1 Developing Racial and Ethnic Diversity in Iowa’s Physician Workforce – Recruiting Minority Students and Faculty Des Moines University College of Osteopathic Medicine

2 Presenters: Carolyn Beverly, M.D., M.P.H. Assistant Professor, Family Medicine Medical Director, College of Health Science Project Director Mary Pat Wohlford-Wessels, Ph.D. Associate Professor, Family Medicine Assistant Dean, Academic Quality and Medical Education Research Project Associate

3 Objectives This presentation has two primary objectives:  To provide session participants with an overview of minority student admissions and enrollment, along with minority faculty data and  To present an overview of DMU’s funded minority recruitment project

4 Acknowledgement This project was made possible by grant number 1 D1DHP from the Bureau of Health Professions, Health Resources and Services Administration, U. S. Department of Health and Human Services. DMU’s proposal was funded through the Iowa Department of Public Health.

5 Diversity at Des Moines University Like all post-secondary educational institutions in Iowa, Des Moines University (DMU) has experienced some challenges in recruiting and retaining a well qualified diverse student population. The same challenges exist with hiring an appropriately diverse faculty in the University’s College of Osteopathic Medicine (COM.)

6 Diversity in Medical Education Two data sources were used to develop the background for this project and presentation – the AACOM Annual Report & the AAMC Minority Report The AACOM 2004 Annual Report indicates that:  Underrepresented minorities (Black/African American, Hispanics and Native Americans) have kept pace with, but not gained on other groups in terms of enrollments. Students from the Asian/Pacific Islander minority group have steadily increased their share of first-year and total enrollment.

7 Diversity in Medical Education Underrepresented minorities were 8.3% of total first-year enrollment in , somewhat below the level of a decade ago. Asian/Pacific Islanders have increased their share of first-year enrollment from about 10% to more than 15% over the decade.

8 Diversity in Medical Education A similar pattern exists in total enrollments, with underrepresented minorities generally maintaining a level share, and the Asian/Pacific Islanders’ share rising to its current level of 15.4% of total enrollment.

9 Osteopathic Medical School Enrollment - Total Enrollment of Ethnic Minority Groups by School (03-04)

10 Osteopathic Medical Schools - Total Enrollment of Ethnic Groups

11 Diversity in Medical Schools AAMC Data Source: Minorities in Medical Education; Facts and Figures 2005 In 2004, Blacks constituted 7.8% and Hispanics constituted 7.1% of all applicants. Of all minority applicants in 2004, Asians were the largest group (nearly 19%). In 2004 nearly half (49.4%) of all applicants to medical school were accepted. Of the total number of Hispanic applicants 48.8% were accepted, and of Black applicants, 41.3% were accepted.

12 Medical School Applicants by Race and Ethnicity, AAMC

13 Medical School Applicants by Race and Ethnicity, 1974 – 2004 AAMC

14 Total Enrollment by Ethnic Group (03-04)

15 Medical School faculty by Race and Ethnicity – AAMC 2004

16 Medical School Faculty by Rank within Race and Ethnicity

17 In Summary - National Issues Medical Schools have made significant investments in minority student recruitment, yet the yield is less than expected, this is especially true for underrepresented minorities. The same old recruitment strategies have not worked – medical schools may need to invest in innovative programs. Medical Schools do not have sufficient minority faculty mentors – in the basic sciences or among clinical faculty.

18 Minority Population and Practicing Physicians in Iowa Race% of Population in Iowa % of Physicians in Iowa African American Hispanic4.60.9

19 Enrollment in Iowa’s Medical Schools University of IowaDes Moines University Class Size Class Size Under represented minority (2005) 14%4% Other Minority (2005)7%16%

20 DMU’s Funded Recruitment Project Two Objectives:  Student Recruitment African American & Hispanic  Physician Recruitment African American & Hispanic  Lecturers  Clinical Preceptors  Mentors

21 Student Objective – Two Components Focus Group Research and Survey Research Focus Group Research – to determine student perceptions related to :  being a minority.  the importance of having minority faculty and preceptors.  the three most important determinants in selecting a medical school  solicit feedback to be used in the development of a survey instrument

22 Focus Group Themes Regarding Student Perceptions Hispanic vs. African American Students perceptions A parent or teacher had significant influence on the students decision to attend medical school Wanted to be perceived as excellent students, rather than minority students Little identification with their minority status Didn’t feel the need to be connected to a minority community Generational Passion (facilitator vs. student expressed passion)

23 Survey Questions – We Asked… Who had the greatest influence on your decision to enter medical school? Which factors were most important to you in choosing to matriculate at DMU? How important is it to you to have opportunities to work with minority mentors during medical school?

24 Survey Questions, con’t Thinking of yourself, as a student and in the future as a practicing physician, how important are the following:  your status as a member of a minority population  your ability to serve minority and/or underserved populations  opportunities to be mentored by a minority physician

25 Results – Respondents Year DMU has 25 underrepresented minority students 11 chose to complete the survey  1 st year = 27%  2 nd year = 45%  3 rd year = 0%  4 th year = 18%

26 Results – Respondents by Ethnicity Hispanic = 36% Black = 45% Other = 18%

27 Question: Many factors influence students decisions to become a physician, of the factors listed, please indicate how much influence each factor had on your decision to pursue a career in medicine? 1 = no influence 2 = some degree of influence 3 = moderate degree of influence 4 = great degree of influence

28 Influence to become a physician

29 Influence to become a physician

30 Influence – AAMC 2004

31 Question: When you think about the reason you chose to attend DMU, what factors were most important to you? 1 = unimportant 2= of little importance 3 = moderately important 4 = very important

32 Reason Student Chose DMU

33 AAMC 2004 data

34 Question: How important is it to have opportunities to work with minority mentors during medical school? 1 = unimportant 2 = of little importance 3 = moderately important 4 = very important

35 Minority Mentors

36 Question: When you think about the curriculum, do you believe there is sufficient content regarding minority health and cultural competence? 100% said “no”

37 Summary I’m not sure we know what prospective minority students want and expect. More information is needed to determine the best recruiting strategies, what we’ve invested in hasn’t produced a difference in yield. Some schools are doing a great job, and we could learn from them.

38 Physician Recruitment Objective  Physician Recruitment—add five additional physicians to our adjunct faculty African American & Hispanic  Lecturers  Clinical Preceptors  Mentors

39 Physician Recruitment Choice of underrepresented minorities targeted  IA Chapter of the National Medical Association  Prominent Hispanic physician in Des Moines

40 Physician Recruitment Methods chosen to find these minority physicians:  Contacting medical societies  Checking current DMU adjunct faculty list  Word of mouth  INMA membership directory

41 Physician Recruitment Initial plan:  Develop more culturally appealing recruitment documents  Group presentation at the next INMA meeting--result  Face to face with Hispanic physician--result

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44 Physician Recruitment Second Plan  Face to face individual meetings with a meal—result  Time and labor intensive work for one person- -result

45 Physician Recruitment Third Plan  EUREKA!!! Dr. Wohlford-Wessels locates one source in IA that keeps an extensive database of physicians that includes race- ethnicity  Provides us with 81 black names and addresses and 32 other that appear to be Hispanic

46 Physician Recruitment Some of the black names were duplicates but none of the other names were. We then sent out a mass mailing with recruitment information to everyone on the list.

47 Physician Recruitment Results to Date 1 st planGroup 2 expressed interest Face to Face 1 signed up as preceptor 2 nd planFace to Face One signed up for preceptor or lecturer 3 rd plan3 contacted me with interest

48 Solutions to Recruitment and Retention For years educators have spoken about the need to increase the number of minority students applying to medical schools to decrease health disparities in health care.

49 Solutions to Recruitment and Retention The question yet to be fully answered is: How best is that done?  Creating long-term solutions by creating pipelines within our K-12 schools will make minority students more skilled in sciences and math

50 Recruitment and Retention (R and R) Issues for Faculty For faculty, the following are often cited as reasons for unsuccessful R and R efforts:  Feelings of isolation of faculty  Paucity of other faculty of color  Insufficient mentoring and guidance  Resistance from students and colleagues  Disproportionate demands for informal advising and committee work

51 Solutions to Recruitment and Retention We must take long-range ongoing processes to success—not a single event. The advertising and interviewing process must be sophisticated and posting must be able to reach minorities. Strong leadership and accountability are important in recruiting faculty.

52 Solutions to Recruitment and Retention Faculty search committees need to be educated about best practices for proactive faculty search processes that identify a diverse yet outstanding applicant pool. Dual career issues should be addressed carefully.

53 Solutions to Recruitment and Retention ALWAYS be searching—networking at conferences and meetings is important. Review your publicity materials—are they inviting to people of color as well? Ensure you have a diverse search committee—going outside of the campus if possible and necessary.

54 Solutions to Recruitment and Retention Do not forget the Historically Black Colleges and Universities or even local universities. Regularly evaluate your success at recruitment efforts and success in hiring and retention—if possible try to learn why someone is moving on.

55 Summary Efforts in the past have been less than successful – for both the recruitment of students and faculty. Underrepresented students may need assistance to be more competitive in math and science. We need to engage students at a very young age.

56 Summary Minority physicians must be identified and sought to serve as mentors and role models. Used “mixed methods” to recruit students and faculty

57 Thank You!