• Will Patients Find Diversity in the Medical Home?

    One Pagers | Jul 15, 2008
    Eddie J. Turner, MD, Andrew W. Bazemore, MD, MPH, Robert L. Phillips, Jr., MD, MSPH and Larry A. Green, MD

    Mexican Americans and blacks experience disparities in health outcomes relative to white populations. During the past five to 10 years, fewer blacks and Mexican Americans are going to medical school and entering primary care professions. To assure the availability of a patient-centered medical home for all Americans, policy makers must work to support a culturally competent and diverse primary care workforce.

    A diverse primary care workforce improves access and quality, patient choice and satisfaction, educational experiences for medical students, and health care disparities for patients of racial and ethnic minorities.1 In the past, minorities were more likely to enter primary care and treat underserved populations than their white medical school classmates.1-3 Like their white peers, these groups are now choosing specialty careers over primary care. Mexican Americans and blacks show a 50 percent decrease in primary care, from 40 percent in 1999 to 20 percent in 2004. By 2050, current minority groups will grow to represent more than one half of the U.S. population.4 These groups already experience health disparities and poorer access to care, yet their population growth is occurring even as fewer from their communities are going to medical school and choosing primary care (see accompanying figure).5 Although the trend of minorities' interest in primary care is similar to that of the non-minority population, the combination of declining minority interest and projected increases in underserved minority populations threatens our ability to provide a diverse physician workforce. 

    Figure. Minority students' choice of primary care* compared with other specialties from1999 to 2004.

    PC = primary care; SP = specialty career *Family Medicine, General Internal Medicine and General Pediatrics. †Specialties include medical and pediatric subspecialties, surgery and surgical subspecialties, and support specialties. Source: AAMC GQ Survey 

    Policy solutions that could have a more immediate impact include:

    • Enhancing premedical educational opportunities for underrepresented minorities 
    • Medical school admissions policies promoting racial and ethnic diversity 
    • Reducing medical education debt for minorities 
    • Raising the profile of primary care specialties within academic medical centers 
    • Supporting Title VII programs proven to enhance primary care recruitment of minorities 
    • Improving primary care compensation to make it more financially attractive


    1. Missing Persons: Minorities in the Health Professions: a Report of the Sullivan Commission on Diversity in the Healthcare Workforce. Durham, N.C.: Sullivan Commission, 2004.
    2. Cohen JJ, Gabriel BA, Terrell C. The case for diversity in the health care workforce. Health Aff (Millwood). 2002;21(5):90-102.
    3. Komaromy M, Grumbach K, Drake M, et al. The role of black and Hispanic physicians in providing health care for underserved populations. N Engl J Med. 1996;334(20):1305-1310.
    4. Gutierrez CM. Statistical abstract of the United States: 2007. The National Data Book. Washington, DC: The Bureau, 2007.
    5. AAMC. Diversity in the physician workforce: facts & figures 2006. Washington, DC: AAMC, Division of Diversity Policy and Programs, 2006.
    The information and opinions contained in research from the Graham Center do not necessarily refliect the views or the policy of the AAFP. 
    Published in American Family Physician, Jul15, 2008 Am Fam Physician. 2008: 78(2):183. This series coordinated by Sumi Sexton, MD, AFP Associate Medical Editor.