Lack of Black Doctors Traced Primarily to Pre-College Factors, Study Finds

UVA Today, February 17, 2010

African-Americans have long been underrepresented among health care professionals. As of 2005, blacks made up slightly more than 8 percent of first-year medical students in the United States–roughly half of their share of the U.S. population (15.4 percent in 2007), and just 1 percent more than their share of first-year medical students in 1975.

Much of that overall gap can be traced to social and economic problems that generate substantial group differences that become entrenched before the college years, according to a new study led by an associate professor of economics at California State University, Sacramento, and co-authored by six University of Virginia professors representing four disciplines: economics, psychology, education and nursing.

The study, “The Educational Pipeline for Health Care Professionals: Understanding the Source of Racial Differences,” is based on research done while lead author Jessica Howell was a visiting professor of economics at U.Va. during the 2005-06 academic year. It appears in the Winter 2010 issue of the Journal of Human Resources.

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The cohort was tracked into their 30s, long enough to collect data on college attendance and graduation, post-collegiate schooling and career choices, Howell said. The representation of blacks in the 1972 cohort declined from 11 percent at the point of high school graduation, to 9 percent at college entry, to 7.2 percent at college graduation, and to 4.1 percent at the stage of entry to the health professions (which, for this study, included physicians, therapists, dentists, registered nurses, pharmacists, psychologists, optometrists, dietitians and veterinarians, among others.)

Howell and her team modeled the changes in the cohort at each stage along the educational pipeline. The modeling found that when personal background factors (including rural versus non-rural location and parents’ educational attainment) were taken into account, black students were more likely than others both to enter college and to graduate from college. Although this finding may seem surprising to some, this general finding has been well documented by social scientists, Howell said.

The majority of the differences in the representation of blacks and whites at the post-baccalaureate stage of entry to a health profession can be traced to gaps generated much earlier in the educational pipeline, Howell said, and stem from factors like parents’ education level and students’ attending schools with lower per-pupil spending, higher poverty rates, and lower average scores on standardized tests.

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Remedies that narrow the pre-college educational gaps between black students and other students, Howell said, would improve not just the proportion of blacks in health care, but would also affect any number of professions, such as black representation in law or in business management.

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Controlling for background characteristics and the type of college attended, measured by both institutional selectivity and status as a historically black college or university, black college graduates were “substantially” less likely than other college graduates to pursue post-baccalaureate health care programs, the study found.

This post-college leakage can probably be explained by financial incentives, the study suggested. {snip}

Proposals to provide subsidies to encourage blacks to enter the health care professions could reduce the post-college leakage, but would not address the main cause of black underrepresentation, said study co-author Steven Stern, a U.Va. professor of economics who served as Howell’s doctoral adviser at U.Va. (Howell completed her Ph.D. in 2004.)

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