Diversity is vital to high-quality primary care, and both patients and primary care providers are better served by a diverse workforce. But this week, the U.S. Supreme Court undermined decades of progress toward creating that diversity and reducing health inequities when they overturned long-standing precedent that allowed educational institutions to consider racial diversity as part of their efforts to create a strong, diverse student body.
At PCDC, our core mission is to strengthen communities and build health equity through primary care, which saves lives, improves individual and community health, and is central to health equity. In fact, primary care is the only part of the health system that has been proven to lengthen lives, reduce health disparities, and reduce costs. However, historically marginalized communities, including communities of color, have the least access to primary care and the worst health outcomes – in part because they have the least access to providers who are representative of the communities they live in.
It is critical that the pipeline of health care providers include strong representation from individuals raised in disinvested, medically underserved communities. These providers are the most likely to return to their own communities to provide needed care,[i] and the most likely to be trusted by their patients when they do.[ii] Trust is a critical component of effective health care, as patients are more likely to feel comfortable with their provider’s advice and to follow it if they feel that the provider shares their background or values. [iii] Given the extreme and long-standing racial disparities in the health status and outcomes in this country, it is vital that patients from all types of backgrounds be able to seek providers who share these characteristics. [iv] In light of this Supreme Court decision, PCDC believes that it will be important for educational institutions to encourage all of their students to consider health care as a career, including elementary, middle, and high schools in traditionally underserved areas. We further strongly urge college and medical schools to continue to take into account, as the Court states they may, their individual applicants’ diverse backgrounds and life experiences, including the communities in which they were raised and where they might return to contribute after graduation.
As the diversity of the U.S. population increases, creating opportunities for an equally diverse primary care workforce is more important than ever. The dissenting justices in yesterday’s decision understood the important point raised by the American Medical College and others that “increasing the number of students from underrepresented backgrounds who join ‘the ranks of medical professionals’ improves ‘healthcare access and health outcomes in medically underserved communities’” and also that “all physicians become better practitioners when they learn in a racially diverse environment.” [v] PCDC strongly agrees and urges all stakeholders in the field to continue their efforts to diversify the primary care and health care workforce.
PCDC envisions a future where all people have access to high-quality primary care, and we must continue to find every opportunity to ensure that better health outcomes and health equity and justice prevail.
References
[i] See e.g. H. Rabinowitz, et al., Increasing the supply of rural family physicians: recent outcomes from Jefferson Medical College’s Physician Shortage Area Program (PSAP), 86 Academic Medicine : Journal of the Association of American Medical Colleges 264 (2011).; Davis G. Patterson, C. Holly A. Andrilla, & Lisa A. Garberson, Preparing Physicians for Rural Practice: Availability of Rural Training in Rural-Centric Residency Programs, 11 J. of Graduate Med. Educ. 550 (2019), available at https://doi.org/10.4300/JGME-D-18-01079.1
[ii] Georgetown University Health Policy Institute, Cultural Competence in Health Care: Is it important for people with chronic conditions?, https://hpi.georgetown.edu/cultural/(last visited December 8, 2021).
[iii] Richard L. Street et al., Understanding Concordance in Patient-Physician Relationships: Personal and Ethnic Dimensions of Shared Identity, 6 The Annals of Fam. Med. 198 (2008); Alyson Ma, Alison Sanchez & Mindy Ma, supra note 59; Ann S O’Malley, Vanessa B Sheppard, Marc Schwartz, et al., The role of trust in use of preventive services among low-income African-American women, 38 Prev. Med. 777 (2004), available at https://pubmed.ncbi.nlm.nih.gov/15193898/.
[iv] Lisa A. Cooper & Neil R. Powe, Disparities In Patient Experiences, Health Care Processes, And Outcomes: The Role Of Patient–Provider Racial, Ethnic, And Language Concordance, The Commonwealth Fund, July 2004, available at http://drstokesfoundation.org/images/cooper_raceconcordance_753.pdf.
[v] Students for Fair Admission Inc. v. President and Fellows of Harvard College, 600 U.S. __, slip op. at 65 (2023) (Sotomayor, J., dissenting); see also Georgetown University Health Policy Institute, Cultural Competence in Health Care: Is it important for people with chronic conditions?, https://hpi.georgetown.edu/cultural/(last visited December 8, 2021).