Diversity in medicine can save lives. Here's why there aren't more doctors of color
Sabina Spigner says she's always known she wanted to be a doctor. But, as a premed student at the University of Pennsylvania, she found herself struggling to balance a heavy class load while also working as many as 20 hours a week.
"I was always working, because I didn't have money and I was a work-study student," says Spigner.
Her grades suffered as a result. In her junior year, she turned to her pre-med adviser for help. "She was like, well, you know, you're just not going to get into med school with that GPA, so I think you should consider something else. And she didn't really present me with many resources or options other than just giving up," Spigner says.
That conversation happened nearly eight years ago. Spigner — who is Black and Southeast Asian American — says when she recalled the experience on Twitter last month, "unfortunately, a lot of people shared similar stories."
"You know, this is something that's happening across the country and it's very, very common, especially for students of color, to experience discouragement," she says.
For decades, leading medical organizations have been trying to diversify the ranks of physicians, where Black and Hispanic doctors remain vastly underrepresented relative to their proportion of the U.S. population. That matters, because research has shown that people from underrepresented racial and ethnic groups can have better health outcomes when their doctors look like them.
But arecent study in the journal JAMA Health Forum highlights the factors, including financial pressures and discrimination, that can keep determined students of color from actually making it to medical school.
The study looked at responses from more than 81,000 students who took the Medical College Admission Test. The standardized exam is grueling: People study for it for months, if not years, says the study's first author,Dr. Jessica Faiz of the University of California, Los Angeles.
"You paid for the test. You took all that time to study. You are definitely quite committed to applying" to med school, says Faiz, an emergency physician and fellow with the National Clinician Scholars Program at UCLA.
Even so, Faiz and her colleagues found that Black and Hispanic test takers were significantly less likely to go on to apply and enroll in med school than white test takers. Not only that, but Black, Hispanic and Native American students were more likely to say they faced financial barriers, such as difficulty affording test prep materials and already having large student loans.
"Even further, they're more likely to face discouragement from advisers when applying to medical school compared to their white counterparts," says study co-author Dr. Utibe Essien, an assistant professor of medicine and health equity researcher at UCLA.
Another key finding: Black, Hispanic and Native American students were more likely to have parents without a college degree and more likely to go to a low-resourced college, which the researchers defined as a college with a less-selective admissions process and a majority of students living off campus.
Those factors "really trickle down to your social networks that are really integral in succeeding as a medical student," Faiz says. For instance, the study found that students of color were less likely to have shadowed a physician — an experience that can burnish a med school application. Faiz says that likely reflects a lack of the kinds of connections that make it easier to set up that kind of experience.
Essien notes that decades of research have found that patients of color can benefit from having a doctor of their own racial or ethnic background. For example, studies have found they were more likely to have received preventive care in the prior year and more likely to be satisfied with the health carethey receive.
For minorities, says Essien, "having a doctor who looks like you makes you more likely to accept flu vaccination, to have a colonoscopy, to consider having a more invasive heart procedure."
There's even striking new evidence that Black people live longer if they reside in counties with more Black physicians. But that new study came with a sobering discovery: A little over half of U.S. counties were excluded from the national analysis because they didn't have a single Black primary care physician. Faiz says that finding, which was published on the same day as the study she led, underscores why it's so critical to better understand the factors that keep students of color from med school.
Adds Essien: "We're not just advocating diversity out of the goodness of our hearts. It really, literally is saving lives."
Dr. Jaya Aysola is executive director of Penn Medicine's Center for Health Equity Advancement. She wrote a commentary that accompanied the study in JAMA Health Forum. Aysola says the study sheds much-needed light on the financial barriers and unconscious biases that can block the path to med school for students of color.
"From who advises you to submit an application to who then eventually helps select your application, to those who interview you, there's bias all along those processes," Aysola says.
As for Sabina Spigner? She didn't let her premed adviser's discouragement stop her from pursuing her med school dreams. She decided to pursue graduate school first. She ended up with two master's degrees — in science and public health — before heading to the University of Pittsburgh School of Medicine. When she graduates next month, she'll officially be Dr. Spigner at last.
She says she lives by the philosophy that "only you can tell you if you can succeed or not. It's not somebody else's job to say that."
"I'm proof that there's a way," she adds.
She'll start her OB-GYN residency at Northwestern University in June.
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Tofauti katika tiba yaweza kuokoa uhai. Sabina Spinner, ambaye ni daktari wa rangi, alisema kuwa amekuwa akijaribu kuwa daktari. Alipokuwa mwanafunzi wa chuo kikuu cha Pennsylvania, alijikuta akijitahidi kusawazisha mzigo mzito wa darasa na wakati huohuo kufanya kazi kwa saa 20 kwa wiki. "Sikuzote nilikuwa nikifanya kazi, kwa sababu sikuwa na pesa na nilikuwa mwanafunzi wa kufanya kazi", asema Spigner. Matokeo yakawa kwamba alama zake zilipungua. Katika mwaka wake wa kwanza, alimwomba mshauri wake wa kabla ya matibabu amsaidie. "Amesema, ""Hata hivyo, kwa sababu ya GPA yako, unaweza kuamua kuchagua kitu kingine.""" Na kwa kweli hakunipa rasilimali nyingi au chaguzi nyingine isipokuwa tu kuacha", Spigner anasema. Mazungumzo hayo yalifanyika karibu miaka minane iliyopita. Spigner, ambaye ni Mmarekani mweusi na wa Asia ya Kusini-Mashariki, anasema alipokumbuka uzoefu huo kwenye Twitter mwezi uliopita, "kwa bahati mbaya, watu wengi walishiriki hadithi kama hizo". "Hii ni kitu ambacho kinatokea kote nchini na ni jambo la kawaida sana, hasa kwa wanafunzi wa rangi, kupata kukata tamaa, ""alisema." Kwa miongo kadhaa, mashirika ya kuongoza ya matibabu yamekuwa yakijaribu kugawanya safu za madaktari, ambapo madaktari weusi na wa Kihispania bado hawawakilishwa sana ikilinganishwa na uwiano wao wa idadi ya watu wa Marekani. Hii ni muhimu kwa sababu utafiti umeonyesha kuwa watu kutoka makundi ya rangi na makabila yasiyo na uwakilishi wa kutosha wanaweza kuwa na matokeo bora ya afya wakati madaktari wao wanaonekana kama wao. Utafiti uliochapishwa katika jarida la JAMA Health Forum unaonyesha kuwa kuna sababu nyingi, ikiwa ni pamoja na shinikizo la kifedha na ubaguzi, ambazo zinaweza kuwazuia wanafunzi wenye rangi ya rangi kutoka kwa kufanya hivyo kwa kweli kwenda shule ya matibabu. Utafiti huo ulichunguza majibu ya wanafunzi zaidi ya 81,000 waliochukua mtihani wa uandikishaji wa Chuo cha Matibabu. "Hata hivyo, utafiti huo unaonyesha kwamba ""watu hujifunza kwa miezi, au hata miaka, ili kuhitimu,"" anasema mwandishi wa kwanza wa utafiti huo, Dakt. Jessica Faiz, Mtaalamu wa Utafiti wa Chuo Kikuu cha California, Los Angeles "Uliilipia mtihani huo. Ulichukua muda mwingi sana kujifunza. "Kama unavyojua, ni rahisi sana kuamua kuhamia shule ya matibabu, ""anasema Faiz, daktari wa dharura na mwanachama wa Programu ya Kitaifa ya Wanafunzi wa Kliniki katika UCLA." Hata hivyo, Faiz na wenzake walipata kwamba wachunguzi weusi na Wahispania walikuwa na uwezekano mdogo wa kuomba na kujiandikisha katika shule ya matibabu kuliko wachunguzi weupe. Wanafunzi weusi, Wahispania na Wenyeji wa Asili wa Amerika walikuwa na uwezekano mkubwa zaidi wa kusema walikabiliwa na vizuizi vya kifedha, kama vile ugumu wa kupata vifaa vya maandalizi ya mtihani na tayari kuwa na mikopo mikubwa ya mwanafunzi. "Hata hivyo, wana uwezekano mkubwa zaidi wa kukabiliwa na kukata tamaa kutoka kwa washauri wakati wa kuomba shule ya matibabu ikilinganishwa na wenzao weupe, ""anasema mwandishi mwenza wa utafiti Dk Utib Essien, profesa msaidizi wa dawa na mtafiti wa usawa wa afya katika UCLA." "Wanafunzi wa asili ya Amerika, Hispania na weusi walikuwa na uwezekano mkubwa wa kwenda kwa chuo kikuu cha chini, ambacho watafiti walifafanua kama ""koleji na mchakato wa uandikishaji wa chini na wengi wa wanafunzi wanaoishi nje ya chuo kikuu.""" "Kama vile ilivyo kwa wanafunzi wa matibabu, ""mfano wa kufanikiwa ni kuwa na uhusiano wa karibu na marafiki wa karibu na kuwa na uhusiano wa karibu na marafiki wa karibu,"" Faiz anasema." Kwa mfano, utafiti uligundua kwamba wanafunzi wa rangi walikuwa na uwezekano mdogo wa kuwa na kivuli daktari - uzoefu ambao unaweza polish maombi ya shule ya matibabu. Faiz anasema kwamba uwezekano huonyesha ukosefu wa aina ya uhusiano ambayo hufanya iwe rahisi kuanzisha aina hiyo ya uzoefu. "Essens anasema: ""Utafiti wa miaka mingi umeonyesha kwamba wagonjwa wenye rangi ya rangi wanaweza kufaidika na kuwa na daktari wa rangi yao au asili yao." Kwa mfano, utafiti umeonyesha kuwa watu hao walikuwa na uwezekano mkubwa zaidi wa kupokea huduma za kuzuia ugonjwa mwaka uliopita na walikuwa na uwezekano mkubwa zaidi wa kuridhika na huduma za afya wanazopokea. "Kuhusu watu wa jamii ndogo, Essien anasema, ""kuwa na daktari anayefanana na wewe hufanya iwe rahisi kukubali chanjo ya mafua, kufanya uchunguzi wa utumbo, au kufikiria upasuaji wa moyo wenye kuathiri zaidi.""" Utafiti wa hivi karibuni unaonyesha kuwa watu weusi wanaishi kwa muda mrefu zaidi katika maeneo yenye madaktari weusi. Utafiti huo ulifunua kwamba zaidi ya nusu ya wilaya za Marekani hazikujumuishwa katika uchunguzi huo kwa sababu hazikuwa na daktari mweusi. Faiz anasema matokeo hayo, ambayo yalichapishwa siku ileile ya utafiti aliokuwa akiongoza, yanaonyesha kwa nini ni muhimu sana kuelewa vizuri sababu zinazoweka wanafunzi wa rangi kutoka shule ya matibabu. "Essene anasema: ""Hatuwezi kuamini kwamba kuna tofauti kati ya watu wa jamii moja na ile nyingine kwa sababu ya ubinadamu." "Hakika, kwa kweli, ni kuokoa maisha.""" Jaya Aysola, Mkurugenzi Mtendaji wa Kituo cha Penn Medicine cha Maendeleo ya Usawa wa Afya Alitoa maoni yake katika jarida la JAMA Health Forum. Aysola anasema utafiti huo unaangazia vikwazo vya kifedha na upendeleo usio na fahamu ambao unaweza kuzuia njia ya shule ya matibabu kwa wanafunzi wa rangi. "Kutoka kwa wale wanaokushauri kuwasilisha maombi hadi wale wanaokusaidia kuchagua maombi yako, hadi wale wanaokuhoji, kuna upendeleo katika mchakato huo wote, ""Aysola anasema." Kuhusu Sabina Spigner? Hakuruhusu kukata tamaa kwa mshauri wake wa kabla ya matibabu kumzuia kufuatia ndoto zake za shule ya kitiba. Aliamua kwanza kwenda shule ya kuhitimu. Alimaliza na digrii mbili za uzamili <unk> katika sayansi na afya ya umma <unk> kabla ya kwenda Chuo Kikuu cha Pittsburgh Shule ya Tiba. Wakati yeye kuhitimu mwezi ujao, yeye itakuwa rasmi kuwa Daktari Spigner hatimaye. "Anasema: ""Ninaamini kwamba ni wewe tu unayeweza kujua kama utafanikiwa au la." Si kazi ya mtu mwingine kusema hivyo". "Mimi ni uthibitisho kwamba kuna njia", aongeza. Atachukua nafasi yake ya kuwa daktari wa wanawake na uzazi katika Chuo Kikuu cha Northwestern mwezi Juni. Copyright: NPR Kwa maelezo zaidi, tembelea www.nl.org.