By Ronald Rodriguez, MD

Challenges and Opportunities in Increasing the Hispanic Participation in Our Medical Schools

By Ronald Rodriguez, MD

Nationally, there has been an improving trend in training Hispanic medical students. In 2015, only 6.4% of medical school matriculants were Hispanic, and the national percentage of Hispanic physicians was roughly 5%. In 2021, Hispanic medical students represented 12.7% of all medical school matriculantsup 12% from the prior year and nearly twice the rate seen only six years earlier. However, in 2019 the graduation rate of Hispanic medical students was 5.3% (Figure 1), closer to the current national estimates of Hispanic physicians in the US (5.8%). Presumably, with more time, the increased matriculation rates will translate to increased Hispanic physicians, but only if the production of such physicians occurs faster than attrition of these physicians and if the graduation rates of these Hispanic medical students are comparable to non-Hispanic white students. While these results are a step in the right direction nationally, the physician shortage in Texas, particularly in San Antonio and the greater South Texas region, is much more concerning.

In the first quarter of 2021, there were 1.674 million healthcare and social assistance employees in Texas, up 6.3% from the same quarter in 2016. Growth occurred despite the harmful economic impact of the COVID-19 pandemic. Healthcare and related jobs will continue to be the most dominant industry in Texas moving forward, as the growing population of the elderly and the young are projected to be among the highest in the overall population.1 Healthcare jobs in the Alamo workforce development area are expected to grow at least 27% over the next five years, more than any other occupation in this region. Despite significant underestimates in the Latino community from the 2020 Census,2 at least 66% of the population in the San Antonio area is Hispanic, and 7% are black, while 22% of the physicians are Hispanic and 3% are Black. Compared to national Hispanic physician rates, these are impressive numbers. But compared to the local demographic, the fold disparity in the San Antonio area is no different from the rest of the nation (Figure 2). The disparity among Hispanic/Latino providers is even more disturbing when looked at geographically (Figure 3). Nearly all primary care providers have offices in the medical center and the Northside, with relatively few providers located South of Highway 90. The Southside is a predominantly Latino community (>90%), with high disease morbidity but relatively little access to care. Additionally, the income disparity between the North and South is among the highest in the nation for any large metropolitan area.3 According to the AAMC, between 2019 and 2034, the Hispanic population is projected to grow by 32% nationally.4 In the San Antonio area, this would predict 87% Hispanic by 2034.

In order to address the current and changing demographic, our medical schools need to attract and train more Hispanic students. At first glance, the increased number of physicians trained locally through UT Health San Antonio and the relatively new UIW School of Osteopathy look encouraging to meet this local need. However, while the national average matriculation of Hispanic medical students was 12.7% compared to an 18.4% national Hispanic population, the local matriculation of Hispanic students in 2021 was 19.6% (UTHSA) compared to a local Hispanic population rate of 66%. This translates to a 1.4-fold disparity nationally but 3.3-fold disparity locally. Even with some of the highest Hispanic matriculation rates in the country, the local training of medical students is falling well short of even the national average. These data predict some stark realizations, including: 1. We cannot rely on meeting our local needs for Hispanic physicians by local training alone. We must find solutions that make San Antonio a favored destination for Hispanic providers. Currently, as our

Figure 1. Race/Ethnicity of Medical School Graduates 2018-2019, USA.

Figure 2. Hispanic Physician Disparity. Figure 3. Primary Care workforce supply mapped geographically. Note the large geographic disparity for availability of primary care providers. Data provided by Sg2 Healthcare analytics.

Hispanic physician disparity is identical nationally and locally (Figure 2), San Antonio is not any more attractive a site for Hispanic doctors as the rest of the nation. 2. We must escalate our investing in our pipeline programs (at the High School level or even earlier) with culturally sensitive preparation for health careers. Fortunately, we have two health careers high schools in San Antonio which are actively engaged in this process. Our efforts to support the Health Professions High School and the newer CASTMED High School must be expanded. Additionally, efforts must be focused on enhancing cultural sensitivity training for our students while engaging them in the community to empower them and develop a strong desire to stay in the area. 3. The academic and business community must identify and promote newer innovative methods of recruitment and retention of Hispanic providers by providing career advancement opportunities that reward success in promoting diversity, and hold strict accountability for those leaders who do not demonstrate continuous improvement in those domains.

In summary, we are at a critical inflection point in the changing demographic of the nation and our beloved community. We are the only top-10 city in the nation with a majority-minority population, and this community’s Hispanic predominance will continue to grow. There is substantial healthcare disparity in our community due in part to an impossibly complex healthcare system, which is systemically structured to place our most vulnerable patients at a disadvantage. Additionally, not enough of our providers reflect the language, culture and sensibilities of the communities they serve. If we don’t take active measures to our approaches to our local biomedical and healthcare enterprise, these disparities will only widen. But despite these stark warnings, San Antonio is a community of immigrants, and a melting pot of cultures which for centuries have demonstrated the most profound resiliency. The COVID-19 pandemic demonstrated a glimpse of the immense vulnerabilities of our at-risk populations. However, I believe that with strong leadership, community engagement, and thoughtful collaboration between the business and academic communities, we can solve these problems and brighten our future.

Ronald Ridriguez, MD, PhD is a Professor of Urologic Science at UT Health San Antonio. He is also a member of the Bexar County Medical Society.

References: 1. Commission, T.W., Report on Texas Growth Occupations. 2021,

State of Texas: https://lmci.state.tx.us/shared/PDFs/High-Growth-

Annual-Report-Final-Review-full-2021.pdf. p. 1-94. 2. United States. Congress. House. Committee on Oversight and Reform, Reaching hard-to-count communities in the 2020 census : hearing before the Committee on Oversight and Reform, House of

Representatives, One Hundred Sixteenth Congress, second session,

January 9, 2020. 2020, Washington: U.S. Government Publishing

Office. iv, 79 pages. 3. Bureau, U.C., US Census, Document S2001: Median earnings of those who worked full-time, year-round in 2020, filtered to Bexar

County, U.D.o.C. , Editor. 2020. 4. AAMC The Complexities of Physician Supply and Demand: Projections from 2019-2034. 2021.