printable versionProgram to promote physician diversity faces drought in critical federal funds
BY MICHELLE L. BRANDT
The clock is ticking. A federal program that aims to boost the number of minority medical students and physicians faces its demise unless Congress acts to restore federal funding later this fall. Without the money, dozens of institutions across the country—including the School of Medicine—could be forced to shut down their Center of Excellence programs.
Two years ago, Congress allocated $33.6 million in grants to 34 COEs; last fiscal year it allotted $11.8 million for only four centers. (Stanford was not included.) President George W. Bush proposed no funding for COEs in his budget plan for the current fiscal year, which began on Oct. 1, though the budget is still under consideration by Congress when it reconvenes after the elections.
While Stanford's COE has continued with medical school funds, it is uncertain how much longer it can last without federal support. "This funding cut will hamper our ability to inspire, educate and assist young minority or socio-economically disadvantaged students to fulfill their dreams to enter the fields of medicine and science," said Philip Pizzo, MD, dean of the School of Medicine. "Our medical school has been a national leader in recruiting under-represented minorities, but our success rests on the support received from the Center of Excellence."
The federal COE program, which was started in 1987, was designed to help academic institutions train, recruit and retain medical students and medical faculty members from under-represented groups. According to the American Association of Medical Colleges, more than 400,000 under-represented minorities have participated in COE or a related program, the Health Careers Opportunity Program.
Both of these programs were established in response to the persistent under-representation of minorities in medicine. The medical colleges association reports that 2.8 percent of physicians in the United States are Latino and 3.3 percent are black, despite the fact that Latinos and blacks together make up 25 percent of the U.S. population.
Recent evidence about health-care disparities in the country gave impetus to the push for greater diversity among health-care professionals. An influential 2002 Institute of Medicine report showed that racial and ethnic minorities receive lower-quality health care than Caucasians, and it said having more minority health care providers was one way to fix this problem. "If we're going to do anything to improve health [of minorities], this is the one thing we need to do," said Fernando Mendoza, MD, principal investigator of Stanford's COE and associate dean of minority advising and programs.
Stanford's own COE was established under the guidance of Mendoza and Ronald Garcia, MD, assistant dean of minority affairs and director of the COE, in 1993. The center encompasses numerous outreach projects, including a regional and national premedical student recruitment program, an early matriculation program to provide summer research opportunities for incoming medical students and a course addressing cultural competency. It also offers financial assistance for students to attend leadership conferences, such as the National Hispanic Medical Association's annual meeting.
Iris Gibbs, MD, assistant professor of radiation oncology, went through COE's early matriculation program in 1990, and she credits the program for providing a smooth transition into medical school. "I was the first in my family to become an academic physician, so I didn't have anyone guiding my way," said Gibbs, who is African American and grew up in a low-income neighborhood in Delaware. "My [career] success is directly attributable to the efforts of the COE staff and program."
Mendoza said there is an emphasis at COE on getting students to go into academic medicine, as Gibbs and approximately 18 percent of Stanford COE alumni do. Under-represented minorities comprise around 7 percent of medical school faculty nationwide, according to the American Association of Medical Colleges, and Mendoza said such programs could help boost that percentage.
Despite successes like Gibbs', funding for the COE program has been threatened for the past several years. Mendoza, for one, is unsure why. "The government has said to us, 'These programs have not done what they're supposed to do'—but they're saying that with no information," he remarked.
Mendoza, Pizzo and others have attempted to educate leaders in Washington on the issue. The medical college association has written a letter to members of Congress in support of COE. And Rep. Joseph Crowley, D.-Bronx, has criticized the funding cuts.
"This program allows more minorities to be represented in the medical field. These individuals often return to their communities—many of which are underserved—to provide medical care," said Crowley. "I think it would be a disservice to our fellow Americans to not include funding for this."
Rep. Anna Eshoo, D.-Palo Alto, has also expressed her support for the program. "I'm proud to have fought for preserving funding for these critical programs, which go a long way to promote and sustain higher education opportunities for minority students and faculty," she said. "Stanford has had great success in attracting students and faculty from under-represented groups and to continue doing so, the COE and the Health Careers Opportunity Program must receive adequate federal funding."
Crowley, whose district is home to the Hispanic Center of Excellence at Albert Einstein College of Medicine, said he plans to propose a budget amendment this month to provide $43 million for COE grants for this fiscal year. Congress is scheduled to consider and approve budget items in the next few weeks.
If funding isn't reinstated, medical schools must find support elsewhere or perhaps prepare to close the doors of their COEs. In a recent survey from the medical colleges association, 83 percent of COE program directors said they'd be unable to continue their program without federal support.
At Stanford, Mendoza and others have been exploring alternative funding options to continue the program, but there is still much concern about the future. "We're striving to continue as much of these programs as we can, but it will be hard to sustain without federal support," said Pizzo.