been truly inspirational, laboring beyond the call of duty to help minority students realize their dreams. By encouraging quality minority students to consider careers in medicine, they have helped these students participate directly in the noble cause of eliminating disparities and thereby improving the quality of health care for their communities
Even though formal funding for HPPI has ended, our work is far from finished. Medicine’s racial and ethnic diversity gap remains one of the profession’s most glaring deficiencies. Disparities in health care quality among racial and ethnic groups persist over a wide range of illnesses and services. And while the pool of medical school applicants from minority backgrounds is growing, we still have a long way to go in making up for important ground lost since the demoralizing anti-affirmative action climate of the mid-1990s. Additionally, many reports since HPPI’s inception have underscored the need for a much greater degree of racial and ethnic diversity and have even called upon academic medicine in particular to help.4–6
In responding to these calls, the many lessons learned from HPPI will be invaluable. And while the previous article has already touched upon these lessons, three in particular merit further attention: starting early, working along segments of the pipeline, and integrating partnership cultures.
Starting early in the process: The University of California, San Francisco, Fresno Latino Center for Medical Education and Research Health Professions Pipeline, Fresno, CA
Several of the HPPI partnerships described in this supplement developed pipeline programs beginning as early as elementary school. In Fresno, California, the idea of starting early evolved as the project unfolded. Here, leaders of the University of California, San Francisco, Fresno Latino Center for Medical Education and Research Health Professions Pipeline Program originally intended to focus at the undergraduate level, but soon discovered that prospective students lacked a sufficient foundation in math and science. As a result, a new pipeline segment in the form of a Doctors Academy for high school students was established. Shortly thereafter, program partners realized that the pipeline needed to be extended further and established a Junior Doctors Academy for seventh and eighth graders. They also established empowerment workshops to guide parents and family members in supporting and encouraging their children. The workshops, which include bilingual interpreters in Spanish and Hmong, focus on effective parent–child communication as well as preparation for college admission.
These pipeline extensions, combined with the Fresno program’s many other activities, have yielded remarkable results. For example, in Fresno County overall, 50% of high school students drop out. By contrast, 100% of high school students in the Fresno pipeline program graduated from high school and all were accepted into four-year academic institutions.*
Working along segments of the pipeline: The University of Connecticut HPPI Pipeline, Hartford, CT
In addition to Fresno, many other HPPI partners conducted simultaneous projects at several different educational levels (elementary school, high school, college, medical school, and other health professional schools). One of the most interesting success stories comes from Hartford, Connecticut, where three academic institutions (the University of Connecticut, Wesleyan University, and Central Connecticut State University) joined together with local partners to form the University of Connecticut HPPI Pipeline.
From its “Great Explorations” after- school and summer enrichment program for middle-schoolers to its postbaccalaureate study program for prospective medical and dental students, the Connecticut program includes 13 different programs and activities. Two programs in particular, the Pre-College Enrichment Program (PCEP) and College Science Partnership Series, focus specifically on developing a pool of qualified underrepresented and educationally disadvantaged students hoping to pursue careers in health care and allied fields.
The range of the Connecticut pipeline program is impressive, and the results equally remarkable. Since the pipeline program’s start in 1996, 137 students from the University of Connecticut’s Health Career Opportunity Programs have successfully matriculated into medical and dental schools nationwide. Additionally, recent data from the PCEP program show that 88% of student participants graduated from college.†
Like other HPPI programs, the Connecticut program has weathered numerous personnel changes, including six different Hartford Public School superintendents. The program’s ability to sustain such change, according to project leaders, is due to the support it has enjoyed from local community leadership, most notably the buy-in from multiple levels of the local school system.
Integrating partnership cultures: Bridge to Health Care, Birmingham, AL
One of the most striking aspects of HPPI is the way academics at all levels have joined together in the true spirit of partnership. The fact that so many medical school teachers and administrators not only ventured out into their communities, but also stayed for the long haul to plan programs collaboratively with neighboring colleges and K–12 districts, is another strong indicator of the HPPI program’s success.
One of the best examples of this meeting of the academic minds is Bridge to Health Care, where changing the culture of Birmingham, Alabama’s underrepresented minority students meant partners first appreciating each other’s culture. As project leaders note in their case study, bringing together the University of Alabama School of Medicine, Birmingham City Schools, and local chapter of the Urban League meant resolving a wide spectrum of issues, both logistical and interpersonal, from scheduling issues arising from their different academic calendars to “overcoming each organization’s cultural bias toward the other partners.”7 Most importantly, project leaders needed to convince faculty, staff and administration that HPPI was not only a good social investment, but also an “educationally and economically sound” one.7
Like other HPPI partnerships, Birmingham was challenged by personnel and financial cutbacks. It has been the partners’ original success in learning to appreciate each other’s strengths as well as constraints that has prevailed over time; what project leaders refer to as the ability to “incorporate programs that fit into the fabric of the university and to that of our partners.”7
A New Call to Action
Through the lessons noted above, as well as those described in the previous articles, HPPI partners have found ways to institutionalize and sustain their activities for years to come. That is good news in more ways than one, especially since the fundamental idea of “having” a pipeline is ensuring support throughout the academic journey both for today’s students and generations to come.
With the end of formal HPPI funding comes a new call to action for academic medicine: It is time for medical schools and teaching hospitals to use their considerable political leverage to convince policymakers and society at large that having a medical profession that looks more like our nation serves the health care needs of everyone. Closing medicine’s diversity gap is a moral issue, and it is a health issue. And it is our issue.
1 Cohen JJ. Finishing the bridge to diversity. Acad Med. 1997;72:103–9.
2 Komaromy M, Grumbach K, Drake M, et al. The role of black and Hispanic physicians in providing health care for underserved populations. N Engl J Med. 1996;334:1305–10.
3 Saha S, Komaromy M, Koepsell TD, Bindman AB. Patient physician concordance and the perceived quality and use of health care. Arch Intern Med. 1999;159:997–1004.
4 Smedley BD, Butler AS, Bristow LR (eds). In the Nation’s Compelling Interest: Ensuring Diversity in the Health Care Workforce. Washington, DC: National Academies Press, 2004.
5 Smedley BD, Stith AY, Nelson AR (eds). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press, 2002.
6 Missing Persons: Minorities in the Health Professions: A Report of the Sullivan Commission on Diversity in the Healthcare Workforce/Sullivan Commission on Diversity in the Healthcare Workforce.
7 Priest M, Ginwright SS. Bridges to Health Care: Alabama’s Health Professions Partnership Initiative. Acad Med. 2006;81(6 Suppl):S17–S20.
*According to the first two cohorts of high school graduates. Cited Here...
†According to PCEP cohorts of 1996–2000. Cited Here...