Putting the Right People in the Right Places 

Minority Health Professionals Serve Community Needs 

By Nicole Lurie, MD, MSPH


Closing the Gap, Putting the Right People in the Right Places • May/June 1999


Recruitment, retention, training, and promotion of racial and 

ethnic minorities within the Nation’s health professions 

workforce will not only help eliminate disparities in the health 

care received by minorities, it will improve the health of all Americans. 

Racial and ethnic minority physicians are, in general, more willing to 

provide care to poor patients who find themselves with no insurance 

or public insurance such as Medicaid, according to a recent survey of 

U.S. medical school graduates. The survey also revealed that almost 

one-half of underrepresented minority graduates, compared to less 

than one-fifth of their non-underrepresented counterparts, indicated 

that they planned to practice in an underserved area. These professionals fill a great need. Underserved communities with high proportions of Black and Hispanic residents have been described as four 

times as likely as others to have a shortage of physicians. 

Research also shows that minority physicians are more likely to 

practice in areas where a high percentage of residents come from racial 

and ethnic backgrounds which are similar to their own. A 1996 study 

I co-authored in the New England Journal of Medicine with colleagues 

from the University of California, San Francisco, titled, “The Role of 

Black and Hispanic Physicians in Providing Health Care for 

Underserved Populations,” found that Black physicians practiced in 

areas where the proportion of Black residents was nearly five times as 

high as in areas where other physicians practiced. Similarly, Hispanic 

physicians worked in communities with twice the proportion of Hispanic residents when compared to their non-Hispanic colleagues. 

This willingness to care for minority populations in underserved 

areas may stem from attitudes of social responsibility held by 

underrepresented minority medical students. The Association of 

American Medical Colleges (AAMC) reported that 67 percent of 

underrepresented minority medical school students strongly agreed 

that physicians are obligated to care for the poor, compared with 56 

percent of others. These attitudes translate into voluntary placement 

of underrepresented minorities in underserved areas at the time of 

graduation. For example, 1993 AAMC data indicate that among 

graduates planning generalist careers, 60 percent of underrepresented 

minorities intended to practice in underserved areas, as opposed to 24 

percent of others. 

Minority physicians can also bridge linguistic, cultural, and historical barriers that hamper access to care. According to the 1990 

census, 25.1 percent of Asian Americans, 23.8 percent of Hispanics, 

4.5 percent of Pacific Islanders, 4 percent of American Indians/Alaska 

Natives and 0.9 percent of Blacks were linguistically isolated. The 

number of people with limited or no proficiency in English is growing, with the 1990 census indicating that 14 percent of people in the 

U.S. over age five spoke a language other than English at home, as 

opposed to 11 percent in 1980. For optimal communication, it is 

usually better if the patient and provider speak the same language; 

bilingual/ multilingual translators are only a second-best, and often 

unachievable alternative. This issue assumes importance when one 

considers the grave consequences of medical miscommunication, in 

that physicians could miss diagnoses or patients could become sicker 

because there has not been effective communication about problems 

or treatment regimens. 

Other cultural barriers can be just as problematic. For example, 

many Vietnamese patients believe that Western medications are too 

strong—given the smaller size and weight of Asian patients— and in 

response may halve their doses, rendering treatment ineffective. 

Finally, historical antagonisms between Blacks and Whites have 

often inhibited the formation of trustworthy relationships, jeopardizing the quality of care delivered. As long ago as 1973, our current 

Surgeon General David Satcher, MD, expressed concern in an editorial in the Journal of the American Medical Association, saying that 

traditional social relationships between Blacks and Whites had resulted in inhibited communication between the two. It was his observation that Black patients who are dissatisfied with their care resorted 

to non-compliance rather than questioning their White physician’s 

authority. 

These barriers to communication have deep historical roots, causing many Black patients to distrust the predominantly White medical 

profession. There is no reason to think that these dynamics are limited 

to Blacks and Whites. As Dr. Satcher concluded, the “community 

must develop trustworthy... personnel to help plan for better health 

care.” One way to do so is to assure greater diversity in the workforce. 

Minority physicians can play a valuable role in educating their 

colleagues. Having more minority physicians and other health care 

professionals would help eliminate racial and ethnic stereotypes that 

have existed for so long. 

For all these reasons, it is important that we bring attention to the 

subject of health professions development. The articles in this issue of 

Closing the Gap give a renewed sense of the importance of this subject. It is my hope that with this information, we will press on with our 

efforts to ensure that our workforce represents and serves all Americans. 

Dr. Lurie is Principal Deputy Assistant Secretary for Health, U.S. 

Department of Health and Human Services.

Office of Minority Health Resource Center U.S. Department of Health and Human Services