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Developing Racial and Ethnic Diversity in Iowa’s Physician Workforce – Recruiting Minority Students and Faculty

Des Moines University College of Osteopathic Medicine

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Presenters:

Carolyn Beverly, M.D., M.P.H.

Assistant Professor, Family Medicine

Medical Director, College of Health Science

Project Director

Mary Pat Wohlford-Wessels, Ph.D.

Associate Professor, Family Medicine

Assistant Dean, Academic Quality and Medical Education Research

Project Associate

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Objectives

This presentation has two primary objectives:To provide session participants with an

overview of minority student admissions and enrollment, along with minority faculty data and

To present an overview of DMU’s funded minority recruitment project

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Acknowledgement

This project was made possible by grant number

1 D1DHP06382-01-00 from the Bureau of Health Professions, Health Resources and Services Administration, U. S. Department of Health and Human Services.

DMU’s proposal was funded through the Iowa Department of Public Health.

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Diversity at Des Moines University Like all post-secondary educational institutions

in Iowa, Des Moines University (DMU) has experienced some challenges in recruiting and retaining a well qualified diverse student population.

The same challenges exist with hiring an appropriately diverse faculty in the University’s College of Osteopathic Medicine (COM.)

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Diversity in Medical Education Two data sources were used to develop the

background for this project and presentation – the AACOM Annual Report & the AAMC Minority Report

The AACOM 2004 Annual Report indicates that: Underrepresented minorities (Black/African American,

Hispanics and Native Americans) have kept pace with, but not gained on other groups in terms of enrollments. Students from the Asian/Pacific Islander minority group have steadily increased their share of first-year and total enrollment.

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Diversity in Medical Education Underrepresented minorities were 8.3% of

total first-year enrollment in 2003-04, somewhat below the level of a decade ago. Asian/Pacific Islanders have increased their share of first-year enrollment from about 10% to more than 15% over the decade.

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Diversity in Medical Education

A similar pattern exists in total enrollments, with underrepresented minorities generally maintaining a level share, and the Asian/Pacific Islanders’ share rising to its current level of 15.4% of total enrollment.

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Osteopathic Medical School Enrollment - Total Enrollment of Ethnic Minority Groups by School (03-04)

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Osteopathic Medical Schools - Total Enrollment of Ethnic Groups 1994-2003

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Diversity in Medical Schools AAMC Data

Source: Minorities in Medical Education; Facts and Figures 2005

In 2004, Blacks constituted 7.8% and Hispanics constituted 7.1% of all applicants. Of all minority applicants in 2004, Asians were the largest group (nearly 19%).

In 2004 nearly half (49.4%) of all applicants to medical school were accepted. Of the total number of Hispanic applicants 48.8% were accepted, and of Black applicants, 41.3% were accepted.

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Medical School Applicants by Race and Ethnicity, 2004 - AAMC

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Medical School Applicants by Race and Ethnicity, 1974 – 2004 AAMC

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Total Enrollment by Ethnic Group (03-04)

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Medical School faculty by Race and Ethnicity – AAMC 2004

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Medical School Faculty by Rank within Race and Ethnicity - 2004

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In Summary - National Issues Medical Schools have made significant

investments in minority student recruitment, yet the yield is less than expected, this is especially true for underrepresented minorities.

The same old recruitment strategies have not worked – medical schools may need to invest in innovative programs.

Medical Schools do not have sufficient minority faculty mentors – in the basic sciences or among clinical faculty.

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Minority Population and Practicing Physicians in Iowa

Race % of Population in Iowa

% of Physicians in Iowa

AfricanAmerican

2.0 1.2

Hispanic 4.6 0.9

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Enrollment in Iowa’s Medical Schools

University of Iowa Des Moines University

Class Size 2002 142 202

Class Size 2005 142 217

Under represented minority (2005)

14% 4%

Other Minority (2005) 7% 16%

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DMU’s Funded Recruitment Project

Two Objectives:Student Recruitment

African American & HispanicPhysician Recruitment

African American & Hispanic Lecturers Clinical Preceptors Mentors

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Student Objective – Two ComponentsFocus Group Research and Survey Research

Focus Group Research – to determine student perceptions related to :being a minority. the importance of having minority faculty and

preceptors. the three most important determinants in

selecting a medical schoolsolicit feedback to be used in the

development of a survey instrument

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Focus Group Themes Regarding Student Perceptions

Hispanic vs. African American Students perceptions A parent or teacher had significant influence on the

students decision to attend medical school Wanted to be perceived as excellent students, rather

than minority students Little identification with their minority status Didn’t feel the need to be connected to a minority

community Generational Passion (facilitator vs. student expressed

passion)

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Survey Questions – We Asked… Who had the greatest influence on your

decision to enter medical school? Which factors were most important to you

in choosing to matriculate at DMU? How important is it to you to have

opportunities to work with minority mentors during medical school?

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Survey Questions, con’t Thinking of yourself, as a student and in

the future as a practicing physician, how important are the following:your status as a member of a minority

populationyour ability to serve minority and/or

underserved populationsopportunities to be mentored by a minority

physician

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Results – Respondents Year

DMU has 25 underrepresented minority students

11 chose to complete the survey1st year = 27%2nd year = 45%3rd year = 0%4th year = 18%

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Results – Respondents by Ethnicity

Hispanic = 36% Black = 45% Other = 18%

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Question: Many factors influence students decisions to become a physician, of the factors listed, please indicate how much influence each factor had on your decision to pursue a career in medicine?

1 = no influence 2 = some degree of influence 3 = moderate degree of influence 4 = great degree of influence

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Influence to become a physicianDescriptive Statistics

11 3.0909 .70065

11 3.0000 1.26491

11 2.8182 1.32802

11 2.6364 1.12006

11 2.3636 1.02691

11 1.6364 .80904

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Influence of sciencecourse

Influence of parent

Influence Health RelatedWork Experience

Influence of physician

Influence Experiencewith an illness

Influence Teacher

Valid N (listwise)

N Mean Std. Deviation

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Influence to become a physician

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Influence – AAMC 2004

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Question: When you think about the reason you chose to attend DMU, what factors were most important to you?

1 = unimportant 2= of little importance 3 = moderately important 4 = very important

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Reason Student Chose DMUDescriptive Statistics

9 3.7778 .44096

9 3.4444 .72648

10 3.1000 .99443

10 3.0000 .94281

11 3.0000 .77460

11 2.6364 1.20605

10 2.6000 1.07497

11 2.4545 .82020

9 2.4444 1.01379

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Chose DMU -Friendliness

Chose DMU - Reputation

Chose DMU - TeachingMethods

Chose DMU - Curriculum

Chose DMU - Ablitiy toplace Residents

Chose DMU - Location

Cose DMU - CommunityExperience Opportunities

Chose DMU - Cost toAttend

Chose DMU - MulticulturalAffairs Department

Valid N (listwise)

N Mean Std. Deviation

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AAMC 2004 data

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Question: How important is it to have opportunities to work with minority mentors during medical school?

1 = unimportant 2 = of little importance 3 = moderately important 4 = very important

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Minority MentorsDescriptive Statistics

10 3.6000 .51640

10 3.5000 .52705

11 3.2727 1.19087

11 3.1818 1.16775

11 3.1818 1.25045

11 3.0909 1.22103

11 2.7273 1.19087

11 2.7273 1.27208

11 2.6364 1.02691

11 2.6364 1.28629

11 2.4545 1.21356

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Importance of being ableto serve minoritypopulations in the future

Importance of being ableto work in anunderseerved area

Importance of serving asa minority physicianmentor in the future

Importance of beingmentored by a minorityphysician

Importance of minorityclinicians during years 3& 4

Importance of minorityclinicians duringthroughout the curriculum

Importance of beingconsidered a minority asa physician

Importance of minorityclinical faculty

Importance of beingconsidered a minority asa student

Importance of minoritybasic science faculty

Importance of minorityresearchers

Valid N (listwise)

N Mean Std. Deviation

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Question: When you think about the curriculum, do you believe there is sufficient content regarding minority health and cultural competence?

100% said “no”

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Summary

I’m not sure we know what prospective minority students want and expect.

More information is needed to determine the best recruiting strategies, what we’ve invested in hasn’t produced a difference in yield.

Some schools are doing a great job, and we could learn from them.

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Physician Recruitment Objective

Physician Recruitment—add five additional physicians to our adjunct faculty

African American & Hispanic

LecturersClinical PreceptorsMentors

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Physician Recruitment

Choice of underrepresented minorities targeted

IA Chapter of the National Medical Association

Prominent Hispanic physician in Des Moines

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Physician Recruitment

Methods chosen to find these minority physicians:

Contacting medical societiesChecking current DMU adjunct faculty listWord of mouth INMA membership directory

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Physician Recruitment

Initial plan:

Develop more culturally appealing recruitment documents

Group presentation at the next INMA meeting--result

Face to face with Hispanic physician--result

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Physician Recruitment

Second Plan

Face to face individual meetings with a meal—result

Time and labor intensive work for one person--result

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Physician Recruitment

Third PlanEUREKA!!! Dr. Wohlford-Wessels locates

one source in IA that keeps an extensive database of physicians that includes race-ethnicity

Provides us with 81 black names and addresses and 32 other that appear to be Hispanic

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Physician Recruitment

Some of the black names were duplicates but none of the other names were.

We then sent out a mass mailing with recruitment information to everyone on the list.

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Physician Recruitment Results to Date

1st plan Group

2 expressed interest

Face to Face

1 signed up as preceptor

2nd plan Face to Face

One signed up for preceptor or lecturer

3rd plan 3 contacted me with interest

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Solutions to Recruitment and Retention For years educators have spoken about

the need to increase the number of minority students applying to medical schools to decrease health disparities in health care.

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Solutions to Recruitment and Retention The question yet to be fully answered is:

How best is that done?Creating long-term solutions by creating

pipelines within our K-12 schools will make minority students more skilled in sciences and math

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Recruitment and Retention (R and R) Issues for Faculty

For faculty, the following are often cited as reasons for unsuccessful R and R efforts:Feelings of isolation of facultyPaucity of other faculty of color Insufficient mentoring and guidanceResistance from students and colleaguesDisproportionate demands for informal

advising and committee work

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Solutions to Recruitment and Retention We must take long-range ongoing

processes to success—not a single event. The advertising and interviewing process

must be sophisticated and posting must be able to reach minorities.

Strong leadership and accountability are important in recruiting faculty.

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Solutions to Recruitment and Retention Faculty search committees need to be

educated about best practices for proactive faculty search processes that identify a diverse yet outstanding applicant pool.

Dual career issues should be addressed carefully.

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Solutions to Recruitment and Retention ALWAYS be searching—networking at

conferences and meetings is important. Review your publicity materials—are they

inviting to people of color as well? Ensure you have a diverse search

committee—going outside of the campus if possible and necessary.

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Solutions to Recruitment and Retention Do not forget the Historically Black

Colleges and Universities or even local universities.

Regularly evaluate your success at recruitment efforts and success in hiring and retention—if possible try to learn why someone is moving on.

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Summary

Efforts in the past have been less than successful – for both the recruitment of students and faculty.

Underrepresented students may need assistance to be more competitive in math and science.

We need to engage students at a very young age.

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Summary

Minority physicians must be identified and sought to serve as mentors and role models.

Used “mixed methods” to recruit students and faculty

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Thank You!