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Summary of Twelfth Report

Minorities in Medicine
May 1998

The full version of this report is available in PDF format (313 KB)

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Executive Summary

Between the time it issued its first report in 1988 and the present, the Council on Graduate Medical Education (COGME) has repeatedly voiced its concern that minorities are greatly underrepresented in medicine, and has made wide-ranging recommendations to address the consequences of a physician work force that does not reflect the nation's racial and ethnic diversity. COGME's Fourth Report, issued in 1994, argued that efforts to increase minorities in medicine are justified, not only because the nation values equal opportunity, but also because the nation's health depends on a physician work force that reflects the nation's increasingly diverse population.

This report, the twelfth since COGME's inception, contends that, despite nearly two decades of efforts to increase minority representation in medicine, many minorities remain critically under-represented at every level of medicine. COGME's attention to minority representation in medicine continues during a period when policy changes severely impact minority physicians and potentially the health of minority populations. Changes in affirmative action policy have already begun to erode the meager and hard-won gains in the underrepresented minority physician work force that have been made in the last 20 years. Unfortunately, these attitudinal shifts occur at a time when disparities in health between minority groups and whites are in some instances increasing, and the entry of underrepresented minorities into medical schools is losing ground. Moreover, changes in the systems of paying for and providing medical care, especially under the spreading influence of managed care, will surely impact many aspects of work force education and practice.

This report focuses on several issues relevant to minorities in medicine: the implications for medicine of the nation's rapidly changing demographics; the health status of minority populations and the important role minority physicians play in improving minority access to care; trends in minority participation in medicine; and programs that work effectively to increase the level of minority participation in medicine. Based on its findings, the report makes recommendations to address these issues.

Implications of Changing Demographics in the United States

Today, minority populations are the fastest growing segments of the U.S. population. Black Americans, Hispanic Americans, Asian Pacific Americans, and American Indians/Alaska Natives made up 26.4 percent of the U.S. population in 1995. By 2010, according to U.S. Census Bureau projections, these groups will make up 32.0 percent of the population, and, by 2050, 47.2 percent. Thus, physicians of the next century will provide care to a population whose characteristics will differ markedly from those of the population in the United States today, and who may have significantly different patterns of disease and health care needs. The report contends that these projected demographics call for two parallel responses: enlisting greater numbers of minority physicians into the work force; and training all physicians to become culturally competent to care for all populations. Physicians must learn appropriate communications skills, understand ways to identify health beliefs in different groups, and understand the barriers and biases that limit access to health care systems.

The Health Status of Minority Populations

Black Americans, Mainland Puerto Ricans, Mexican Americans, and American Indians/Alaska Natives have some of the worst health indicators among U.S. population groups. Some indicators of poorer health status, which vary by and within specific minority populations, include lower life expectancy, greater prevalence of chronic diseases, and poorer outcomes for pregnancy. In addition, minorities obtain some technological and surgical procedures and routine health care preventive services less frequently than whites do. The report contends that physicians from racial and ethnic minority groups can help improve access to care for minority groups. These minority physicians are more likely than white physicians to practice in underserved areas and are more likely to care for minority, poor, underinsured, and uninsured persons. At the same time, to adequately serve the diverse minority population, all physicians need to be appropriately trained in cultural competency.

Table 1 - Selected Health Indicators by Race/Ethnicity, 1995

	White	Black	Hispanic	American Indian/ Alaska Native1	Asian Pacific American
Infant Mortality Rate2 % Live Births w/ Prenatal Care in First Trimester Life Expectancy at Birth (M/F, years) Age-Adjusted Mortality Rate3	6.3   83.5   73.4/79.6   477.6	14.9   70.3   65.4/74.0   758.6	6.9   70.4   NA   378.7	8.8   62.0   73.2*   594.1	5.5   77.6   NA   293.2