Underrepresented

When Bill McDade entered medical school at the University of Chicago in 1980, he was the only African American in his class. (Photo by Rebekah Raleigh)

When Bill McDade entered medical school at the University of Chicago in 1980, he was the only African American in his class. (Photo by Rebekah Raleigh)

In 1980, when Bill McDade entered medical school at the University of Chicago, he was the only African American student in his class. “I felt very isolated,” said McDade, who graduated in 1990 and then did his residency at Harvard University’s Massachusetts General Hospital. “I came to all the classes. I took all my own notes. I never really collaborated with anybody in terms of studying in medical school.”

In the 24 years since, the U.S. Supreme Court has declared that university admissions boards can include race among the factors they use to weigh applicants, and several Chicago medical schools have developed recruitment programs to attract “underrepresented minorities”—blacks, Latinos and Native Americans.

But none of this has made Odey Ukpo’s class at Loyola University Chicago any different from McDade’s. Ukpo is also the only African American in his medical school class this year. “It is an environment that I’ve gotten used to,” he said. He recalls being the only black student in honors and advanced placement courses in high school and one of only a handful of biochemistry majors as an undergraduate at Loyola Marymount University in California. “There are obviously relating issues and things that are different between me and the other students,” he said. “But, when it comes down to school, this is just how it’s always been for me.”

Despite several efforts to actively boost their enrollment, African American and Latino students still are not attending any of the Chicago-area medical schools in large numbers, especially in comparison with the area’s general population.

Cook County is 26 percent African American and 20 percent Latino, and blacks and Latinos together make up about 23 percent of all the students at the city’s 10 largest universities. But, in 2002, blacks were 6 percent of the students in Chicago-area medical schools, and Latinos were 4 percent. Whites were 52 percent of all students at the medicals schools, and Asians were 30 percent.

Officials at six medical schools—the University of Chicago, Loyola University, the University of Illinois at Chicago, Northwestern University, Rush Medical College and The Chicago Medical School—say that increasing those numbers is vital in order to address the striking health care gap that separates white from black and Latino communities, since African American and Hispanic health professionals are more likely to practice medicine in those underserved areas. But the future of focused recruitment efforts is unclear, as minority programs and admissions policies at universities across the country have been halted under pressure from two anti-affirmative action groups.

Nationwide, the number of blacks enrolled in medical schools has dropped by 6 percent in the last decade. Last year, blacks and Latinos made up about 13 percent of all entering medical school students nationwide—about half of their percentage in the general population.

But those numbers don’t trouble the Center for Equal Opportunity or the American Civil Rights Institute. The groups are leading a nationwide battle against admissions policies and programs that “racially discriminate” against whites and Asians. They say that deliberately boosting the numbers of blacks and Latinos will force schools to admit less-qualified students.

“I don’t think that we should expect the medical profession or any other profession to mirror precisely the racial and ethnic makeup of the rest of the country,” said Roger Clegg, vice president and general counsel for the Center for Equal Opportunity, a nonprofit public policy research organization in suburban Washington, D.C.

“There is no question that some students have more advantages than other students do,” said Clegg, who is white. “If the justification for the [minority] programs is to identify students who come from disadvantaged backgrounds, then the criteria should be economics and not race.”

But some school officials said that increasing the number of black and Latino medical students does not require them to come up with different standards, just different strategies.

“We don’t have any different set of criteria, don’t relax standards for [minorities],” said Dr. Raymond Curry, executive associate dean for Northwestern’s medical school, who is white. “It’s simply a matter of how actively you recruit minorities. We have that responsibility as a major urban medical center.”

Odey Ukpo, a second-year student at Loyola University Chicago Stritch School of Medicine in Maywood, is president of a student group that encourage blacks and Latinos to pursue medical careers. (Photo by Rebekha Raleigh)

Finding blacks and Latinos for medical school involves “casting a wide net” across the entire board of applicants, said Dr. Jorge Girotti, associate dean of admissions at the UIC medical school. He said UIC looks at college grades and Medical College Admissions Test scores, but also tries to account for challenges the applicants have overcome—such as working a part-time job while attending school.

Admissions policies considering these circumstances provide more opportunities to blacks and Latinos, but Girotti argues this does not mean the school is admitting underqualified students. “College grades and MCAT scores only tell you part of the story,” said Girotti, a Latino who is also the director of the medical school’s Hispanic Center. “By considering conflicts students have faced, we find people who can survive medical school.”

Each summer, the UIC medical school offers a six-week introductory term for as many as 60 newly admitted students—mostly blacks and Latinos—who lack undergraduate science degrees. The school also identifies 12 to 14 applicants each year for its post-baccalaureate program, a federally funded, yearlong curriculum for students without strong science backgrounds. Students receiving a “B” grade or higher and achieving required MCAT scores are guaranteed acceptance into the medical school.

Of all Chicago-area medical schools, UIC has traditionally had the highest representation of blacks and Latinos. In 2002, 9 percent of its students were African American, and 10 percent were Hispanic, according to data from the Illinois Board of Higher Education.

While Girotti thinks the programs help attract blacks and Latinos, he believes word-of-mouth is a stronger recruitment tool. “The diverse environment at UIC supports itself because minority students encourage other minorities to apply,” he said.

By contrast, McDade said the University of Chicago has traditionally had an “unfriendly reputation” among blacks and Latinos. “If you are the only one of anybody in your class, it’s very hard to find a group of people with whom you mesh, who understand where you come from and are interested in trying to work with you to become part of a larger group,” said McDade, who returned to the University of Chicago in 1994. Now, as the medical school’s associate dean of multicultural affairs, he works to recruit more underrepresented students.

Historically, the University of Chicago and other private medical schools in the area have not succeeded in recruiting as many African American and Latino students as UIC. Some officials pointed to higher tuition and fewer scholarships as explanations. Tuition at each of the private medical schools can be three times as high as the tuition at UIC, the only public medical school in the Chicago area.

Girotti said the lack of black and Latino medical school students reflects the dearth of black and Latino applicants—the result of poor academic preparation and advice those students have received. Hispanic students at UIC have told him that they were discouraged by their high school teachers and counselors to pursue math and science careers, he said.

Students from many black and Latino neighborhoods might lack motivation to aim for medical school, said Ukpo, president of Loyola’s Student National Medical Association, a group of minority students that encourages underrepresented minorities to enter medical school. “[They have] this feeling that they can’t do it,” he said. Loyola’s medical school enrollment in 2002 was one of the least diverse in the Chicago area, with African Americans and Hispanics each making up less than 3 percent of the student body.

“I don’t see the number of minorities in medical schools increasing the next few years,” said Ukpo. “We need to change access to education, even before college, so that the minorities will be prepared to be competitive medical applicants. I think that change will take a radical reform. It’s going to be a long process.”

But admissions officials at several medical schools said that increasing the number of black and Latino medical students will be more difficult because of the growing anti-affirmative action sentiment they’ve witnessed in the past five years.

In 1999, the Center for Equal Opportunity sent Freedom of Information Act requests to several Illinois public universities to scrutinize their admissions procedures.

Clegg said the group has also sent letters warning schools in Illinois that they may face legal action if they do not close their “racially exclusive” programs. He wouldn’t reveal which schools received the letters, and officials with each of the major medical schools in the Chicago area said they had not received them.

At least 10 universities across the country, including the Massachusetts Institute of Technology and Princeton University, closed down their minority programs after receiving threats of lawsuits from the Center for Equal Opportunity and the American Civil Rights Institute. The Center for Equal Opportunity is headed by Linda Chavez, a conservative Mexican American political analyst once nominated for U.S. Secretary of Labor. The American Civil Rights Institute is led by Ward Connerly, an African American member of the University of California Board of Regents who led the initiative to end race-based admissions policies in that state’s university system.

The groups have issued several studies of university admissions procedures and minority programs that spurred lawsuits against schools nationwide, including the well-publicized case against the law school at the University of Michigan. In 2002, a group of white students filed a class-action suit challenging the admissions policy at the law school, which was based on a point system that evaluated candidates on several factors, including race. The case gained nationwide attention, and the U.S. Supreme Court upheld a lower court ruling that the point-based plan was unconstitutional.

At the same time, in a separate 5-4 vote, the court ruled in favor of Michigan’s undergraduate admissions process, allowing race to be considered as part of an application as long as no racial quotas were set.

Medical school admissions for the class entering in the fall of 2003 were made in the wake of the University of Michigan decisions—and officials working with Chicago-area medical schools were paying attention.

The decisions sparked conversations that prompted the Association of American Medical Colleges to change the name of the “Minority Medical Education Program” to the “Summer Medical Education Program.” The program is a six-week session held every summer at 11 sites across the country, including a joint session in Chicago for students from the University of Chicago, Northwestern and Rush.

More than 12,000 students have participated in the program since it started in 1989—when it was open exclusively to underrepresented minorities. In 1997, the program was opened to all students but remained focused on the needs of underrepresented minority students and the health issues of some minority groups.

The U.S. Supreme Court decisions prompted officials to eliminate any confusion about the program’s goals and eligibility requirements.

“We prudently considered the impact of the court’s ruling and the [Summer Medical Education Program’s] alignment with the new legal reality,” said Kevin Harris, the program’s deputy director.

Girotti said the recruiting challenges coupled with the legal backlash against minority programs have had a “chilling” effect on the ability of medical schools to attract blacks and Latinos.

Girotti said the number of Latino applicants to the UIC medical school dropped to an all-time low of 53 in 2003, down from the peak of 154 in 1994. It’s a trend he and other Chicago-area medical school officials would like to reverse.

“Developing a larger cadre of underrepresented minority medical students means you’re going to have more people who are interested in researching problems that disproportionately affect underrepresented minorities,” McDade said.

In 2002, some health professionals were shocked when the Institute of Medicine released a congressionally ordered report on the state of minority health in America. Researchers reviewed more than 100 studies conducted over a 10-year period and found the results consistently showed that minorities received worse healthcare than whites, even when all the patients were poor.

In one experiment, a group of medical students were shown tapes of a “patient” with heart trouble. Half the students saw a tape featuring a black female actor while the other half watched one with a white man. Though the presentations were similar, many students rated the white actor’s symptoms as more severe and determined that the black actor’s symptoms were the result of an unhealthy lifestyle. Black students, however, did not rate the two actors differently.

African Americans are nearly one-and-a-half times more likely than whites to die from cancer, diabetes, heart disease and stroke. And the life expectancy for blacks is nearly 10 years shorter than it is for whites.

The study pointed to healthcare providers’ racial biases as one of the explanations for healthcare disparities and the lack of trust some minorities have in the medical profession. Language barriers and clashing cultures between white doctors and minority patients often lead to misdiagnoses and deficient treatments, the study showed. “At the heart of the problem is communication, and distrust among minority patients who may feel that the system isn’t going to treat them as well,” said the chair of the disparity study committee, Dr. Alan Nelson, who is white. “There is no specific evidence that minorities who went to minority doctors received better healthcare, but patients reported higher satisfaction with minority doctors. One could infer that satisfaction leads to higher trust.”

Actively attempting to raise the number of black and Latino medical students, for any reason, discriminates against other students who may be more qualified, said the American Civil Rights Institute’s policy and planning director, Justin Jones, who’s white. Like Clegg, Jones argues that the health disparities could be addressed by providing incentives to attract medical professionals of all races to work in underserved communities.

“Rather than lowering the medical school admissions qualifications and gambling that maybe students will go to those [black and Latino] neighborhoods, the more direct and responsible way to address the problem is to give incentives to students who will practice in that particular area,” Clegg said.

The National Health Service Corps offers scholarships to students of all races who agree to work in underserved communities for two years. About 147 students were accepted last year.

But UIC’s Girotti said that money often isn’t enough to keep those students in black and Latino neighborhoods. “People who stay after their contract ends are the ones who have connections above and beyond the money,” he said. “The doctors who are preparing to practice in those communities really need to have a strong desire.”

The Association of American Medical Colleges’ 2001 graduation questionnaire found that blacks, Latinos and Native Americans were two-and-half times more likely to work in underserved communities than Asians and whites.

Dr. Brenda L. Jefferson-Byrd, an African American doctor, accepted a public health scholarship that paid her way through The Chicago Medical School, and, in return, she was required to work two years in an underserved area upon graduation.

She helped treat poor patients while performing her medical school training at Cook County Hospital and Mount Sinai Hospital, just a few blocks from where she grew up. After graduation, Jefferson said she turned down a number of jobs to meet her scholarship requirement. She is now a family doctor at the Booker Family Health Center in the mostly poor and black Grand Boulevard community area on the South Side. Her two years ended in March, but Jefferson is not leaving. “I choose to stay and work here because I’m comfortable in this environment,” she said. “And I always vowed I’d come back and serve the community I was raised in.”

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