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The Role of Medical Education in Reducing Health Care
Disparities: The First Ten Years of the UCLA/Drew Medical
Education Program
Michelle Ko, MD
1
, Kevin C. Heslin, PhD
2,3
, Ronald A. Edelstein, EdD
4
, and Kevin Grumbach, MD
5
1
Department of Health Services, UCLA School of Public Health, CHS 31-269, Box 951772, Los Angeles, CA 90095-1772, USA;
2
Research Centers
in Minority Institutions, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA;
3
, David Geffen School of Medicine at UCLA,
Los Angeles, CA, USA;
4
Academic Affairs, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA;
5
Department of Family
and Community Medicine, University of California, San Francisco, CA, USA.
BACKGROUND: The University of California, Los
Angeles (UCLA)/Charles R. Drew University Medical
Education Program was developed to train physicians
for practice in underserved areas. The UCLA/ Drew
Medical Education Program students receive basic
science instruction at UCLA and complete their re-
quired clinical rotations in South Los Angeles, an
impoverished urban community. We have previously
shown that, in comparison to their UCLA counterparts,
students in the Drew program had greater odds of
maintaining their commitment to medically disadvan-
taged populations over the course of medical education.
OBJECTIVE: To examine the independent association
of graduation from the UCLA/ Drew program wit h
subsequent choice of physician practice location. We
hypothesized that participation in the UCL A/Drew
program predicts future practice in medically disadvan-
taged areas, controlling for student demographics such
as race/ethnicity and gender, indicators of socioeco-
nomic status, and specialty choice.
DESIGN: Retrospective cohort study.
PARTICIPANTS: Graduates (1,071) of the UCLA School
of Medicine and the UCLA/Drew Medical Education
Program from 1985–1995, practicing in California in
2003 based on the address listed in the American
Medical Association (AMA) Physician Masterfile.
MEASUREMENTS: Physician address was geocoded to
a California Medical Service Study Area (MSSA). A
medically disadvantaged community was defined as
meeting any one of the following criteria: (a) federally
designated HPSA or MUA; (b) rural area; (c) high
minority area; or (d) high poverty area.
RESULTS: Fifty-three percent of UCLA/Drew gradu-
ates are located in medically disadvantaged areas, in
contrast to 26.1% of UCLA graduates. In multivariate
analyses, underrepresented minority race/ethnicity
(OR: 1.57; 95% CI: 1.10–2.25) and participation in the
Drew program (OR: 2.47; 95% CI: 1.59–3.83) were
independent predictors of future practice in disadvan-
taged areas.
CONCLUSIONS: Physicians who graduated from the
UCLA/Drew Medical Education Program have higher
odds of practicing in underserved areas than those who
completed the traditional UCLA curriculum, even after
controlling for other factors such as race/ethnicity. The
association between participation in the UCLA/Drew
Medical Education Program and physician practice
location suggests that medical education programs
may reinforce student goals to practice in disadvan-
taged communities.
KEY WORDS: medical education; health care disparities; UCLA/Drew
program.
DOI: 10.1007/s11606-007-0154-z
© 2007 Society of General Internal Medicine 2007;22:625–631
INTRODUCTION
Maldistribution of physicians persists throughout the United
States, with an estimated 20% of the population living in
federally designated Health Professional Shortage Areas
(HPSAs).
1
Strategies to alleviate physician shortages usually
fall into one of three categories: applicant pool, medical
education, and practice environment.
2
Prior research has
identified potentially favorable applicant characteristics, such
underrepresented minority race/ethnicity,
3–5
growing up poor
6
or in an underserved area,
3,7
participation in the National
Health Service Corps,
3
interest before medical school,
3
and
older age.
8
However, it is not known whether the second
strategy, medical education, can successfully translate this
knowledge into changes in the physician workforce.
Rural education programs, particularly the Physician Short-
age Area Program (PSAP) of the Jefferson College of Medicine,
have shown the greatest success in producing physicians for
rural areas.
9,10
PSAP graduates are more likely to become
rural family practitioners than other Jefferson students with
similar backgrounds.
10
Less is understood about the efficacy
of medica l prog rams that hope t o relie ve i nner-city and
minority populations. Traditionally black colleges such as
Howard and Meharry have shown that in comparison to other
black physicians, their graduates care for larger numbers of
black patients , but not necessarily other disadvant aged
Received August 2, 2006
Revised January 17, 2007
Accepted February 1, 2007
Published online March 3, 2007
625
groups.
5,11
Direct comparisons to other minority groups or
their own nonblack graduates have not been conducted.
12,13
The UCLA/Drew Medical Education Program was developed
under the mission of t he Charles R. Drew University of
Medicine and Science “to conduct education and research in
the context of community service in order to train physicians
and allied health professionals to provide care with excellence
and compassion, especially to underserved populations.” A
joint effort of the Charles R. Drew University of Medicine and
Science (“Drew”, hereafter) and the David Geffen School of
Medicine at the University of California, Los Angeles (UCLA),
the program has selected applicants sinc e 1981 for their
commitment to this mission. In a survey of the 1996–2002
graduates, the percentage of UCLA/Drew students planning to
practice in unde rserved areas increased from 68.5% at
matriculation to 86% upon graduation. In contrast, traditional
UCLA graduates with similar intentions decreased from 28% at
matriculation to 20% at graduation.
14
These differen ces
remained after controlling for race, ethnicity, and other socio-
demographic characteristics. The maintenance of Drew stu-
dent commitment indicates program’s success in nurturing
students’ goals throughout medical school.
The long-term effects of the program on eventual practice
location have not been well characterized. Barnhart et al.
surveyed the classes from 1985–1987 and found that Drew
and minority graduates are more likely to practice in federally
designated shortage areas, but neither association demon-
strated statistical significance.
15
However, this survey was
restricted by its small sample size, absence of socioeconomic
and demographic controls, and limited outcome measure.
In this study, we determined the locations of graduates from
the first 10 years of the UCLA/Drew Program and their UCLA
counterparts who are currently practicing in California. Prac-
tice locations were assessed for the predominance of disad-
vantaged populations and geographic designation of physician
shortage. We examined the association between graduation
from UCLA/Drew and practicing in a disadvantaged commu-
nity, incorporating student demographics, socioeconomic sta-
tus, and specialty choice predictors. We hypothesized that
when controlling for premedical and educational factors,
participation in the UCLA/Drew program predicts future
practice in medically disadvantaged areas.
METHODS
Respondents
The study sample consisted of graduates of the UCLA School of
Medicine and the UCLA/Drew Medical Education Program
from 1985 to 1995, with a self-reported mailing address in
California listed in the American Medical Association (AMA)
Physician Masterfile in 2003. As residency and fellowship
training may extend 7–10 years following graduation, we chose
graduates from 1985–1995 to evaluate physicians who have
had sufficient time to complete their education and choose a
practice setting.
Data Sources
We conducted a retrospective analysis of s econda ry dat a
collected by the Association of American Medical C olleges
(AAMC) and the 2003 American Medical Association (AMA)
Physician Masterfile. The student data were obtained from
AAMC biographical files and the Prematriculation Question-
naire (PMQ). The PMQ is administered with the Medical College
Admissions Test, before a student’s admission and matricula-
tion into medical school. The AMA Masterfile information was
then linked to the AAMC data by unique identifiers.
Physicians’ preferred mailing addresses were geocoded to a
California Medical Service Study Area (MSSA), as described by
Grumbach, et al.
16
The sample was restricted to physicians
currently practicing in California. Although there have been
efforts to develop a standardized set of rational physician
service areas throughout the US, these methods are still in the
process of being validated.
17
Moreover, definitions of disad-
vantaged areas—such as those used in this study—that
categorize communities on the basis of minority resident
population and household income are difficult to standardize
across states (as opposed to within states) because of the wide
variation across states. Those physicians with an address in
California (67.9% of all graduates of both programs) were
geocoded to a California Medical Service Study Area (MSSA).
16
Data on the race/ethnicity and mean household income of the
populations residing in each MSSA were obtained from the
2000 Census. The use of these archived data for research
purposes was approved by the institutional review boards of
both UCLA and Drew.
Outcome Variables
A medically disadvantaged MSSAwas defined as meeting any one
of the following criteria: (a) federally designated primary care
Health Professional Shortage Area (HPSA) or Medically Under-
served Area (MUA); (b) rural area; (c) high minority area; or (d)
high poverty area. The State of California classifies an MSSA as
“rural” if it has a population density less than 250 residents per
square mile and contains no city with a population of 50,000
residents or greater. An area was defined as “high minority” if the
percentage of African-American or Latino residents was greater
than or equal to the 85th percentile of all areas for the state.
4
An
MSSAwas coded as “high poverty” if the mean household income
was in the lowest quartile of mean incomes for the state.
4
Predictor Variables
Independent variables were chosen for their association with
an intent to practice in underserved areas in prior studies.
3–5, 7
Demographics. Demographic variables were obtained from the
AAMC biographical file. We included age at matriculation as a
continuous variable. We dichotomized race/ethnicity into
underrepresented minority groups (URM) and non-URM.
Underrepresented minority groups were defined in accordance
with the Association of American Medical Colleges policy during
the study period: African American, Latino/Hispanic, and
Native American/Alaskan/Hawaiian.
18
Social Background. Social background variables were collected
from the PMQ. Parent education was categorized as: high
school degree or less; some college or post-high school
vocational training; college (4-year) degree; graduate or
professional education. Parent employment was categorized
626 Ko et al.: The Role of Medical Education in Reducing Health Care Disparities JGIM
as: professional/managerial/owner or not, to differentiate
between occupations with relative affluence and those
associated with lower socioeconomic status levels. We
included high school community as a measure of where
applicants spent at least some of their formative years. This
variable was categorized into three types: urban, suburban, or
rural area. State of origin was dichotomized as California
versus non-California at the time of application.
Medical Education. Medical education program was categorized
as enrollment in the UCLA School of Medicine or the UCLA/Drew
Medical Education Program. We also included year of graduation
to address potential secular trends.
Specialty. Physician specialty was dichotomized as primary
care v ersus no n-primary c are. Primary care specialties
included Family Medicine, General Internal Medicine,
General Pediatrics, and Obstetrics And Gynecology.
Although we have shown intent at matriculation to practice
in an underserved community predicts student intent at
graduation,
14
this variable was not part of the Matriculation
Questionnaire (MQ) until 1991, such that we were only able to
obtain responses from 1994–1995 graduates. Similarly, we
have demonstrated an association between intent at graduation
and subsequent practice in underserved areas,
14
but the
graduation intent variable was assessed by the Graduation
Questionnaire (GQ), for which the data were not complete until
the class of 1996. Given our preference to focus on post-training
physicians who have had time to settle into practice, we deemed
that these recent graduates would not be appropriate for study.
STATISTICAL ANALYSIS
Bivariate analyses were performed to examine relationships
between the predictor variables and the outcomes of interest,
and odds ratios with 95% confidence intervals were calculated.
We used the chi-squared test for categorical variables and t-tests
for continuous variables.
In an assessment of potential multicolinearity, none of the
variables had correlation greater than 0.70, the strongest being
between father’s education and occupation (r = .52). We then fit
two multivariate logistic regress ion models to estimate the
association of the UCLA/Drew program with practice in under-
served areas, in the context of previously identified predictors.
Independent variables were included if they were associated
with the outcome in bivariate analyses, or if previous literature
review suggested they may be important for their content.
3–5,7
We fit two regression models because the missing PMQ data
led to a reduction in sample size of 37% (i.e., from 1,047 to 672
observations). For the first analysis (“model 1”), social back-
ground variables from the PMQ were excluded. In the second
analysis (“model 2”), social background variables were added.
To assess potential interactions, we tested product terms of
the UCLA/Drew program with URM race/ethnicity, gender,
age, and parental education and occupation. We identified no
significant interactions in multivariate analysis, and these
terms were not included in the final models.
Although the proportions lost to follow-up because of out-of-
state relocation for the Drew and UCLA graduates were not
different (72.3% and 67.8%; P = .239), we performed a sensi-
tivity analysis to assess the impact of different assumptions
about the locations of the two groups on the results.
SPSS 11.0 for Windows and Mac OSX were used to perform
statistical analyses.
RESULTS
The AMA Physician Masterfile lists records for 1,706 UCLA and
UCLA/Drew graduates from 1985 through 1995. Slightly over
Table 1. Social, Demographic, And Practice Characteristics Of The
1985–1995 Graduates Of The UCLA/Drew Medical Education
Program And The UCLA School Of Medicine, Practicing In California
In 2003 (N=1,071)
Variable Percent
(%)
Number
(N)
Age
Mean (years) 22.8
Gender
Male 62.0 660
Female 38.0 405
Minority status
Non-URM* 76.9 814
URM* 23.1 244
State of origin
All other 6.1 65
California 93.9 1,003
Year of graduation
1985 9.5 102
1986 10.4 111
1987 9.8 105
1988 9.4 101
1989 10.5 112
1990 8.8 94
1991 8.6 92
1992 9.2 98
1993 8.3 89
1994 7.4 79
1995 8.1 86
Medical school program
UCLA 88.1 942
UCLA/Drew 11.9 127
Mother’s level of education
High School or less 29.3 262
Some college/ Business /Technical training 23.2 208
College degree 19.9 178
Graduate or professional work 27.6 247
Father’s level of education
High School or less 16.8 180
Some college/ Business /Technical training 13.7 122
College degree 19.0 169
Graduate or professional work 47.1 420
Father’s occupation
Nonprofessional/manager 22.6 160
Professional/Owner/Manager 77.4 549
Mother’s occupation
Nonprofessional/manager 57.9 407
Professional/Owner/Manager 42.1 296
High school community
Type
Suburban: large and moderate
size cities
35.9 323
Urban: large and moderate size
cities
49.0 441
Rural area to small city 15.1 136
Specialty area
Non-primary care 55.8 598
Primary care 44.2 473
*URM Underrepresented minority
627Ko et al.: The Role of Medical Education in Reducing Health Care DisparitiesJGIM
two-thirds (N = 1,159) have remained in California. Of these
physicians, 7.6% (n=88) were excluded because they were
listed as inactive, retired, or still in residency/fellowship
training. Characteristics of the resulting 1,071 graduates are
shown in Table 1. Eighty-eight percent graduated from the
UCLA S OM, and 11.9% (N = 127), from the UCLA/Drew
program. Twenty-three percent are underrepresented minori-
ties (URM). Somewhat less than half (44.2%) are practicing in a
primary care specialty.
Practice in Medically Disadvantaged Areas
Twenty-nine percent of active graduates are located in one of
the types of medically disadvantaged areas (MDAs, Table 2). Of
these physicians, 38.7% are listed in federally designated
HPSAs, while 31.6% are in high poverty areas. Only 16.8%
practice in rural areas. Many practice in minority communi-
ties, with 51% in high black areas and 33% in high Hispanic/
Latino areas. The total of the frequencies of each outcome
exceeded 100% because 27% of graduates are located in an area
that met multiple criteria for the disadvantaged designation.
Graduates of the UCLA/Drew Program
Over 50% of UCLA/Drew graduates are located in MDAs, in
contrast to 26.1% of UCLA graduates (Table 2). This associa-
tion remained consistent for both URM and non-URM physi-
cians (Fig. 1) and across all types of disadvantaged areas, with
the exception of rural areas (Table 2). Compared with their
UCLA counterparts, UCLA/Drew students had higher odds of
practicing in a medically disadvantaged area (OR: 3.23; 95%
CI: 2.20–4.73) (Table 3).
In multivariate analysis, only URM race/ethnicity (OR: 1.57;
95% CI: 1.09–2.25) and participation in the UCLA/Drew
program (OR: 2.47; 95% CI: 1.59–3.83) remained predictive of
practice in an MDA (Table 3). After controlling for both
premedical and educational factors, the only variable associ-
ated with practice in an MDA was the UCLA/Drew indicator
(OR: 2.05; 95% CI: 1.14–3.68).
The sensitivity analysis showed that, if we assume that
100% of out-of-state Drew graduates are not practicing in
MDAs and holding the proportion of out-of-state UCLA grad-
uates at 26%, the Drew effect remains (OR: 1.88). To conclude
that no Drew effect exists, 100% of Drew graduates out-of-state
would have to be practicing in non-MDAs, and 68% of out-of
state UCLA graduates would have to be located in MDAs.
DISCUSSION
The Martin Luther King, Jr. Medical Center and the Charles R.
Drew University of Medicine and Science provide care for one
of the most impoverished populations in Los Angeles County.
The results of this study suggest that the UCLA/Drew Medical
Education Program has been preparing physicians in accor-
dance with the Drew mission. Our findings are consistent with
those for the Jefferson Physician Shortage Area Program
(PSAP), which has demonstrated that after controlling for rural
background and premedical interest, PSAP graduates are more
likely to become rural family physicians.
9
No factor has been
as strongly linked service to the underserved as minority race/
ethnicity. In this study, we found that after controlling for URM
status, Drew graduates have greater odds of practicing in
disadvantaged communities. We propose that an inner-city-
based program may have a reinforcing effect on those students
initially inclined to work in these communities.
As does the PSAP, the UCLA/Drew Program contains two
main nontraditional components: first, an admissions process
that emphasizes applicant commitment to service; and second,
longitudinal clinical experiences in the target community. The
Drew admissions committee assesses applicants’ involvement
in community service, leadership potential, motivations, un-
derstanding of the needs of underserved populations, and the
maturity and clarity of their career goals. In a previous study
Table 2. Graduates Of The UCLA/Drew Medical Education Program
And The UCLA School Of Medicine, 1985–1995: Practice In
Medically Disadvantaged Areas In California* (N=1,062)†
Outcome
variable
Total UCLA/Drew UCLA P
Percentage
(%) (No)
Percentage
(%) (No)
Percentage
(%) (No)
(1,062) (124) (938)
Any medically
disadvantaged
area (rural,
high minority,
high poverty,
or HPSA/MUA)
29.2 (310) 53.2 (66) 26.1 (244) <.001
HPSA/MUA 11.2 (120) 22.0 (28) 9.8 (92) <.001
High poverty
area
9.2 (98) 17.5 (22) 8.1 (76) .001
High Black
area
14.8 (158) 28.6 (36) 12.9 (121) <.001
High
Hispanic/
Latino area
9.7 (103) 19.8 (25) 8.3 (78) <.001
Rural area 4.9 (52) 4.0 (5) 5.0 (47) .607
Note that percent (%) do not total 100% because of multiple designations.
*Defined as: (a) any medically disadvantaged area (rural, HPSA, high
poverty or high minority); (b) Health Professions Shortage Area (HPSA); (c)
high poverty area (average income below 25th percentile for state); (d)
high black area (above state 85th percentile); (e)High Hispanic/Latino
area (above state 85th percentile); and (f) Rural area.
†Missing 0.8% (9/1,0 71): no MSSA (Medic al Servi ce Study Area )
designation available
Figure 1. Percentage of graduates practicing in medically disad-
vantaged areas in California, by race/ethnicity and medical
school program. URM Underrepresented minority, non-URM non-
underrepresented minority (Asian-American/Pacific Islander, and
Non-Latino Caucasian).
628 Ko et al.: The Role of Medical Education in Reducing Health Care Disparities JGIM
on student intentions, we found that students in UCLA/Drew
program showed increased commitment over the course of
medical school in contrast to their UCLA classmates with the
same initial career goals, who experienced a decline in inter-
est.
14
In conjunction with our present findings, this suggests
that the program’s success may be attributable in part to the
selection and development of exceptionally motivated students.
Medical programs can provide a supportive environment for
students in a number of ways. Although short-term rotations
have no demonstrated effect, cumulative experiences during
medical training predict family medicine residents’ intent to
practice in underserved areas.
19
After their first 2 years of basic
science instruction at UCLA, students complete core clinical
rotations at the King/Drew Medical Center (KDMC), participate
in a longitudinal primary care clinic in a neighborhood health
center, and conduct a research thesis specific to disadvantaged
populations. As a result, students spend a majority of their
clinical time in south Los Angeles and through their experi-
ences, develop ties to the patient population and community. In
addition, Drew students’ goals may be further nurtured and
reinforced through interactions with like-minded peers and
faculty. Furthermore, the student body at Drew is quite diverse,
with ∼70% of students being of URM backgrounds. Students in
medical schools with greater racial diversity have more favor-
able attitudes to underserved populations.
20
One of the strengths of the present study is the robustness
of the findings across several indicators of “medically disad-
vantaged areas.” The most common measures are federally
Table 3. Graduates Of The UCLA/Drew Medical Education Program And UCLA SOM, 1985–1995: Bivariate And Multivariate Analysis Of
Practice Location In Any Medically Disadvantaged Area
Variable Bivariate Unadjusted P Multivariate Model 1* P Multivariate Model 2* P
OR 95% CI OR 95% CI OR 95% CI
Age at
matriculation
(years)
1.04 0.99–1.09 .16 0.93 0.95–1.05 .93 0.98 0.91–1.06 .66
Gender
Male†
Female 0.97 0.74–1.28 .85 0.85 0.63–1.13 .26 0.92 0.62–1.36 .67
Race/ethnicity
Non-URM†
URM 2.15 1.59–2.90 <.00 1 1.59 1.11–2.27 .011 1.52 0.92–2.50 .10
Region of origin
All other†
California 1.51 0.88–2.77 .18 1.43 0.77–2.68 .26 1.20 0.58–2.50 .62
Medical Program
UCLA†
UCLA/Drew 3.23 2.20 –4.73 <.00 1 2.49 1.60–3.88 <.00 1 2.05 1.14–3.68 .016
Year of graduation (years) 1.011 0.97–1.06 0.60 1.01 0.97–1.06 .52 1.02 0.95–1.10 .52
Specialty choice
Primary care
Non-primary care†
Primary care 1.10 0.85–1.44 .47 0.96 0.72–1.29 .85 1.06 0.73–1.55 .76
Parents’ education
Mother
High school or less 1.73 1.17–2.55 .006 1.31 0.75–2.30 .34
Some college/business/
technical training
1.48 0.98–2.25 .06 1.64 0.92–2.92 .091
College degree 1.07 0.68–1.68 .76 1.48 0.76–2.89 .25
Graduate or professional work†
Father
High school degree or less 1.65 1.13–2.41 .009 0.75 0.44
–1.27 .29
Some college/business/
technical training
1.78 1.16–2.73 .008 1.18 0.66–2.11 .58
College degree 0.90 0.59–1.37 .61 0.79 0.39–1.58 .50
Graduate or professional work†
Parents’ occupation
Mother
Nonprofessional/manager 1.44 1.03–2.02 .04 1.66 0.96–2.86 .068
Professional/manager/owner†
Father
Nonprofessional/manager 2.26 1.56–3.28 <.001 1.00 0.64–1.54 .99
Professional/Manager/Owner†
High school community
Suburban: large and
moderate size cities†
Urban: large and moderate
size cities
1.19 0.86–1.63 .30 0.93 0.63–1.38 .73
Rural area to small city 1.25 0.81–1.95 .31 0.96 0.56–1.62 .87
*Model 1: N=1,047 (Missing 2.24%; 24/1,071). Model 2 (inclusion of social background variables from the Prematriculation Questionnaire: N=672 (Missing
37.3%; 399/1,071).
†Reference category
629Ko et al.: The Role of Medical Education in Reducing Health Care DisparitiesJGIM
designated “Health Professional Shortage Areas” (HPSAs) or
Medically Underserved Areas (MUAs), but these classifications
may have limited validity as indicators of community-level
need. The HPSA “special population” criterion does not include
groups with persistent health care access problems such as
minorities other than Native Americans, and although under
consideration, revised designation methods have yet to be
formally adopted. We find these concerns especially pertinent
to this study, because until recently, only the King-Drew
medical facility received the HPSA designation, and not the
surrounding poor, minority, inner-city community. Therefore,
we expanded our measures beyond the HPSA designation to
include minority and high-poverty populations and found
again that Drew graduates had greater odds of practicing in
disadvantaged areas than their UCLA counterparts. We found
no relation between the Drew program and practice in rural
areas—which, given the urban location of the program, was
expected.
In the attempt to evaluate the efficacy of a program with a
broadly stated mission, we encountered several limitations. The
definition of medically “underserved” or “disadvantaged” area
has not yet been operationalized for research at the national
level, thus, restricting our analysis to California. We cannot
dismiss the possibility that these physicians limited their
practices to serving higher-income subgroups in their practice
areas, but given the stringency of the outcome criteria, the vast
majority of the population is likely to be medically disadvan-
taged. Nearly one-third of physicians did not complete the
Prematriculation Questionnaire (PMQ), which limited our abil-
ity to account for socioeconomic background. We were also
unable to determine if a graduate grew up in an underserved
area, instead, using a type of high school community as an
approximation of childhood environment. Furthermore, we did
not assess student intentions before medical school, and thus,
acknowledge an inherent selection bias in the type of student
who chooses to enter the program. It is not feasible to conduct a
randomized controlled trial or compare students with appli-
cants who were accepted but chose not to enter the program.
Because this study addressed two medical education programs
in Los Angeles, the results may not be generalizable to other
programs across the nation. Therefore, we limit our conclusions
to suggest that the success of the program may be attributed
significantly to the selection and training of exceptionally driven
students. Overall, this study represents an important first step
in illustrating the potential of medical education to shape
physician supply and distribution.
The next step would be to examine the practice patterns of
the graduates throughout the nation, including teaching and
research activities that may also be aimed at health care
inequities. Career paths have yet to be described, e.g., whether
physicians practice in disadvantaged areas after their careers
have been established or if increasing financial obligations or
physician burnout lead to an exodus from these areas. Ideally,
policymakers and educators would be able identify the key
factors to retain physicians in underserved communities for the
duration of their careers and demonstrate that having dedicat-
ed local care providers improves health outcomes.
As state initiatives have drastically reduced schools’ ability
to ensure adequate minority student enrollment,
21
the need to
train committed physicians to serve poor and minority com-
munities is perhaps greater than ever. We believe the UCLA/
Drew Medical Education Program can serve as a model for
other institutions to counter persistent disparities in access to
physician services along lines of race, ethnicity, income, and
geography.
Acknowledgments: We would like to acknowledge the contribu-
tions of Lois Colburn, LuAnn Wilkerson, EdD, Deborah Danoff, MD,
Carol Hodgson, PhD, Kehua Zhang, Shobita Rajagopalan, MD, Deyu
Pan, MS, Magda A. Shaheen, MD, PhD, Elizabeth Mertz, MPA, and
the staff of AMA data services for their guidance and assistance. We
would also like to thank Dr. Keith Norris for institutional support.
Renee Taylor provided administrative assistance. Data analysis
and manuscript development was suppor ted by the National
Center for Research Resources (P20-RR11145 and G12-RR03026-
15), the National Center on Minority Health and Health Disparities
(1 P20MD00148-01), the Agency for Healthcare Research and
Quality (1R24-HS014022-01A1) and (T 32-HS00046), and the
Bureau of Health Professions, Health Resources and Services
Administration (U79HP00004). The abstract from this study was
presented at the Society of General Internal Medicine 29th Annual
Meeting Poster Session, April 27, 2006.
Drs. Edelstein and Heslin are employees of the Charles R. Drew
University of Medicine and Science and are faculty members of the
David Geffen School of Medicine at UCLA.
Conflicts of interest: None disclosed.
Corresponding Author: Michelle Ko, Department of Health Ser-
vices, UCLA School of Public Health, CHS 31-269, Box 951772, Los
Angeles, CA 90095-1772, USA (e-mail: jassmine@ucla.edu).
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