STATEMENT FROM JORDAN J. COHEN, M.D. PRESIDENT, ASSOCIATION OF AMERICAN MEDICAL COLLEGES IN SUPPORT OF THE AMERICAN COLLEGE OF PHYSICIANS' URBAN HEALTH PARTNERSHIP INITIATIVE
Good morning. On behalf of the nation's medical schools and teaching hospitals, I want to applaud the American College of Physicians (ACP) for taking action to address the critical health and social needs of our nation's inner cities. The College is to be commended for launching the Urban Health Partnership Intitiative, which will foster public-private partnerships to improve services to our nation's most beleaguered neighborhoods. ACP should also be lauded for its continued advocacy on behalf of universal health care coverage for all Americans. In its wisdom, the College recognizes, as so many of us in medicine do, that universal coverage is essential for making real progress toward improving the health of Americans, by whatever strategies we choose to employ.
The organization that I represent, the Association of American Medical Colleges, is ready to support ongoing and new efforts to help ensure that ACP's worthy initiative succeeds. One way in which our nation's medical schools and teaching hospitals can make a big impact on the health of our urban communities is by providing the highly skilled and culturally competent physicians needed to do the job. Another, and equally important, ingredient is adequate incentives to attract more physicians to practice in inner city areas.
Let me elaborate on both of these issues. The American population, which has always been racially and ethnically diverse, will become even more so in the 21st century. Nowhere else will this diversity be more evident than in our inner cities. If the nation's workforce of physicians is to provide effective care for an increasingly heterogeneous population, all physicians must be educated to deliver culturally competent care. That means all physicians must have a firm grasp of how various belief systems, cultural biases, family structures, historical realities, and a host of other factors influence the way people experience illness and the way they respond to advice and treatment.
Learning cultural competence in medicine requires much more than a textbook--it requires diversity among both the medical school faculty who teach tomorrow's physicians and among the medical students we enroll. However, while African Americans, Native Americans, and Hispanics represent 21 percent of the U.S. population, these same groups together account for only 12 percent of the students in U.S. medical schools. If we are to achieve the diverse and culturally competent physician workforce America needs, we clearly have much work to do. If we fail to bolster diversity within the ranks of the medical profession, research shows us that the communities hurt the most will be those comprising our nation's minority and poor inhabitants, many of whom populate America's inner cities.
An article published last year in the New England Journal of Medicine showed that: communities with large numbers of black or Hispanic residents were four times more likely than other areas to have a shortage of physicians regardless of community income; black doctors care for nearly six times as many black patients as do non-black doctors, and Hispanic physicians care for more than twice as many Hispanic patients as do non-Hispanic doctors; and 45 percent of black doctors' patients were covered by Medicaid versus only 18 percent of white doctors' patients. Similarly, Hispanic doctors see 50 percent more uninsured patients than do their non-Hispanic white colleagues.
The Association of American Medical Colleges has had a longstanding commitment to increasing diversity and cultural competency in the nation's physician workforce. A major part of this commitment, Project 3000 by 2000, is aimed at strengthening the educational pipeline from grade school to medical school for minority students. The progress we have made to date can only be enhanced further by the ACP's inner city initiative. But producing a culturally competent and diverse physician workforce is only a part of the solution. Equally important is the need to see that that workforce is accessible to the nation's medically underserved communities. Therefore, we must take action to address the chronic geographic maldistribution of physicians in this country.
Last month, the AAMC joined forces with five other national medical education associations in issuing recommendations for achieving a more appropriate balance between the demand and supply for U.S. physicians. The consensus statement calls for policy makers to provide federal funds to medical schools to create more diverse student bodies and develop additional training opportunities in rural and inner city communities. In addition, the document recommends that federal incentives should be established to encourage students to pursue careers in underserved areas. This consensus statement has received an historic level of support from the medical education community and it is our intention that the recommendations presented in it should guide national policy makers in developing critically needed, sound public policy to address not only the size and composition of the physician workforce, but as importantly, its geographic distribution. These recommendations underscore the medical education community's strong support to increase rural and inner city populations' access to physicians.
The American College of Physicians' Urban Health Partnership Initiative provides an important and timely mechanism to turn this commitment into action. Through new collaborations, programs and successes, we can make a difference and improve the health care services available to our nation's inner-city communities.
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