Poor Representation of Blacks, Latinos, and Native Americans in Medicine

摘要

Background and Objectives: In this article, the authors discuss how various systems in medicine are limiting representation of blacks, Latinos, and Native Americans. Flat and decreasing percentages of Underrepresented Minorities in Medicine (URMM), especially in the black and Native American populations, is concerning for family medicine since members from URMM groups care for minority and underserved populations in greater numbers. Underrepresentation is not only noted in the medical community but also in our medical schools when it comes to numbers of URMM faculty. The changing definition of “disadvantaged” in medical school admissions has also played a part in limiting URMM representation. In addition, the Medical College Admissions Test (MCAT) excludes black, Latino, and Native American students in greater numbers. The authors support these arguments with evidence from the medical literature. Although unintentional, these systems effectively limit representation of blacks, Latinos, and Native Americans in medicine. Effective changes are suggested and can be implemented to ensure that URMM individuals have equal representation in careers in medicine.(Fam Med 2015;47(4):259-63.)In “Accommodating Bigotry,” an opinion piece recently published in JAMA, the author discusses patients’ refusal of care by clinicians solely on the basis of race or culture. The article is nuanced and well crafted, and the author concludes that, in some circumstances, patient-centered care can justify tolerating bigotry.1 Accommodating bigotry in the medical encounter, however, can reinforce behaviors and systems in medicine that exclude persons of color from both academic medicine and medical practice in general. In short, these systems and behaviors can limit opportunities for black, Latino, and Native American physicians and students. Academic medical systems can also limit Underrepresented Minorities in Medicine (URMM) participation by concentrating leadership, higher salaries, academic faculty positions, and medical student representation in the non-URMM population. The absence of URMM faculty has a negative effect on all medical students and faculty. These negative effects include limited exposure to underserved care, reduced research with minority patients, and fewer mentors for URMM students. Pipeline programs depend on URMM faculty who provide support for URMM students in the form of role models, educators, and mentors.2 Since URMM faculty teach students to care for underserved/minority patients by caring for those patients themselves, their relative absence among the faculty also has a negative effect on patient care. Increasing URMM faculty can in turn increase the quality of health care, as diversity of experiences creates a more effective physician workforce. This essay will discuss systems and behaviors that make it difficult for URMM students and faculty to participate in medicine. We will examine four systems that limit URMM participation in medicine: Medical Faculties, Disadvantaged Status, Admissions Testing, and the Dismantling of Affirmative Action. We will define URMM as black, Latino, or Native American. We will also define Latino as those whose origins are in the Spanish-speaking countries of Africa and the Americas.Medical Faculties