On days when she wonders if she will ever survive medical school, Jessica Nunoz has 30 Hispanic and black classmates at the University of California at Davis to turn to for support.
If she had entered the university’s medical school this year, only three out of the first-year class of 91 medical students would belong to one of those ethnic groups."I would have felt so much more alienated,” says the fourth-year student, who goes out of her way to hug and encourage the only two Hispanic women in the first-year class.
The situation at Davis reflects a national trend. After several years of growth, the number of"underrepresented” minority students -- those who are black, Mexican American, or American Indian -- starting medical school has declined in the past two years.
The University of Texas Health Science Center at San Antonio, which enrolled 47 new underrepresented minority students in 1995, had 31 in 1996. New York Medical College went from 10 to 3 in the same period.
The national decline from 1995 to 1996 was 5 per cent, according to the Association of American Medical Colleges. The trend was particularly striking in California, which saw a 19-per-cent drop.
“The substantially decreased enrollment of minorities in California schools is a red flag for the medical profession that 30 years of work to achieve a truly diverse work force of physicians is in serious danger of collapsing,” says Jordan J. Cohen, president of the association.
Dr. Cohen, in a speech in November to his group’s annual meeting, said recent bans on affirmative action in California and Texas could have serious consequences, because those states include about a third of the nation’s underrepresented populations.
In other states, he says, admissions committees, wary of lawsuits, are tiptoeing around the diversity issue. Some observers say medical schools that just a few years ago were admitting minority candidates with marginal grades and test scores are now apparently rejecting those same applicants.
“It’s pretty clear the anti-affirmative-action climate is having an effect,” says Timothy Ready, an assistant vice-president of the medical-college association.
He concedes that the group is unlikely to reach its goal, set in 1991, of enrolling 3,000 new, underrepresented minority students in a single year by 2000. That would translate to 19 per cent of all new medical students -- a proportion that matches their share of the total population in the United States.
In 1995, members of the minority groups made up 12.4 per cent of all new medical-school students, compared to 9.6 per cent in 1991.
In the first few years of"Project 3,000 by 2000,” with big jumps in the enrollment of underrepresented minority students, the association’s goal seemed realistic. Only in the past few years have the numbers begun to level off and even to decline.
Many of the association’s efforts, such as encouraging partnerships among medical schools, universities, and public schools, are long-term projects, designed to increase the number of minority candidates in the pipeline.
But some medical educators argue that it is unrealistic to expect significant increases in the numbers of minority medical students, because the supply of qualified applicants is not large enough, and colleges are already using affirmative action to give those applicants extra help. Of applicants accepted to medical schools for enrollment in 1995, the average score of black students on the Medical College Admission Test was 7.6 out of a possible 15, while Mexican Americans had an average of 8.5, and white students an average of 9.9.
“There are some very strong underrepresented minority students out there, and they’re being wooed by everyone,” says Barbara Rupp, director of admissions for the University of Rochester School of Medicine."We get who we can, but we’re having to make tough decisions about the other candidates, who aren’t as strong. We don’t want to bring people in who aren’t going to succeed, and we don’t want to dilute the academic integrity of our program.”
Other educators say that while the pool of minority medical applicants is relatively small, that is no excuse for failing to aggressively recruit a diverse student body.
“That’s the most ridiculous, time-worn excuse. Creating a diverse student body is not really that difficult to achieve if you have support from the top,” says James L. Phillips, associate dean of the Baylor College of Medicine."Students have to know there is someone high up who will go to bat for them.”
Dr. Phillips, a black physician whose parents did not complete elementary school, makes a personal effort to recruit students from disadvantaged backgrounds and to see that they feel comfortable at Baylor. Over the past two years, at the same time that minority enrollment was dropping nationally, first-year enrollment of underrepresented minority students at Baylor doubled to 38 students, or 23 per cent of the class.
In one of its most successful recruiting tools, Baylor has worked with Rice University in running a six-week summer program for minority students who are interested in medical careers. Students spend mornings paired with Baylor physicians or researchers, and afternoons taking courses at Rice.
Second-year student Eric Miller decided to attend Baylor after learning of its extensive support programs for minority students."I felt that I could get a quality education a lot of places, but that I’d get more support here,” says Mr. Miller, who is black."Medical school is stressful enough. It’s important that you feel comfortable in your environment.”
First-year student Paula Lee decided to attend Baylor after Dr. Phillips and his wife visited her in Boston and took her out to dinner."When he called, I thought something was wrong with my application. That kind of personal attention means a lot.”
Ms. Lee has dozens of minority classmates, unlike medical students on many other campuses. At the University of California at Davis, for example, Roxanna Martinez was dismayed to find out that she was one of only three medical students from underrepresented minority groups in her class.
“Everyone’s pretty overwhelmed here, but there are times when I just want to sit down and talk about my family to someone I can really relate to,” says Ms. Martinez, whose parents are from Guatemala."It’s pretty upsetting.”
It’s disturbing, also, to Davis administrators, who point out that although 37 underrepresented minority applicants were accepted to the 1996-97 class, only three enrolled.
Davis officials say that the University of California Board of Regents’ disapproval of affirmative-action policies has discouraged many students from attending medical school in California, and that the problem will grow worse with the November passage of Proposition 209, an even more sweeping prohibition of affirmative action. Neither ban has been enforced yet because of various court challenges, but some university officials believe that the mounting attacks on affirmative action are making many minority students feel unwelcome in California.
“Our school has been very successful in the past recruiting underrepresented minorities, so to have this kind of decline is very disappointing,” says Edward D. Dagang, director of admissions for the Davis medical school.
Davis isn’t alone in its frustration over the limited number of minority students applying to medical schools.
As the nation’s minority population continues to grow, medical colleges have a moral responsibility to produce physicians sensitive to the needs of those groups, argues Dr. Cohen, of the medical-college association.
Dr. Cohen cites studies by his organization showing that minority physicians are more likely than their white counterparts to work in low-income areas of the United States.
Thirty-nine per cent of the 1995 medical-school graduates belonging to underrepresented minority groups said they planned to work in poor areas, compared with 10 per cent of other graduates.
Jerry Estep, a second-year medical student at Baylor who grew up in El Paso, says he can relate to some of the insecurities felt by other Hispanic men about health care.
“My grandfather was scared to death of physicians, and the language barrier just made it worse,” he says."A lot of males don’t want to go to a doctor. It’s almost a macho thing. Someone who understands the culture is going to be better able to reach them.”
Daniel Delgado, a fourth-year medical student at the University of California at Los Angeles, says Hispanic patients often find his presence comforting.
At a clinic recently,"I had patients waiting to see me who recognized me as their doctor even though I’m not really a doctor yet,” he says."One mother told her son, ‘He’s Latino like you, and he’s going to speak Spanish with you.’”
Mr. Delgado readily acknowledges that his ethnic background -- his parents are from Peru -- probably helped him get into medical school."I don’t think I was part of a quota, but I think being part of an underrepresented group was considered,” he says."It dismays me to think that other people won’t be given that opportunity to shine.
“One of the main reasons I want to be a pediatrician is so that I can be a role model,” Mr. Delgado adds. The little boy he treated at the clinic might grow up being a little less fearful of doctors, he says -- and might even think of becoming a doctor himself.