SACRAMENTO, Calif. -- California has struggled for years to recruit aspiring physicians of color into its health care workforce, despite the state’s highly diverse population.
Research shows that patients whose physicians look like them report higher levels of well-being and satisfaction with care. As a result, experts warn that failing to cultivate a diverse workforce would further exacerbate health disparities in already underserved communities.
“Having racial and ethnic and language diversity among physicians really matters,” said Diane Rittenhouse, a senior researcher with policy consulting group Mathematica Inc. who has studied California’s health workforce diversification programs.
“Black and Latinx Californians are vastly underrepresented in the physician workforce.”
Now, a new state-funded program seeks to address both the physician shortage and diversity gap by propelling community college students onto medical school.
Known as the California Medicine Scholars Program, the initiative wants to make medical school and physician careers more accessible for students from underrepresented backgrounds. This includes lower-income students, people of color, and speakers of English as a second language.
The program consists of four regional hubs — greater northern California, the San Joaquin Valley, the Inland Empire and the San Diego area — led by the medical schools at UC Davis, UCSF Fresno, UC San Diego and UC Riverside. Each medical program partners with several undergraduate institutions and community colleges to recruit students who might be interested in medical careers.
Harnessing the state’s diversity
What sets the scholars program apart from other diversification programs is its “intersegmental” approach, said Rowena Robles, the program’s executive director.
Instead of just trying to diversify residency applicants and medical school students, the program engages students early on.
The resulting “web of support,” Robles said, provides a warm hand-off for students as they transition between community college, their four-year degree program and finally medical school.
Without this level of support, students might be more likely to drop out of higher education or choose a different profession because they deem their goals unachievable.
“The major goal is making students feel welcome very early on,” Robles said. “Many are first-generation, and so oftentimes, they’re juggling family or outside jobs.”
Rittenhouse noted that the long-term support the program provides could help students feel a sense of belonging and successfully complete their studies. One-on-one advising, mentoring, tutoring and test preparation could make the difference between a student deciding to become a doctor or taking an offramp to a different career.
“To have more diversity among physicians, you really do have to start early,” Rittenhouse said. “You have to help people overcome the systemic and structural barriers that exist along the way, because it’s such a long road.”
The program could harness the inherent diversity of California’s community colleges — more than 70% of the state’s community college students are non-white and close to 64% qualify as economically disadvantaged.
But at the same time, those students will likely need extra support beyond the classroom to successfully complete their studies. For example, more than 50% of California community college students surveyed in 2019 reported experiencing food insecurity.
“The fact that you can get an A while you don’t even know where your next meal is coming from shows some incredible grit and fortitude from the student,” said Dr. Kenny Banh, an assistant dean at UCSF Fresno who oversees programming for the San Joaquin Valley hub’s program scholars.
As part of the UCSF Fresno program, Banh says family members are included in events to help them understand what kinds of support their students will need during their eight-year medical education.
“We can’t just tell them, ‘Hey, suck it up, you have to help them for eight years,’” Banh said, “because we have to understand families can’t always do that.”
Up to 200 students each year will join the program and take advantage of resources like one-on-one mentoring, academic counseling, interview practice, standardized test preparation, paid research opportunities, stipends and financial assistance with application and test fees.
The first cohort kicks off this spring with a group of 140 students from across the state.
‘I’d like to come back and practice here’
Pilar Lara, 19, knew she wanted to go into medicine after helping her late grandmother battle cancer. The first-year at Riverside City College used to drive her grandmother to medical appointments and often sat in on meetings with her doctors.
The diligent care and attention her grandmother received inspired Lara to start exploring medicine in late high school. As a junior, she started, shadowing some medical students in a UC Riverside neuroscience lab.
Lara’s biology professor told her about the program and encouraged her to apply. Now that she’s part of the program, she hopes to continue both her undergraduate and medical degrees at UC Riverside and one day become a neurologist.
“I think it’s really important that areas, like Riverside and the Inland Empire get good doctors,” Lara said. “I was born in Riverside, and I’ve lived here my whole life, so the Inland Empire is very dear to my heart.
“Even if I have to go away for school for some reason, I’d like to come back and practice here.”
Fellow Inland Empire scholar Mariana Moreno, of Lake Elsinore, hopes to pursue primary care and develop long-lasting one-on-one relationships with patients. She credits her initial interest in medicine with positive experiences she had with her own doctors. But access to advising and mentoring through the program has helped her discover classes and clinical work experiences that she doubts she would’ve otherwise found.
Like Lara, Moreno hopes she can come back home to practice once she graduates.
“If I am able to give that experience back to my community as they’re helping me get to my goal, that would be the best thing I could do as a doctor,” Moreno said. “I’m very lucky to have found this program.”
Data supports need for more diverse physicians
Across California, Black and Latino physicians are significantly underrepresented in the workforce. The Department of Health Care Access and Information reported in January this year that the state would need 37,000 more Latino physicians to achieve parity. Black Californians are well represented among recently graduated physicians, but they still only comprise 4% of the total physician workforce compared to 5.6% of the total population.
The physician workforce is also unevenly distributed across the state, with rural areas suffering the worst shortages. Residents in the Inland Empire and the San Joaquin Valley live with the lowest and second lowest number of primary care providers per capita in California, according to data from a 2020 California Health Care Foundation study.
The study also found the Inland Empire only had 42 primary care providers per 100,000 residents, and the San Joaquin Valley had only about 45. In contrast, the rest of California had an average of almost 60 providers per 100,000, which still sits on the low end of the 60-80 physicians recommended by the U.S. Department of Health and Human Services.
An aging physician workforce further aggravates the problem. About 35% of California’s physicians are over 60 years old, according to the state’s Department of Healthcare Access and Information. Physicians are also leaving the workforce faster than new doctors can replace them.
California facilitates numerous programs through the department to help medical professionals repay loans and diversify the medical profession through internship programs. Additionally, the University of California recruited underrepresented medical students for years through its Programs in Medical Education, which aim to place doctors in medically underserved areas.
While these programs tackle elements of the physician shortage, they don’t provide the transitional support that CMSP does Banh at UCSF Fresno said developing “homegrown physicians” like Lara and Moreno is the long-term solution to the doctor shortage in areas like the Inland Empire.
“The only way you can actually get doctors to stay and work in those under-served areas, is to literally grow physicians from that region to funnel back into that region,” Banh said. “But that requires a huge long-term investment.”
Rittenhouse calls the scholars program “exactly the type of program we need to be investing in as a state.” But she warns that proper implementation and evaluation will determine whether the program is deemed successful.
The program currently only has one-time funding from the 2021-22 budget, but the program’s success depends largely on whether it receives ongoing funding to support students through a seven-to-10-year educational journey.
At the same time, given the state’s projected $22.5 million budget shortfall for 2023-24, state officials might be hard-pressed to invest more in a program that won’t show results for many more years.
“I do think that it’s going to be challenging because what it requires is building bridges from the community colleges to four-year universities to medical schools to residencies within the state,” Rittenhouse said. “Ultimately, where people do their residency tends to be where they practice medicine.
“If we want to diversify the physician workforce, and we do for important reasons, then this is the kind of program that we need to be investing in.”
