"Affirmative action" programs begun in medical schools in the 1970s have succeeded in dramatically increasing the number of minority group members who become doctors but new obstacles may be cropping up that will keep the number of such physicians disproportionately low, a new Rand Corp. study concludes.
Moreover, while the equal opportunity programs have also made medical services more accessible to residents of ghettos and barrios and have seen large proportions of minority group doctors enter so-called primary care fields, the programs at the same time have been largely able to avoid further segregating medical care.
In all, the research found evidence to confirm many of the theoretical benefits that had been claimed for equal opportunity admission programs when they were inaugurated. Dr. Robert Ebert, former dean of Harvard Medical School and now an official of the Robert Wood Johnson Foundation, said the study represents the first quantification of a concept that had been accepted almost on faith. "The survey sort of supported everything that everybody wanted," said Ebert, who also served as chairman of an advisory committee overseeing the Rand project.
But at the same time, the new study concluded that doctors who are minority group members lag significantly behind their white counterparts in academic performance in medical school and in the proportion by which they earn specialty board certification. The Rand group argued that the marketplace for medical services--which, in wealthier communities, tends to equate board certification with minimum competency--may discount the need for such credentials in minority communities.
No Basis of Comparison
The Rand team conceded it could find no way to compare the quality of medical care being provided by minority group and non-minority group members; two of the principal authors conceded it is possible that at least some doctors may have elected to practice in inner-city areas after they were unsuccessful in their attempts to pass board certification examinations.
In the main, though, the Rand study said, equal opportunity admission programs have resulted in vastly increased numbers of inner-city doctors offering care in the crucial fields in general internal medicine, obstetrics-gynecology, pediatrics and family practice.
Such programs were set up in the early 1970s with the intention of raising to 12% the proportion of medical students who are minority group members. That objective was never met, however, the Rand team noted, and by 1976--the year the 12% goal was to have been reached--only 8.2% of medical students were minorities. Many observers believe the growth in minority group enrollment was stunted by two major court cases that undermined the right of medical schools to give admission preference to non-whites.
Today, according to the American Medical Assn., 10.8% of all medical students are black, Puerto Rican, Latino or Native American. Students of Asian descent are not counted as members of a minority group in the calculations.
New Risks Ahead
The Rand report's authors warned, however, that a variety of factors may pose new risks to further increases in the numbers of minority group doctors. Medicine has entered a period of slight decline in popularity among young people in general as the number of doctors in popular areas reaches or exceeds the saturation point and it becomes more difficult to practice in a geographically desirable place.
Too, the researchers said, financial constraints have already begun to reduce the income doctors can anticipate. That factor, combined with disappearance of public support for medical education and the need for students to rely on loans totaling up to $60,000, will make it more difficult for young people from impoverished backgrounds or families of modest means to consider medicine.
In this atmosphere, agreed two of the Rand study experts, many minority students will likely pursue fields requiring fewer and less expensive years of training and that bring with them a more certain income level. Medicine may find itself unable to compete for many able, intelligent young minority group members, these experts said.
The Rand study is being published today in the New England Journal of Medicine. It was conducted by researchers from Rand, the Charles R. Drew Postgraduate Medical School here and the Washington-based Assn. of American Medical Colleges. The study focused on doctors who graduated from medical schools in 1975 since, because of the time required to complete internship and residency training and get established in practice, a doctor's actual preferences--as opposed to those he or she may claim during training--cannot usually be determined with certainty until five or 10 years after graduation.