First-year MCG/UGA Medical Partnership student Lum Frundi interviews 91-year-old Consie Ellington about her medications at the Athens Community Council on Aging. Frundi, originally from Cameroon, now lives in Georgia, where she would like to practice pediatrics. Photo by Andrew Davis Tucker
ATHENS - Shirley Mapp was admitted to Athens Regional Medical Center for chest pain in 2006. When her doctor came into the room, Mapp recalls, he didn’t look at her or speak to her. “He said to the nurses, ‘There’s nothing wrong with her heart. She’s just got high blood pressure.’ “ Then he left the room without ordering tests to confirm his diagnosis.
“I was just another black person with high blood pressure,” Mapp said. Right then she thought, “I’ve got to get a black doctor.”
But that can be easier said than done.
There are simply not enough black doctors in Georgia to go around. In fact, physicians of all descriptions are scarce in most of rural Georgia and in urban communities where many minority patients live. These areas are federally labeled “medically underserved areas.”
Leaders of Georgia’s four medical schools are working to remedy this situation, a quest they say will improve health care and the schools themselves.
The United States faces an overall shortage of physicians, and the most pressing need is for minority doctors, according to the American Association of Medical Colleges (AAMC). By 2050, racial and ethnic minorities are expected to make up half the U.S. population. Today one in four Americans is black, Hispanic, or Native American, but only one in 16 practicing doctors is, AAMC says.
Thirteen percent of Georgia’s physicians are African American, according to 2008 statistics, while about 30 percent of the state’s population is black.
This makes it hard for patients like Mapp to be choosy. She survived a brain aneurysm in 1999, and she lives with chronic high blood pressure, a problem far more common among blacks than whites. She knows she needs regular medical care, but admits that when the only physicians available are white, she puts off going to the doctor. Mapp, 58, says many of her peers do the same thing.
Studies show that black patients – already at overall greater risk for chronic disease than whites – consistently get better results when treated by black doctors.
Better health outcomes
Mapp has not yet found a black doctor, but she is happier now with Dr. Emad Ahmed, whom she describes as “not white.” Unlike the physician who dismissed Mapp’s chest pain as “just high blood pressure,” Ahmed, who is from Bangladesh, runs tests for kidney and heart problems – common in people with long-term hypertension – at every visit. He also explained the tests, which Mapp said was a first.
Overall, minority doctors order more tests for minority patients than non-minority doctors do, said Ngozi Anachebe, assistant dean of admissions and student affairs at Morehouse School of Medicine in Atlanta. They are also more likely than white physicians to engage minority patients in decisions about treatment options.
Medical schools try to make students aware of these disparities so they can avoid them, but that’s harder than it sounds. Non-minority doctors don’t intend to treat minorities differently, but cultural disconnects can undermine good intentions. “Sometimes we don’t ask the right questions, or maybe we don’t make the patients feel comfortable enough to tell us what’s wrong,” Anachebe said.
Regardless of their preference for a doctor who shares their background, many black, Hispanic, Native American and rural Americans lack convenient access to any doctor at all.
In Georgia, physicians cluster around metro Atlanta but are scarce in rural areas. Ninety percent of the state’s doctors practice in a 60-mile radius of Atlanta. The remaining 10% cover the rest of the state, said Pam Reynolds, director of the Southwest Georgia Area Health Education Center, whose Pathways program helps rural med school applicants compete with their metro Atlanta counterparts.
In 2005, a U.S. government analysis showed that more than 15% of Georgians lived in medically underserved areas, or MUAs, where residents have higher rates of undiagnosed and chronic diseases – and worse health in general – than people who have easier access to doctors.
Ironically, the southwest Atlanta neighborhood around Morehouse School of Medicine – an institution dedicated to providing equal care for all – is considered an MUA.
One way to lighten the burden of poor health would be to educate more doctors who want to practice where people need them. Because medical students who come from underserved communities are most likely to go back and practice in them, schools are competing to enroll them.
A black male with top grades and test scores will likely get an interview invitation from every school where he applies, said Geoffrey Young, dean of admissions at Medical College of Georgia. (There are more black female applicants than black males.) Strong rural applicants are intensely pursued as well.
At historically black Morehouse School of Medicine, “We have white students who come from very small towns in Georgia because we’re hoping that eventually they’ll go back to their communities and practice there,” Anachebe said.
Mercer also seeks strong candidates from small towns. Daniel Gordon grew up admiring family practitioners in his hometown of Hartwell (population 4,200) and plans to practice there.
“It’s hard to have a heart for it, if you’re not from there,” said Gordon, a first-year Mercer student.
The AAMC says that medical schools are gradually becoming more diverse, in terms of race and geography, but the flow of applications from doctor-starved communities is sluggish. The Hispanic and Native American applicant pools grew nationally last year by 6.9 percent and 9.5 percent respectively, but black applicants decreased, and rural numbers have been falling for years.
The key to diversifying the physician workforce is making K-12 education universally good, said Marc Nivet, the AAMC’s chief diversity officer.
“Rural areas just don’t have the resources that suburban Atlanta has in high school,” added Maurice Clifton, former dean of admissions at Mercer School of Medicine. Inner-city high schools with large black populations have the same resource gap.
College and career counseling may also fall short. Too often, minority and rural students aren’t told how to become doctors, said Clifton.
The Pathways program, though, helps college sophomores and juniors from rural areas compete with med school applicants from cities and suburbs. Participants in this free summer program go to Albany for four weeks. They shadow doctors for 60 hours, complete research projects and get help editing the personal statement that admissions committees scrutinize. Eighty-nine percent of Pathways participants go on to medical school, including some at Mercer.
Top medical schools receive so many applications that they could fill their entering classes with straight-A students who missed nearly nothing on the Medical College Admission Test. Few rural or minority applicants, who come from less rigorous secondary schools, fit this description.
But as patients know, it takes more than top grades to be a compassionate physician. The American Medical Association now urges medical schools to take other criteria into consideration, such as an undergraduate major in the liberal arts, which may be an indicator of compassion, some studies suggest.
Both Morehouse and Mercer accept students with MCAT scores below the national average, and they pride themselves on giving a chance to students who weren’t accepted by the ‘’elite’’ schools.
Despite their lower MCAT scores, Morehouse and Mercer students score at and above national averages on the national medical examinations required for licensing.
Pipeline programs and innovative admissions criteria can improve and enlarge the applicant pool, but there’s no guarantee that Georgia medical schools will actually enroll their top choices.
This fall an out-of-state school won a promising black male student away from MCG. “If there are few African-American men, and I’m a very competitive applicant, schools are going to try to recruit me,” said Young, the MCG admissions dean. “They may provide a very nice scholarship package with other added incentives.”
Emory School of Medicine also struggles to enroll the minority students it accepts, said Ira Schwartz, dean of admissions.
Caring for each other
Realizing that demand will exceed the supply of new doctors from rural or minority backgrounds for years to come, medical schools are broadening the horizons of all their students.
Mercer’s orientation program includes a daylong road trip through rural Georgia, an eye-opener for many students.
First-year student Naheed Lakhani grew up mainly in metro Atlanta, though her father’s work took the family to several developing countries. She thought she’d have to work in Haiti or Guatemala to help needy populations. Mercer’s van trip showed her otherwise.
“America was always in my mind a developed country, but when I went to these areas, I was reminded of developing countries where they die because they can’t get to the hospital in time,” Lakhani said.
Experience with people in need dictated Kristen Walker’s plans. An upper-middle class white woman from Alpharetta, the first-year Mercer student says there is no place she’d rather be than Grady Memorial Hospital in Atlanta. She worked there as a nurse for two years, caring for prostitutes, drug abusers and victims of domestic violence at the public hospital for the poor. She enrolled in medical school because she wants to be the doctor treating indigent patients at Grady.
“I don’t ever want to turn a patient away because they need surgery and they don’t have insurance,” she said.
Students at Emory and Morehouse all do rotations at Grady. Schwartz, the Emory admissions dean, is blunt with successful applicants who choose from several medical schools. “If you don’t want to work hard at a hospital like Grady, if you don’t want to take care of patients as sick as those at Grady, you should not come to Emory.”
Morehouse medical students are exposed to underserved Atlanta neighborhoods from day one. In their third-year clinical rotations, they are required to live and work in a rural area for one month.
Cultural competency training and exposure to the poor and uninsured are standard fare at Georgia’s medical schools, driven by the hope that all doctors will be equipped to care for all who need them. This is not an unattainable goal, according to MCG’s Young.
“As a clinical psychologist, I’ve treated African Americans, whites, Hispanics, and the most powerful tool is respect,” he said.