The six members of Medical Team 4 have a lot in common. Each wears a white coat, has a stethoscope for a necklace and has stayed up late this week. They can all start an IV and work up a solitary lung nodule.
They share something less obvious, too. With one exception, none has a grandparent born in the United States.
Med 4 at the Veterans Affairs Medical Center in Northwest Washington is the new face of American medicine. Its members happen to come from Georgetown and George Washington universities, but the team is indistinguishable from similar groups of young doctors and doctors-to-be at many of the country’s 125 medical schools.
In the past 15 years, U.S. medicine has seen a huge influx of first- and second-generation immigrants. It follows and augments a different demographic trend that began 30 years ago with the acceptance of increasing numbers of women into medical schools. As a result of that earlier revolutionary change, half of new practitioners today are women.
The Norman Rockwell-Marcus Welby image of the American doctor—an avuncular white man, often in a bow tie—is rapidly disappearing.
From 1980 to 2004, the fraction of medical school graduates describing themselves as white fell from 85 percent to 64 percent. Over that same period, the percentage of Asians increased from 3 percent to 20 percent, with Indians and Chinese the two biggest ethnic groups.
Counted in the “white” category, moreover, are a moderate number of ethnic Persians whose families fled the 1979 Iranian revolution, and a smaller number of more recent arrivals from Eastern Europe and the former Soviet Union. In the “black” category is an unknown number of graduates whose families recently arrived from Africa, predominantly Nigerians and Ghanaians.
“We are seeing more and more kids of foreign-born parents, especially in the last eight to 10 years. I don’t think there is any doubt about it,” said Milford M. Foxwell, a physician and dean of admissions at the University of Maryland School of Medicine. In his 18 years on the job, he has reviewed about 75,000 applications.
Although the Association of American Medical Colleges asks all medical school applicants and matriculants to describe their race and ethnicity in general terms, there is little published information about national background and none about family history. Anecdotes, however, suggest that immigrants’ children are more likely to attend schools on both coasts.
S. Balasubramaniam, a surgeon at Charles R. Drew University of Medicine and Science in Los Angeles who emigrated from India in 1971, recently queried 50 medical schools and calculated that 12 percent of the class that entered in 2006 is of Indian heritage. The highest percentages are in California, Texas, New York, New Jersey and New England.
Na Shen, 25, a second-year medical student at Maryland who was born in Shanghai, calculated that 12 percent of her school’s students are from China, Taiwan, Korea and Japan, and 1 percent from Southeast Asia. When South Asians are included, the Asian portion of the school rises to 21 percent.
In contrast, University of Kansas medical school students since 1996 have consistently run about 10 percent “either born overseas or of parents who were born overseas,” said Glendon Cox, the vice dean.
The most recent arrivals—Africans—are the hardest to quantify.
Morehouse School of Medicine, in Atlanta, has 12 students born in Africa out of about 210 in the M.D. program. Meharry Medical College, another historically black institution, in the past eight years has had an average of two foreigners per year in its incoming classes of about 60. It has no data, however, on students with recent ties to Africa who are U.S. citizens or permanent residents. Howard, the third historically black medical school, did not provide information when asked.
Lauree Thomas, an African American physician who is associate dean for admissions at the University of Texas Medical Branch in Galveston, estimated that “20 to 30 percent of the black applicant pool” at her school is students who were born in Nigeria, or of Nigerian parents. Foxwell, the Maryland dean, estimates that close to half the black students there have recent ties to Africa.
This is a touchy subject in the black medical community.
Albert Morris Jr., a diagnostic radiologist in Memphis who is president of the predominantly black National Medical Association, said he recently talked to black students at Pennsylvania State University’s medical school in Hershey. Afterward, several took him aside and quietly complained about the rising number of Africans.
“It was a big topic—that people were coming in and getting slots that they thought should be going to African Americans,” he recalled.
Blacks constitute about 13 percent of the U.S. population, but only 4 percent of U.S. doctors. There has been much effort in the last two decades to remedy this imbalance. Morris, a graduate of Howard, said he understands the students’ sensitivities.
“We are happy to see doctors who are ready to treat minority populations, no matter their nationality,” said Morris, 56. “But we want to make sure that those of us who have helped open the doors [to medical school for blacks] get to share in the bounty.”