Educating Health Professionals: Are We Failing Minorities? 

By Miguel R. Kamat, MD, MPH


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


Major discrepancies persist in the 

representation of racial and ethnic minorities within the Nation’s 

health professions workforce. For instance, 

African Americans, Hispanics and American 

Indians and Alaska Natives account for only 

10 percent of the health professions 

workforce, even though they make up approximately 25 percent of the U.S. population. 

Blacks/Hispanics in Health Professions 

Although there are wide variations 

among professions, Blacks and Hispanics are 

underrepresented throughout the health 

workforce, particularly in professions that require extensive training such as medicine, 

dentistry, and pharmacy (see Table 1). Blacks 

are well represented in a few professions that 

require substantial formal education such as 

dietetics (they constitute 18.2 percent of dietitians) and social work (23.4 percent), and 

are close to parity in some others (psychologists, physician assistants). They also are well 

represented in occupations that require little 

formal training (health aides and nursing 

aides, orderlies and attendants). Hispanics are 

well represented among dental assistants and 

dental laboratory and medical appliance technicians, but are poorly represented among 

virtually all other professions that require formal education. 

American Indians and Alaska Natives 

constitute approximately 0.05 percent of 

physicians and less than 0.05 percent of dentists and pharmacists, although they represent 0.9 percent of the population. The Association of American Medical Colleges 

(AAMC) includes Native Hawaiians, but not 

other Asian American or Pacific Islanders, in 

its definition of underrepresented minority 

groups within the medical student body. 

However, it is important to keep in mind 

that the AAMC definition of underserved 

minorities does not acknowledge potential 

underrepresentation by certain Asian American and Pacific Islander subgroups, such as recent immigrants and refugees. 

Office of Minority Health Resource Center 1 U.S. Department of Health and Human Services 

Trends over Time Medical Schools 

The number of degrees in the health Between 1950 and 1995, African 

professions awarded to Blacks increased from American, Hispanic and American Indian/ 

a baseline of 5.0 percent in academic year Alaska Native first-year enrollments in allo1985-86 to 5.9 percent in 1993-94, well pathic medical schools steadily increased. 

below the national disease prevention and During the early 1990s, they accelerated at a 

health promotion target of 8.0 percent set by rate faster than their growth in the U.S. popuHealthy People for the year 2000. Hispanics lation, instilling confidence that enrollment 

progressed from a baseline of 3.0 percent of in allopathic medical schools might reach 

all health professions degrees in 1985-86 to parity by year 2000. 

4.3 percent in 1993-94, again below the tar­ But in 1996 and 1997, the number 

get of 6.4 percent for the year 2000. Finally, and percent of Black, Hispanic and Amerifor American Indians/Alaska Natives, the can Indian/Alaska Native first-year enrollees 

baseline was 0.3 percent (1985-86); this pro­ declined for the first time since 1985, widportion increased to 0.4 percent in 1993­ ening the gap between their representation 

94, still below the target of 0.6 percent for in medical schools and the U.S. population. 

the year 2000. This deficit is expected to increase according 

to year 2010 projections. continued>>>> 

Table 1. Black and Hispanic Employment* 

in Health Occupations: 1998 

Health Profession % Black % Hispanic 

Physicians 4.9 4.8 

Dentists 2.8 2.0 

Registered Nurses 9.3 3.2 

Pharmacists 4.1 5.1 

Dietitians 18.2 4.3 

Respiratory Therapists 11.7 2.0 

Occupational Therapists 6.5 0.7 

Physical Therapists 4.2 5.4 

Speech Therapists 1.9 6.3 

Physician Assistants 10.6 2.8 

Psychologists 10.2 4.0 

Social Workers 23.4 6.4 

Clinical Laboratory Technologists and Technicians 15.0 6.4 

Dental Hygienists 3.9 3.9 

Radiologic Technicians 8.2 2.0 

Licensed Practical Nurses 17.4 5.8 

Dental Laboratory and Medical Appliance Technicians 6.8 12.6 

Dental Assistants 6.1 12.1 

Health Aides (except nursing) 24.4 9.3 

Nursing Aides, Orderlies and Attendants 34.0 9.8 

U.S. Population** 12.1 11.4

 *Employed civilians ages 16 years and older. Source: Current Population Survey. 

** 1998 Bureau of the Census 
Educating Health Professionals: Are We Failing Minorities? 

By Miguel R. Kamat, MD, MPH


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


According to the AAMC, “over two-thirds of the decline oc- Attrition rates for these groups from undergraduate institutions 

curred at schools affected by Proposition 209 (California) and the are greater than those for Whites—a high of 36 percent for Blacks 

Hopwood decision (Texas, Louisiana, and Mississippi)—rulings that versus a low of 8 percent for Whites (contrasting 1991 and 1993 

prohibited the consideration of race or ethnicity in the admissions undergraduate cohort enrollment profiles). 

process.” 

Underrepresented minority medical students encounter greater High School 

obstacles to financing and completing their medical education than 

their colleagues. About 80 percent of underrepresented minority During high school, where math and science serve as the foundamedical students were in debt when they entered medical school, tion upon which future health careers are built, the types of math and 

compared with only 43 percent of others. And 94 percent of science courses taken by underrepresented minority and White stuunderrepresented minority medical students graduated in debt in dents diverge sharply. For example, unlike Asian Americans and 

1997, compared with 82 percent of others. Only 80 percent of Whites, Black, Hispanic, and American Indian high school graduates 

underrepresented minority medical school students graduated within were more likely to have taken remedial math than trigonometry, 

five years of matriculation, compared to 93 percent of others. despite the fact that the proportion of Blacks and Hispanics taking 

math, chemistry and physics doubled between 1982 and 1992. A 

Health Professions Schools weak scientific foundation in turn adversely affects Scholastic Aptitude Test (SAT) scores. It’s no surprise then that Whites had higher 

The underrepresented minority enrollment in health professions math scores than all groups except Asian Americans on the SAT in 

schools is currently 13 percent and needs to be increased an additional 1994. 

12 percent to reach parity with representation in the general population (25 percent). Conclusion 

A detailed analysis demonstrates that health profession schools 

have a low enrollment of African American, Hispanic and American It is clear that Blacks, Hispanics and American Indians/Alaska 

Indian/Alaska Native students. Apart from American Indian/ Alaska Natives within the U.S. population are underrepresented in high 

Native representation in osteopathic medical schools—which is at school math and science courses, in college, graduate school, and in 

parity with the population—no health profession can boast African the workforce itself. We must work to increase the education, trainAmerican, Hispanic, or American Indian/Alaska Native enrollment at ing, and recruitment of minorities to the Nation’s health professions in 

parity with the U.S. population. And only in public health are the order to overcome the health disparities experienced by minority comAfrican American, Hispanic and American Indian/ Alaska Native en- munities. If we can do this, we will have a workforce that adequately 

rollees greater than 15 percent of total enrollment. reflects the rich diversity of this country, fully uses the potential of our 

people, and best serves the American public.

Undergraduate Education 

Table 2. Selected Enrollment Compared With Populations in 

Degrees in science and engineering serve Health Professions Schools: 1996-1997 

as valuable credentials for college graduates % % % American 

seeking to enter health professions graduate African American Hispanic Indian/Alaska Native 

schools. The number of science and engineer- U.S. Population* 12.1 11.4 0.9 

ing bachelor’s degrees awarded to underserved Allopathic Med (M.D.) 8.0 3.4 ** 0.8 

minorities increased by 47 percent between Osteopathic Med (D.O.) 4.1 3.8 0.9 

1985 and 1993. This progress notwithstand- Podiatry 3.7 3.4 0.6 

Dentistry 5.4 4.0 0.5 ing, Blacks, Hispanics and American Indians Optometry 2.4 3.9 0.5 still earned a disproportionately low share of Pharmacy 7.7 2.8 0.4 undergraduate degrees when compared with Veterinary Med 2.2 3.0 0.6 

their representation in the population. Collec- Public Health 8.0 8.8 0.8 

tively, they earned only 13 percent of all sci- Nursing (RN) 9.9 3.9 0.8

ence and engineering baccalaureates in 1995, 

although they constituted 28 percent of col- * 1998 Bureau of the Census estimates 

** Mexican American + Mainland Puerto Rican Source: adapted from table 

compiled by HRSA, Bureau of Health Professions, National Center for Health 

Workforce Information and Analysis. 

lege-age students that year. 

Office of Minority Health Resource Center 1 U.S. Department of Health and Human Services