Developing the Health Professions Pipeline: Now or Never

AMHPS Developing the Health Professions Pipeline: Now or Never Introduction and Background The Minority Health Workforce Consortium is a group which grew out of a need identified during the Association of Minority Health Professions Schools, Inc. (AMHPS) 2007 strategic planning process. AMHPS is a consortium of the nation s historically Black graduate health professions schools in the areas of medicine, dentistry, pharmacy, and veterinary medicine that seeks to improve the health status of African- Americans, other minorities and the disadvantaged by advancing health professions education, research, and service programs. During its 2007 strategic planning process, AMHPS identified an urgent need to address the dwindling number of students of color who are both academically prepared and committed to the health professions and sciences as a career choice. 1 To more effectively address this problem and reverse this trend, AMHPS convened a group of organizations with similar missions in order to leverage their collective brainpower and resources to address the current and future under-representation of students of color in the health professions and sciences. This group collectively known as the Minority Health Workforce Consortium consists of seven national minority organizations: Association of American Indian Physicians, Association of Minority Health Professions Schools, Inc., National Hispanic Medical Association, Asian & Pacific Islander American Health Forum, Hispanic-Serving Health Professions Schools, National Association of Medical Minority Educators, Inc., and Network of Ethnic Physician Organizations. These groups represent educators, students, advisors, and health professionals covering the entire educational spectrum from K-12 to college to health professions schools. Although Consortium member organizations are focused primarily on health professions, the vast experience of Consortium members led them to conclude that in order to increase minority presence in the health professions, it was necessary to focus on the pipeline of students who could assume those roles in the future. In part, this conclusion reflects the acknowledgment that the number of minority students entering the health professions has not dramatically increased--despite years of multiple programs designed to address this shortage. 2 In 1987, African Americans, American Indians/Alaska Natives and Latinos represented only 4.9% of practicing pharmacists, 9.2% of physicians, 5.4% of dentists, less than 4.0% of veterinarians, and 10.4 % of registered nurses. 3 This percentage was disproportionately lower than the 20% of Association of Minority Health Professions Schools, Inc. 1190 West Druid Hills Drive, Suite T-50, Atlanta, GA 30329 www.amhps.org 1 1

African Americans, American Indians/Alaska Natives and Latinos in the United States population. 4 Twenty-one years later, there have been only modest gains. In 2008, African Americans, American Indians/Alaska Natives and Latinos represent just 11.2% of practicing pharmacists, 11% of physicians, 8.5% of dentists, 8.1% of veterinarians, and less than 14.7 % of registered nurses. 5 This percentage of minority health professionals is disproportionately lower than the 28% of African Americans, American Indians/Alaska Natives and Latinos in the United States population and represents only a marginal increase in over two decades. 6 In part, this conclusion reflects the understanding that even if students enroll in health professions schools, they cannot succeed if they are not adequately prepared academically at earlier stages of their education. 7 Consortium members realized the necessity of looking at the pipeline that leads to health professions education. Given the nature of educational building blocks, it would not suffice to look only at the educational level immediately preceding health professions schools, viz., undergraduate college. The educational pipeline extends back much further to high school and even middle and elementary school. In addition, while acknowledging that many other factors influence the student pipeline--social, economic, family, community, etc. the Consortium decided to address only the educational issues. Thus the goal of the Consortium was to develop a blueprint for systemic change that would produce students of color who are academically prepared to successfully pursue careers in the health professions and sciences in general. The issue of minority under-representation in the health professions has been examined many times by other groups. The Consortium wanted to build on the previous efforts of these groups. In particular, the Consortium endorses previous reports documenting that the impediments to increasing minority representation in the health professions are complex, varied and occur at multiple stages of the educational continuum. The Consortium endorses those recommendations as a necessary part of a comprehensive approach. Nevertheless, whereas previous reports 7, 8 proposed recommendations for interventions at multiple levels (e.g., K-12, college, health professions schools), the Consortium sought to determine the single educational level offering the greatest opportunity for maximum impact. After reviewing the extensive literature and looking at numerous best practices across the country, the Consortium made the judgment that the single best stage for educational interventions is at the K-5 level. Although focusing exclusively on one segment of the educational continuum, the Consortium recommendations are multifaceted, offering different kinds of interventions affecting K-5 education. II. RECOMMENDATIONS Local school districts and educational institutions should implement definitive outreach initiatives and programs to improve the quality of science and math education at the K-5 level Local school districts and educational institutions should partner with health professions schools, health professions associations, businesses, corporations and political leaders to: ο develop and support K-5 health ο magnet schools introduce students to the health professions and provide mentoring opportunities for those pursuing health professions Federal and state Departments of Labor, Education, and Health and Human Services should develop plans to jointly 2

III. address pipeline issues with coordinated and comprehensive collaborative strategic plans and efforts Rationale for Recommendations Early intervention. Consortium members began with the acknowledgment that no matter what interventions they made at the level of health professions education, minority presence in the health professions would never increase as long as the number of academically prepared minority students entering health professions schools remained at its current low level. Thus the Consortium decided not to focus on health professions education per se, but rather to look at the academic preparation and health careers exposure of minority students prior to entry into health professions schools. Consortium members understood that the academic preparation and health careers exposure of students take place over a long period of time, beginning at the earliest educational stages. In science, more than many other disciplines, the ability to succeed at a given level is dependent on the knowledge and skills acquired at the previous level, and the ability to succeed at that level is built upon that acquired at an even earlier level. In a kind of reverse domino effect, the ability to succeed (or even matriculate) in the health professions depends on having acquired the requisite knowledge and skills in college. By the same token, college-level knowledge and skills cannot be attained unless the appropriate high school preparation has taken place. 8 The necessary high school courses in science and math cannot be passed without having learned the basic science and math concepts in elementary and middle school. In short, students minority or otherwise cannot succeed in health professions education unless they have acquired a solid foundation in science and math going back as far as the K-5 school level. This pedagogical analysis of the prerequisites for success in health professions education shows that without quality science and math education at the earliest levels, there will never be sufficient numbers of minority students entering health professions education to reflect their presence in the society or to meet the health needs of the increasingly diverse population in the country. A 2006 study by the Bayer Foundation reinforces this conclusion, finding that if students do not acquire interest in science by the 5 th grade, they are unlikely to do so afterwards. 9 Taken together, this demonstrates how critical quality math and science education are even at the earliest school levels. Although high quality K-5 science and math education is necessary, it is still not sufficient. Using the familiar image of an educational and human pipeline, there are so many leaks in the pipeline all along the way, that simply plugging leaks at the K-5 level could never by itself solve the problem of too few students entering the health professions. Ultimately, progress in addressing the underrepresentation of minorities in the health professions can only be achieved if the impediments at each and every level are successfully addressed. The Consortium also acknowledged the fact that multiple efforts to address various impediments at multiple stages over many years have still not succeeded in dramatically increasing the number of minorities entering the health professions. Consortium members were concerned that continued efforts of the same kind in the same way would produce the same results, viz., anemic and token presence of minorities in the health professions. Since the goal of Consortium members was to reverse this trend and increase minority presence, they looked for a different approach. 3

Consortium members acknowledge that educators have the opportunity to introduce students to science and math educational concepts to spark their scientific interest in the early educational stages specifically, the K-5 levels. Consortium members also agree that students who become hooked on science at this crucial educational juncture are more likely to continue their interest further along in the educational pipeline. Thus the Consortium members articulate that science and math education at the K-5 level be dramatically improved for all students, especially minority students. If we fail to capture the interest of students at that level, we are unlikely to capture it later. And if students fail to acquire the foundations they need for later study, their success in subsequent educational stages is significantly impeded. The Consortium proposes a new beginning in which the first step of hopefully many others will be bolstering K-5 science and math education. While Consortium members realize that this intervention alone can not solve the problem of minority underrepresentation in the health professions, they believe that we cannot continue on the path we have traveled for the last few generations. That path has produced too few students with the commitment and the academic preparation needed to succeed. 10 To break out of that pattern we must begin somewhere and K-5 has been shown to be a crucial stage. Clearly, any investment of resources at this level human or financial will take years to bear fruit and will bear fruit only if similar investments are made at every level following K-5 up through health professions schools themselves. But it is equally clear that if we do not begin anew now, then the future prospects will be as bleak as the present. The Consortium believes that ultimately, a comprehensive strategy implemented at multiple intervention levels is required to permanently address this crisis. In the interim, implementing well-thought-out and focused interventions at the K-5 education level, and then building on their success, will make measureable and significant progress. Partnerships and Collaboration. The overarching theme underlying Consortium recommendations is partnerships and collaborations which come into play in multiple ways. The Consortium believes that although developing the requisite knowledge and skills is essential, students need other things as well things that cannot be provided by classroom learning alone. Career awareness. Knowledge and skills are not enough. As part of teaching basic STEM disciplines (Science, Technology, Engineering, Math), schools must also introduce students to the idea of careers in health professions. Such career awareness must begin early and continue at every educational level. This can be done in many ways, but one of the best is to have students meet and get to know people who are themselves engaged in those professions. And while career day activities are good as far as they go, opportunities for shadowing or internships are far better ways for students to really see what life is like as a physician, dentist, pharmacist, veterinarian or a nurse. This is where partnerships between schools and local stakeholders (like hospitals or medical societies or the department of health) are especially valuable. Role models and support. Students need the support and example of role models minority or not--both successful adults and other students interested in sciences. Having contact with practicing professionals e.g., through a mentoring program can do a lot to sustain students through a long term educational process. Multifaceted approach. Because the factors affecting the student pipeline are 4

multidimensional (educational, social, economic, family, community), schools are not capable of solving these problems working in isolation, focusing only on educational issues. The larger context must be taken into account. Thus partnerships between schools and other stakeholders, sectors and organizations are essential. For example, local businesses have a great stake in having a well educated and trained workforce and thus a vested interest in the quality of the graduates from local schools. All Education is Local. Just as all politics is local, so is all education witnessed by the existence of more than 15,000 local school districts nationwide. As a result, respecting the uniqueness of each school system, the Consortium refrained from offering detailed recommendations, opting instead to present general proposals and leaving the details to local educators and stakeholders who can adapt the general goals and ideas to their unique situations. IV. Concluding remarks The Consortium acknowledges that this white paper leaves many important issues unaddressed. This is deliberate. The aspiration of this white paper was to step back from the status quo of past interventions and to look as broadly as possible at the big picture goal of increasing the presence of minority students in the health professions. Thus, this white paper attempts to articulate a framework or blueprint for a fundamentally new approach to achieving this goal. The Consortium has consciously refrained from addressing issues like the resources human or financial needed for success. The Consortium believes that if a compelling case can be made for the recommendations contained in this white paper, individual stakeholders can address the complexities and specifics of what would be needed in their communities to put these recommendations into action. High level policy vs. grass roots concreteness. Some of the recommendations present practical, concrete, grass roots proposals that individual school districts could immediately implement in the short term on a school-byschool or district-by-district basis. Other recommendations present interventions at the level of policy that have the potential for greater change but which also can take a much longer time to enact, implement and produce results. At the policy level, the Consortium recommends that federal (and state) agencies work together to address this problem since it cuts across education, labor, and health and human services. A good example of such joint action is the recent joint statement from the Environmental Protection Agency and the Department of Transportation proposing how the two agencies will work together to reach higher fuel efficiency standards for U.S. made vehicles by the year 2016. AMHPS has been supported by a grant from the Kaiser Health Plan to conduct a series of collaboration meetings between like mission organizations to address the dwindling number of minority students who are academically prepared to enter the health professions and sciences. 5

Supported By The Kaiser Foundation Health Plan Oakland, California Kaiser Permanente is dedicated to improving the health of people living and working in the communities it serves. In 2007, Kaiser Permanente invested more than $1 billion to ensure access to health care and promote healthier lives. To accomplish its goals, Kaiser Permanente pays for medical coverage for the uninsured, fund local community health centers, and train doctors and nurses. It also promotes wellness by sponsoring programs in local communities that focus on prevention, healthy eating, exercise, and environmental improvement. In addition, Kaiser Permanente shares its research and experience because it believes that knowledge is powerful, and everyone should benefit from the latest advances in medicine. 6

List of Participants in the Healthcare Workforce Consortium Marie Soto-Green, MD President & CEO Hispanic-Serving Health Professions Schools Elena Rios, MD, MSPH President & CEO National Hispanic Medical Association Ho Luong Tran, MD, MPH Former President & CEO Asian & Pacific Islander American Health Forum Wilma Sykes-Brown, MA Immediate-Past President National Association of Medical Minority Educators, Inc. Medical College of Georgia Theresa M. Maresca, MD Association of American Indian Physicians Director Native American Center of Excellence Arthur Fleming, MD Chair Workforce Diversity Committee AMA Commission to End Healthcare Disparities; Network of Ethnic Physician Organizations Phyllis R. Champion, MA Chief Executive Officer Association of Minority Health Professions Schools, Inc. Citations (1) Institute of Medicine of the National Academies. (2004). In the Nation s Compelling Interest: Ensuring Diversity in the Health-Care Workforce. (2) The National Science Foundation, Division of Science Resources Statistics (SRS). (2006). Women, Minorities, & Persons with Disabilities in Science and Engineering. (3) Bureau of Labor Statistics, Employed civilians by detailed occupation, sex, race and Hispanic Origin: 1987. (4) U.S. Census Bureau, Statistical Abstract of the US: Populations estimates program, 1980-2000. (5) Bureau of Labor Statistics, 2007, http:// www.bls.gov/cps/cpsaat11.pdf. (6) U.S. Census Bureau, 2006 American Community Survey (7) Sullivan Commission. (2004). Missing Persons: Minorities in the Health Professions. A Report of the Sullivan Commission on Diversity in the Healthcare Workforce. (8) Hrabowski, F. A. and Summers, M. F. (2006). Preparing minority scientists and engineers. Science, 31(1), 1870-1871. (9) Bayer Corporation. (2007). Bridging the Diversity Gap in Science and Engineering: Introducing STEM Industries to K-12 Best Practice Programs. (10) Education Research Center. (2008). Cities In Crisis: Closing the Graduation Gap. For further information or questions about this paper, please contact: Phyllis R. Champion, MA Chief Executive Officer Association of Minority Health Professions Schools, Inc. 1190 West Druid Hills Drive, NE Suite T - 50 Atlanta, Georgia 30329-2121 678-904-4332 - phone 678-904-4496 - fax 7