Last week, we went over a lot of information on the health disparities that the Latine community faces in the United States. For the second part of MURAL's healthcare series collaboration with UConn Medical School's LMSA, we will address Latine representation, or lack of, in the healthcare field, as well as its importance, barriers to diversity, and ways to improve Latine representation in these fields. Impact of the lack of Diversity Before diving into statistics and numbers, let's discuss the importance of representation and diversity in health care. There are many reasons why diversity should be a priority for health care fields, four of which we believe are vital. These are (1) cultural competence, (2) access for underserved communities, (3) a broadened research agenda, (4) to improve the future management of the healthcare field (Cohen, Gabriel & Terrell, 2002). Diversity in the healthcare field would lead to a culturally competent workforce. By 2050, more than 50% of the United States will be Latine/Hispanic, Black, Asian, or multi-racial. This pushes for a need for a health care force that understands the communities they are serving. By cultural competence, we mean the "knowledge, skills, attitudes, and behavior required of a practitioner to provide optimal health care services to persons from a wide range of cultural and ethnic backgrounds'' (Cohen, Gabriel & Terrell, 2002). Health care providers have to understand what different belief systems our communities have, and how to help them while treating their illnesses. Cultural competency is not something that can be learned from reading books. To achieve it, health care providers must be in environments of whichever diverse community they will serve to interact with individuals from different ethnic and racial backgrounds. This is made more effective by having people from these very same diverse communities within the providers, helping others understand. Access for underserved populations will also be improved with a more diverse health care field. The United State's health professions shortage areas are those that are populated predominantly by Black and Latine/Hispanics. Members of these communities who do gain access to health care often receive lower quality care and face discrimination, whether biased or not, when being treated. Data shows that Black, Latine/Hispanic, and Native American physicians are more likely than white physicians to practice in underserved communities, and to treat more minority patients regardless of their income (Cohen, Gabriel & Terrell, 2002). We also know that when patients and health care providers share racial and/or ethnic backgrounds there is a higher rate of satisfaction for patients. This data suggests that a more diverse health care field would reduce the lack of access for minority communities in the United States. Increased representation would create more advocates for broadening health research. As we learned in the first section of the health care series Latines are disproportionately affected by unsolved health problems. There is a strong need for medical research in these fields, but not enough of a push for them despite the large number of the U.S. population that suffers. This research would also include trials, and to have successful trials there would need to be participation from the Latine general public. Having health care providers that share ethnic and racial backgrounds would encourage more people to trust in this process and partake in studies. Lastly, diversity in health care professions would increase the amount of Latine representation in related health care administration jobs. Policy makers and medically trained executives are crucial to managing the health care system. They hold the power to influence governmental efforts that address health care issues in U.S. populations. Therefore having people who reflect the populations they serve, Latine, Black, Asian, and Native American, would be beneficial in leading future efforts towards the right path that helps those they are meant to serve. Current Number of Latines in Healthcare in the United StatesNow let's dive into some numbers. In the figure below, you can see that the majority of applicants to medical school for the academic year of 2018-2019 were white (49%), compared to 6.2% for Hispanic, Latine or of Spanish origin. This came to a total of 3,297 Latines applying for medical school in that year. The figure below breaks down what the backgrounds of the 3,297 applicants look like. Looking closer at medical schools, we see that 63.9% of full-time faculty were white, with only 3.2% of full time faculty being Latine in the same academic year. Even more distressing, the percentage of active physicians in 2018 for whites was 56.2% compared to the 5.8% of Latines. In numbers, this is a total of 516,304 white doctors compared to 53,526 Latine doctors for the entire United States Population. Clearly, there is a deafening lack of Latine representation in physician positions. Barriers for Underrepresented Minorities in Health ProfessionsThe lack of representation in the healthcare field is due to a wide range of barriers. UCSF did a literature review to identify the key barriers. One of the most prominent barriers was the financial cost of entering the healthcare field. Minorities are more likely to have lower socio-economic status, with the median income for Latine households being $47,675 compared to $64,041 for non-Latine White households. This has a huge impact on student's ability to attend 4-year colleges, with 48% of qualified students not going because of financial barriers. In addition, the length of schooling worsens the financial barrier. To receive a medical degree to be a physician, students must attend school for 8 years, meaning many will accumulate debt for those years and no way to pay it off until graduation from medical school. In addition to financial barriers, underrepresented minority (URM) students are less likely to be prepared for the rigorous class load due to weaker high school classes. As a result, they typically have lower GPAs in undergrad, lowering their chances for medical school admissions which are strongly based on GPA and standardized test scores. Additionally, URM students are less likely to access admission test resources due to how expensive these can be. The underrepresentation in medicine alone is a barrier, as there is a lack of mentors for these students. One individual in the study emphasized this point: “One thing medical school is good at is beating you up…if you have mentors that look like you, it’s a sign of hope and is very powerful.” Having racially diverse mentors helps students balance their academic and social needs. In addition, students may feel like they may have to "prove themselves" because of stereotype threat. Being one of the few minorities in the classroom can make one feel uncomfortable and feel the need to show they "deserve to be there". This can have a huge impact on if a student feels mentally prepared to go to a graduate program, despite having all the criteria to be successful. Most importantly, the lack of exposure to health care careers plays a huge role. You can't become what you don't know. Most families don't have doctors in their social networks and if you only have contact with healthcare professionals when you go to your doctor, then you aren't going to be aware of the opportunities that the career has to offer. In addition, they may have difficulty accessing internships which are a huge part of the admissions process. This is added to by poor advising. Pre-health advisors are often unaware of resources for URMs, and often discourage students with low grades from applying, which as stated previously impacts minority students greatly. Ways to Increase RepresentationAfter knowing these barriers it is important to address them to increase URMs in healthcare fields. The earliest intervention can be in elementary and high schools with large minority populations. There are several programs where students from health professional programs and health professionals volunteer to talk with these students and teach them about the many healthcare career opportunities. This early exposure introduces interest at a younger age and helps students develop goals.
There are also institutional changes that should occur in each institution to increase support for minority students: Academic support: Tutoring, admissions test preparation, summer enrichment programs Emotional support: Access to counseling services, workshops for families Financial support: Scholarships, paid internships, loan repayment, assistance with child-care and transportation Social Support: Peer, faculty, alumni, and community mentorships These also include building bridges between high schools with large URM populations and colleges to help support the transition into rigorous coursework and improve grades. Lastly, as representation increases in the healthcare field and increase in important mentorship will increase as well, helping students on their career path. Organizations like LMSA also help greatly. LMSA is an org founded to represent, support, educate, and unify US Latine medical students. Located all over the country it aims to provide mentoring, a voice, leadership, advocacy, and volunteering within the Latine community. This includes helping high schools students, pre-med undergraduates and medical students. To learn more about the mission and opportunities of LMSA visit http://national.lmsa.net/.
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AuthorsPaula Norato - MPA Student at The University of Connecticut, with a Bachelor of Science in Molecular and Cell Biology, minor in Latino Studies. ArchivesCategories |