Focus
Student Scene
October 28, 2002
 Tarayn Grizzard Photo by Jeff Cleary |
A Primary Dilemma for Underrepresented Minorities
The statistics are daunting: in the year 2000, 30 percent of the U.S. population was composed of minorities who are underrepresented among physicians and physicians-in-training in this country. Recent data shows that 12.4 percent of U.S. medical students are self-designated underrepresented minorities (URMs)--African American, Mexican American, Puerto Rican, or Native American. Though this percentage is an improvement on the early days of monochrome medical education, when minorities composed less than 2.5 percent of U.S. medical school students, there is still much work to be done to increase their enrollment.Underrepresentation is alarming because it suggests inequalities in school admissions and other arenas, and it may contribute to the disparities in health care between majority and minority communities. Medical educators and activists alike have argued for increased enrollment of URMs to improve care in these communities. Research has shown that minority students are more likely to enter the fields of pediatrics, general internal medicine, and family medicine than other specialties. Other studies have found that minority graduates are more likely to practice primary care and are far more likely to care for minority patients and accept Medicaid in their practices.
Trouble in Academic Medicine
However, there are further complex issues with respect to underrepresentation in medicine. URMs are especially underrepresented in surgery, radiology, and, more generally, in academic medicine. In 1995, only 3.9 percent of medical school faculty were underrepresented minorities, and those faculty were significantly more likely to describe "dissatisfaction" with their current career and to report considering leaving academia within 5 years. This underrepresentation is a problem in and of itself, but it also is problematic in that minority medical students frequently report a lack of role models and mentorship as a barrier in medical education. So URM students may be choosing primary care as a way to serve their communities, or they may be responding to an environment in which their only minority role models are primary care physicians.Breaking Ranks
This issue has become a matter of great importance with medical educators and URM medical students. For medical educators, the issue lies in creating an equal playing field for both nonminority and minority students, while for the students themselves, the issue often becomes more personal. Many minority medical students feel pressure to choose a primary care career, or at least feign serious interest in primary care, from the start of their medical training. I personally have heard from several different URM medical students, who, upon entering their third year, became interested in fields such as radiology and orthopedics but feel guilty for considering these options when they have their greater communities to think of, a responsibility many are reminded of frequently. Without role models and with social pressure from within medicine itself to provide care for the underserved minority communities, many URM students understandably opt for primary care because the decision to do otherwise does not seem to be ethically or personally tenable.Yet minority representation in these other fields does matter. Representing underserved minority communities in fields like surgery or radiology is a service in and of itself. At the very least, future URM medical students need role models in these areas in order to have greater access--perceived or actual--to these more elusive specialties. Also, minority patients in all areas of medicine should have the option of being treated by minority physicians, and all medical specialties should have the chance to benefit from the unique contributions of underrepresented minority physicians.
--Tarayn Grizzard, a third-year medical student at HMS
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.