In Final Report, Pew Panel Urges Health Professions Students to Perform 'Significant Public Service'; Says Current System Prepares Practitioners for a Bygone Era

Washington, DC, December 9, 1998 -

The Pew Health Professions Commission today offered a sweeping assessment of the health care workforce in the United States, calling for vastly greater racial, ethnic and socioeconomic diversity, and warned that without such diversity, "tomorrow's health care providers will be ill-equipped to care for the nation we will be in the 21st century."

The panel, chaired by former Senator George Mitchell, urged health professions schools to alter admissions policies to more accurately reflect the diversity of the American public and the reality that, early in the 21st century, ours will be "a nation of minorities." The Commission, which includes some of the nation's most respected health care experts, also urged that all students-in-training perform "significant public service" before graduating since so much graduate education is funded by the government and the ranks of the nation's uninsured continue to climb.

The group concluded that "in spite of the dramatic changes affecting every aspect of health care, most of the nation's educational programs remain oriented to prepare individuals for yesterday's health care system. They have not assimilated the new values, techniques and skill sets required to pursue a satisfying and thriving practice in the managed care world."

In its final report released today, the Commission cautioned that today's generation of health professionals do not fully represent the diversity of the nation, and as a result, significant numbers of people are not receiving the most effective care. In fact, great disparities exist in the health status, access and quality of care that many ethnic groups receive compared with the majority of the population.

"Just because a doctor knows how to speak another person's language does not mean he or she is more qualified to care for that person," said Mitchell. "But if that doctor understands the person's culture, beliefs about health care and knowledge of how the health care system works, then that doctor is more likely to be able to effectively meet that patient's needs."

Sociocultural barriers to health care can make even the simple task of scheduling an appointment difficult, lead to misunderstandings between a provider and patient, misdiagnoses and poor follow-through. These barriers are likely to become even more significant as the country's "minority" populations continue to grow. The four minority groups counted by the U.S. Census Bureau -- American Indian, Asian and Pacific Islander, Black and Hispanic -- are expected to increase from 25 percent in 1990 to 32 percent by 2010 and 48 percent by 2050, according to Opening Doors, a program designed to identify and break down nonfinancial, culturally-based barriers to health care.

The problem could grow worse. Since the implementation of affirmative action policies in California, Louisiana, Mississippi and Texas two years ago, medical schools have witnessed a 19 percent to 22 percent drop in the number of minority applicants to medical schools in those states, according to the American Association of Medical Colleges. This compares to a 12 percent drop in 1997 applicants the year before, just one year after the policies went into effect.

In light of the recent affirmative action cases in the states, the Commission in releasing its report: Recreating Health Professional Practice for a New Century offered a new proposal for achieving diversity. For the good of the nation, health professions schools need to ensure that health professionals are not only competent and meet high standards, but that they are also diverse. In addition to considering test scores, schools also have to look at other factors, such as ethnicity, socio-cultural status and commitment to community service, the Commission recommended.

"This is not just about race, and it's not about quotas; this is about a national health need for physicians and other care providers who are best qualified to meet the needs of their patients and society," said Mitchell.

To further encourage greater diversity in the health professions, the Commission also recommended that universities and academic health centers work with the K-12 educational system to provide students with early exposure to the sciences and the health professions, especially to populations what are under-represented in those fields.

In an era when the health care system has become focused almost entirely on the bottom line of health care costs, and where physicians, nurses, and others often do not have any significant time to spend with their patients, the Commission is urging that medical and other health professions students provide some professional services to the community free of charge, and that this service be a requirement for graduation.

"Every school, every program, every professional association, should require its students to perform some significant amount of public service before they graduate," said Ed O'Neil, executive director of the Commission. "Since so much of physician education is funded by the government, physicians and other health professionals need to give something back. In the process, they may become closer to their patients and help to rebuild some of the doctor-patient trust that has eroded over the years."

To boost public service, the Commission also recommended that existing national service programs tied to debt service be expanded and enlarged to incorporate more health professional graduates, not just physicians; that students help design such programs; and that professional associations actively incorporate the idea of public service into regulation and professional development activity.

A major thrust of the Commission's final report is that the health professions are not adequately prepared to practice in the new health care environment of managed care and the 21st century. Noting that there are some serious shortcomings in health professions education, the Commission provides specific recommendations for each of the individual health professions, such as allied health, dentistry, medicine, nursing and pharmacy, and outlines a revised set of competencies for the health professions for the 21st century.

Other major recommendations in the report:

• The government should eliminate graduate medical education payments for international medical graduates who are citizens of other nations, but allow them to complete their education in the U.S. as long as their training is subsidized through foreign aid, their home governments or private funds.

• The government should expand federal graduate medical education funding to the training of advanced practice nurses and other non-physician providers in clinical settings.

• Health professions schools should move more training out of the traditional hospital setting and into ambulatory settings.

As the final report was issued today, Rebecca Rimel, president of the Pew Charitable Trusts, said the Trusts have been proud to fund this important commission. "Over the years, the Commission asked tough, unpopular questions about health professions education," said Rimel. "They gave reform thinking a grounding in an otherwise turbulent time, in a field where it isn't always comfortable or convenient to rock the boat."

The Pew Health Professions Commission works to help policy makers and educators produce health care professionals who meet the changing needs of the American health care system. Administered by the Center for the Health Professions at the University of California, the Commission is funded by The Pew Charitable Trusts.

The Pew Charitable Trusts support non-profit activities in the areas of culture, education, the environment, health and human services, public policy and religion. Based in Philadelphia, the Trusts make strategic investments that encourage and support citizen participation in addressing critical issues and effecting social change. In 1997, with more that $4.5 billion in assets, the Trusts awarded $181 million to 320 non-profit organizations.

The Center for the Health Professions at the University of California, San Francisco is a national center committed to changing the health care workforce. The Center assists health care professionals, health professions schools, care delivery organizations, and public policy makers in responding to the challenges of educating and managing a health care workforce capable of improving the health and well-being of people and their communities.

PEW HEALTH PROFESSIONS COMMISSION

CHAIRMAN
The Honorable George J. Mitchell
Special Counsel
Verner, Liipfert, Bernhard, McPherson & Hand

EXECUTIVE DIRECTOR
Edward H. O'Neil, PhD
Director
Center for the Health Professions
University of California San Francisco

COMMISSIONERS
Stuart Altman, PhD*
Sol C. Chaikin Professor of Nat'l Health Policy
Brandeis University
The Florence Heller Graduate School of Social Policy

Ruth Ballweg, PA-C
Director 
University of Washington
MEDEX Northwest Physician Assistant Program

Troyen A. Brennan, JD, MPH, MD
President
Brigham and Women's Physician Hospital Organization

Carolyne K. Davis, RN, PhD
Pew Health Professions Commission

Mimi L. Fields, MD, MPH, FACPM
Health Consultant & Wellness Physician
HEAL Thyself, Inc.

Robert Graham, MD
Executive Vice President
American Academy of Family Physicians

Phil Nudelman, PhD
Chairman and President
Kaiser/Group Health of Seattle

Glenda D. Price, PhD
President
Marygrove College

Uwe E. Reinhardt, PhD
Professor
Princeton University
Woodrow Wilson School of Public and International Affairs

Barbara J. Safriet, JD
Associate Dean
Yale University School of Law

Louis Sullivan, MD
President
Morehouse School of Medicine

Carolyne K. Davis, RN, PhD
Pew Health Professions Commission

David Swankin, JD
President
Citizen Advocacy Center

Neal A. Vanselow, MD
Chancellor Emeritus
Tulane University Medical Center