“There is an imbalance in the make up of the nation’s physicians, dentists, and nurses. African-Americans, Hispanics, American Indians and certain segments of the nation’s Asian/Pacific Islander population are not present in significant numbers; rather they are missing!” observed the Sullivan Commission on Diversity in the Health Professions in a September 2004 report.

The Sullivan Commission noted that, “This imbalance contributes to the gap in health status and the impaired access to health care experienced by a significant portion of our populations.” The gap arises because minority health professionals are more likely to serve minority and underserved populations. Black physicians are found to practice in areas where the proportion of black residents is nearly five times where other physicians practice. Hispanic physicians work in communities with twice the proportion of Hispanic residents when compared with non-Hispanic colleagues.

Racial and ethnic minorities comprise 26% of the population of the United States, but only 6% of the U.S. physician workforce. Florida is not different from the country as a whole. Florida’s public medical school enrollment grew by 100 seats between 2001 and 2004 to 1,078, but the proportion of blacks and Hispanics in the student body stayed about the same. As a result, Florida’s public medical school student bodies still fail to reflect the state’s diverse population.

Blacks were 14.6% of Florida’s population in the 2000 U.S. Census. In fall 2004, blacks made up only 7% of the students in the state’s public medical schools. Hispanics were 16.8% of the state’s population in the 2000 U.S. Census. In fall 2004, Hispanics made up only 8.9% of the students in the state’s public medical schools. Only in the category of Native Americans did Florida’s public medical schools stand out. One point two percent of its public medical school students were Native Americans, compared to .3% of the state population.

This lack of diversity bodes ill for the state’s minorities and poor people. Studies indicate that female, black and Hispanic doctors are more likely than white, non-Hispanic counterparts to serve minority, poor, and Medicaid populations. Evidence of this is so strong that the American Medical Association’s House of Delegates recently adopted as a policy “a need to enhance underrepresented minority representation in medical schools and in the physician workforce, as a means to ultimately improve access to care for minority and underserved groups.”

Because so many poor and minority people live in Southeast Florida, the region suffers disproportionately from the lack of diversity in the state’s public medical schools. Not only are South Floridians underrepresented in the public medical schools, but they are less likely to be served by the graduates of those schools. In fact, each of the public medical schools provides less than 2% of the region’s doctors. The disparity is most heavily felt in Miami- Dade County.

At the national level, experts from a number of organizations have made three important recommendations to improve diversity in the medical profession:

1) Change the culture of medical schools by setting new admissions and promotion criteria and employing a higher proportion of minority faculty members (now only 4% of all faculty members).

2) Explore new and nontraditional paths to medicine. All medical schools must develop a proactive minority student recruitment program starting as early as high school.

3) Commit at the highest level to minority student and faculty recruitment. Twenty percent of all minority medical school faculty members are in only six medical schools, including the three traditionally African American medical schools, Howard, Meharry, and Morehouse, and the three Puerto Rican medical schools.

In Florida, all these recommendations apply and were considered in the planning of the Florida International University School of Medicine. The new FIU School of Medicine is specially designed with a mission to train culturally sensitive physicians. It is the first medical school in the country to explicitly state this philosophy. A public medical school at Florida International University would be especially practical in solving the problem of minority under-representation. FIU has consistently ranked first in graduating Hispanic undergraduates. In 2004 it also graduated the greatest number of Hispanics with bachelor’s degrees in psychology and health sciences. In 2002 it graduated the greatest number of Hispanics and the fifth highest number of blacks with master’s degrees in health-related disciplines. The pool of highly motivated and talented individuals in the region is deep and has no natural bounds and FIU is ideally positioned to tap into it.

REFERENCES
“Missing Persons; Minorities in the Health Professions”, The Sullivan Report, Kellogg Foundation, September 2004.

Carlos Martini, M.D, MPH, MSC, FFCM, is the Medical School Project Director at Florida International University.
Thomas A. Breslin, Ph.D., is vice provost for Academic Affairs at Florida International University.