Community college pathways: improving the U.S. physician workforce pipeline.

Diversity in the physician workforce increases health care access for underserved populations, improves culturally and linguistically appropriate care, and better positions the workforce to serve the needs of a diverse population.1–9 How to achieve that diversity, however, is not well understood. To our knowledge, no prior research has clarified how or if the undergraduate pathway contributes to a diverse physician workforce that is interested in serving underserved communities. Furthermore, we are not aware of any studies that have explored the community college (CC) as a pathway to medical school. Since CCs (2-year post-secondary educational institutions) serve as a principal higher education attainment pathway for many low-income and underrepresented minority (URM) students10, we chose to investigate the CC pathways to medical school in this study. In 2010, approximately 8 million or 44% of all the undergraduate students in the United States were enrolled at one of the 1,600 CCs throughout the country.11 The percentage of Latinos attending CC’s has nearly doubled since 1992,12 and the majority of CC students come from low-income families.13 CC enrollment in 2010 was as follows: 57% women, 52% White, 17% Latino, 15% Black, 5% Asian, and 11% other race or not reported.11 These data indicate that CC students potentially represent the type of student being targeted by national efforts to encourage URM students to pursue careers in medicine. However, achieving diversity in our future physician workforce is challenged by rising tuition costs that have outpaced family income growth. Although numerous factors influence URM interest in medicine, financial barriers can considerably widen the privilege gap, resulting in a socially stratified higher education system.14 In the United States, the majority of medical students have parents with graduate levels of education and incomes in the top quintile of all American families.15,16 The median student-reported parental income among matriculating medical students in 2012 was $115,000.17 Although cost is a strong deterrent for potential applicants with lower parental income, other determinants, such as disparities in educational attainment and academic preparedness, may explain some of the demographic trends among medical school applicants.18 From 1977 to 2012, the racial-ethnic composition of medical school applicants has changed as follows: Asians increased from 2.6% to 23%, Latinos increased from 2.6% to 8.7%, Blacks increased from 6.4% to 8.1%, American Indians and Alaska Natives decreased from 0.33% to 0.25%, and Whites decreased from 88% to 60%.19 Today, Blacks and Latinos make up 13% and 17% of the U.S. population, and comprise 6% and 5.5% of the physician workforce, respectively.20,21 We describe the characteristics of pre-medical students who use CC pathways and the association of those characteristics with acceptance to medical school, intentions to serve underserved communities, and intentions to work primarily with minority populations. Given the diversity in the CC student body and prior studies identifying factors that support students’ intent to practice in underserved and minority communities2,5,22–24, we hypothesized that CC pathways are used differently by medical school applicants and matriculants with different characteristics, and that students who use CC pathways may be more likely to practice in underserved communities than those who did not use a CC pathway.