From the July/August 2016 Inside OME
Stephen C. Shannon, DO, MPH A
s you read this issue of Inside OME, you will see numerous mentions of diversity, including the personal stories of this year’s recipients of the Arnstein Minority Student Scholarship, recognizing underrepresented minority students attending one of AACOM’s member colleges. The Arnstein scholarship program is named after a very special woman and a former AACOM Executive Director, Sherry R. Arnstein, who believed in social equality and was a leader in moving the nation in that direction through her public policy work.
We dedicate this issue to diversity. Not only because it is a timely topic in medical education but also because it is important to AACOM and of course, to celebrate the achievements and applaud the vision and effort of our DO students. Their stories and their bright futures will inspire others and let them know that they can overcome odds similar to those faced by Arnstein awardees.
Providing opportunities for underrepresented minorities to obtain a medical education is at the heart of Sherry Arnstein’s philosophy and is crucial to ensuring diversity among those striving to become DOs. It is consistent with both AACOM’s mission and its commitment to foster excellence in osteopathic medicine by promoting diversity, and aligns with the osteopathic profession’s historical roots in serving the underserved. The Arnstein scholarship program provides a vehicle for the voices and the visions of minority DO students to reach and motivate others.
Each year, as judges read through the inspiring stories of applicants for the Arnstein scholarships, two common threads emerge: the desire to serve in primary care within underserved communities, and the recognition that diversity in medical education will result in DOs who are better able to serve and advocate for an increasingly diverse patient population.
We know that patients do better when they can identify with caregivers, resulting in better patient outcomes and quality of care when caregivers are people like them. We also know that greater diversity among health care providers reduces the disparity in the quality of health care disadvantaged populations receive.1
“When it comes to minority, it is not motivation or commitment towards a goal that is lacking, but instead relatability,” detailed one of this year’s Arnstein student submissions.
One of this year’s Arnstein awardees, Kathryn Teixeira, OMS-II, RVUCOM, reiterates this understanding in an anecdote from her winning essay:
“I have heard many times that patients feel disconnected from their physician because their doctor speaks over them, looks only at their computer, or skips the physical exam in favor of medication. I did not witness these issues when shadowing this DO. His focus was on the patient not the symptoms, he was motivated to increase access to healthcare for all his patients, and he was committed to rural communities. These three qualities are also core elements of the mission of osteopathic medicine by which I am inspired to change the future of healthcare. I am committed to a career in rural primary care, promoting patient education and prevention, and encouraging minority students to consider a career in osteopathic medicine.”
There are those who will say that the move toward a DO population that more closely represents the U.S. population is underway. They are right. But the movement is slow, too slow. Although the numbers of underrepresented minorities in U.S. medical schools have increased—with the growing diversity of the overall U.S. population—the racial and ethnic differences between medical school graduates and the overall population is actually widening.
Corresponding to the momentous growth in osteopathic medical school applicants, research reports an uptick in underrepresented minority2 (URM) applicants and matriculants to the nation’s COMs. According to data on the current state of diversity in OME, over the past five years, the number of URM applicants has risen from 1,404 (2009-10) to 2,288 (2014-15), and similarly, the number of URM matriculants has increased from 337 to 532. While the increasing trend has resulted in a subtle increase in URM applicants and matriculants of 1.7 percent and 1.2 percent, respectively, latest figures show that only 12.8 percent of total applicants and 8.2 percent of matriculants identify as being URM (2014-15).
While progress has been made, we still have room to grow. Despite these positive figures, total URM enrollment remains stagnant. Additionally, the number of URM applicants compared to matriculants continues to remain lower than their non-URM counterparts. Furthermore, the percentage of URM applicants who have successfully matriculated to osteopathic medical school has actually decreased from 24 percent URM matriculating in 2009-10 to 23.3 percent in 2014-15.
At the same time, according to the U.S. Census Bureau, about 36 percent of the U.S. population in 2010 were underrepresented minorities and that figure is projected to grow to around 45 percent by 2050. This growing disparity cannot be ignored.
As 2016 Arnstein scholarship recipient Qiana Smith, OMS-I, VCOM-VC, shares:
“It's disturbing to hear the many stories of people who lack access to primary care services and health care facilities, which are so vital for the prevention of many chronic conditions and premature deaths. It is equally as disturbing to know that there is such a disproportional misrepresentation in the number of minority physicians in the United States, considering the large amounts of minority populations served. Becoming an osteopathic physician will grant me the opportunity to be an agent of healing and an advocate for those in underserved communities, to make a difference in health care disparities and bring awareness to the osteopathic profession.”
As the diverse needs of the U.S. population continue to change, osteopathic medical education and the profession need to evolve accordingly.
Medical students believe this as well, and their input has helped move diversity from an intangible subject for discussion to a reality in medical training and practice. This belief comes alive in the messages of the Arnstein Minority Student Scholarship applications. These comments by Arnstein applicants are typical of students I meet as I travel to COMs across the country.
While these sentiments are encouraging, they alone will not move the needle toward greater diversity among DO students and the physicians they become.
To do that, we must customize our recruitment efforts at the national and local levels and target disenfranchised and underrepresented communities. We must also expand the pipeline of prospective students by increasing the attractiveness of an osteopathic medical education earlier, including at the K-12 level. As Arnstein applicants are saying:
“Knowledge about osteopathic medicine is lacking. In order to change this mindset, we have to introduce aspiring physicians to the world of osteopathic medicine when they’re young.”
And we must get the message out with clarity and consistency to underserved and underrepresented communities and change the idea that a medical education and career is an unachievable dream, and assure them that other potential DO students–like the Arnstein awardees–had the same fears and doubts, but overcame barriers and found their way into a profession that embraces diversity in all its forms.
“For me, there is nothing more encouraging than seeing that someone else has worn the path out for you a little when you endeavor to do something you couldn’t see yourself doing or that you haven’t done before,” says Anita Boakye, OMS-II, MU-COM, 2016 Arnstein awardee.
If we don’t enhance our efforts to increase diversity in our medical schools, we will be squandering an important resource for new perspectives and overlooking a talent pool that could add significant value to the provision of health care in the neediest corners of our society. In this time of enormous progress in disease management, technological advances in treating ancient maladies and where excellence is the only acceptable standard of care, we must view inclusion as a key driver to discovering our profession’s future leaders.
And it is my personal belief that the osteopathic philosophy instilled in OME will mold DO students to become more relatable, empathic as future physicians, and inspire them to be better people as well.
Osteopathic medicine is an embracing profession. Recognizing that truth, and in our search for health care excellence, let us embrace Sherry Arnstein’s quest for social equality and diversity as we search for the next generation of osteopathic physicians in whose hands we can, without reservation, place the future of our profession and our patients’ care.
1 U.S. Department of Health and Human Services, Health Resources and Services Administration Bureau of Health Professions (2006). The Rationale for Diversity in the Health Professions: A Review of the Evidence. Retrieved from http://bit.ly/2aKsPub.
2 Underrepresented minorities (URM) includes Hispanic/Latino ethnicity, Black/African American, Native American/Alaska Native and Hawaiian/Pacific Islander.