Access to Care

Certain medical education programs may reinforce physicians' goals to practice in disadvantaged communities

One in five Americans lives in an area with a shortage of physicians. These disadvantaged, usually impoverished, areas are often not attractive to new physicians. However, medical education programs that select candidates for their commitment to caring for the underserved may reinforce physicians' goals to practice in disadvantaged communities, concludes a new study.

Researchers found that twice as many graduates of the University of California Los Angeles (UCLA) School of Medicine/Drew Medical Education Program from 1985 to 1995 were working in medically disadvantaged areas 10 years later than graduates the UCLA School of Medicine alone (53 vs. 26 percent).

The UCLA/Drew Medical Education Program was developed to train physicians and allied health professionals to provide excellent and compassionate care, especially for underserved populations. Applicants are selected each year for their commitment to this mission.

The researchers defined a medically disadvantaged area (MDA) as either a federally designated primary care health professional shortage area; or medically underserved area; rural area; high minority area; or high poverty area.

Of a total of 1,071 medical school graduates studied, 88 percent graduated from the UCLA School of Medicine and 12 percent from the UCLA/Drew program. Twenty-three percent were minorities and 44 percent were practicing in a primary care specialty. Overall, 29 percent of active graduates were located in one of the types of MDAs.

Over 50 percent of UCLA/Drew graduates were located in MDAs in contrast to 26 percent of UCLA graduates, a result consistent across all types of disadvantaged areas, with the exception of rural areas. After controlling for educational and other factors, the only factor associated with practice in an MDA was the UCLA/Drew program.

Part of the program's success may be due to an admissions process that emphasizes the applicant's commitment to serve and clinical experiences in the target community. The study was supported in part by the Agency for Healthcare Research and Quality (HS14022 and HS00046).

More details are in "The role of medical education in reducing health care disparities: The first ten years of the UCLA/Drew medical education program," by Michelle Ko, M.D., Kevin C. Heslin, Ph.D., Ronald A. Edelstein, Ed.D., and Kevin Grumbach, M.D., in the May 2007 Journal of General Internal Medicine 22(5), pp. 625-631.

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