RECOGNITION OF THE PLIGHT OF MINORITIES IN THE EDUCATIONAL PROCESS AND HEALTH CARE SYSTEM Vivian W. Pinn-Wiggins, MD President, National Medical Association Washington, DC
I am very pleased and so honored to have been invited to address the National Association of Medical Minority Educators (NAMME). As a charter member of NAMME, having participated in those many discussions which led to its formation and more importantly to its actualization, I have always been a firm supporter of your ideals and goals. I have been proud of its accomplishments over the years and of its continued growth in membership, participation, recognition, and expansion of activities in which we all have a vested interest-that of continued and improved expansion of opportunities for minorities in the health professions. Now, as President of the National Medical Association, I am pleased to be in a position to assist the continued strengthening of the ties which have existed between NAMME and NMA since its inception. As you are aware, the National Medical Association is the oldest black organization in America. It was founded in 1895, and we shall be returning to Atlanta, Georgia, in 1995 to celebrate our centennial in the city in which we were first organized. It is obvious that our organization, which represents over 16 000 physicians who are predominantly black or other minority, must share the same priorities as do the members and supporters of NAMME because without continued access of minoriStatement of The President of the National Medical Association to the National Association of Medical Minority Educators, Oakland, Calif, September 20, 1989. Requests for reprints should be addressed to Dr Vivian W. Pinn-Wiggins, Department of Pathology, Howard University College of Medicine, 520 W Street, NW, Washington, DC 20059. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 82, NO. 5
ties to medical education and their successful completion of their education and licensure, neither of our organizations will have a future. The NMA House of Delegates in 1979 approved a resolution that stated, in summary: ... that the NMA supports the efforts of the National Association of Minority Medical Educators to develop Health Manpower legislation which will emphasize a higher priority being given to matters which impact upon opportunities for minorities to enter and successfully complete the study for the medical degree in this country.
The NMA also, through a resolution in the House of Delegates in 1980, directed its membership to join "the example set by NAMME by providing both emotional and financial support for the defendants in the Scarpelli vs Rempson case." We have intermittently had representatives of NAMME, both physician and nonphysician, who have actively participated in our meetings, especially those of our Council on Talent Recruitment, Retention, and Financial Aid to Medical Students, but these ties and closer recognizable interorganization efforts need to be developed. We join with you in raising the public's concern about the critical shortage of blacks and minority physicians, dentists, veterinarians, pharmacists, and other health care providers. However, too often our efforts are in parallel and not in concert; we know that strength lies in numbers, and expertise and effectiveness are enhanced through collaborative think333
PRESIDENT'S COLUMN
ing and collaborative action. We should, and must, endeavor to join our collective thrusts, such that together we succeed in our missions of preserving the right for entrance of minorities into the health care arena, assuring that they have the guidance and assistance they need to become health care providers and making it further possible that the medically underserved populations of this country, which are predominantly minority, have access to caring, concemed physicians or other providers who understand and appreciate their cultural heritage, their environmental restrictions, and their wounded pride as well as bodies. I invite you, physician and nonphysician, to become members of the National Medical Association to lend to us your guidance and first-hand knowledge of the everyday problems of the medical education process as it relates to minorities and to lend your support in encouraging more NMA members, who have strong interests in medical education, to join NAMME in its organizational efforts. We need each other because the cries of recognition of the plight of minorities in the educational process and in the health care system today are too often lost to rising political conservatism and backlash to our previous efforts for affirmative action and parity. They are too often lost in the semantics of language and legislation. They are too often disguised as being problems of the economically disadvantaged alone, when we know that, even when considering the economically disadvantaged as a group, minorities still have a lesser health status and a lesser opportunity to achieve their career goals. A demanding reason for not just belonging to NAMME and NMA, but also being an active participant, is that both organizations have as their priorities the interests of blacks and other minorities, and we can be strongly vocal and dedicatedly concerned about minority issues, while other organizations may have varied priorities, membership of diverse political and social inclinations, and other issues that take the forefront of their policy and action agendas. The NMA has expressed its concern about the rising costs of medical school tuition, the decrease in federal loans, the lack of increase in the number of minority medical students who are entering our nation's medical schools, the difficulty which minority medical graduates have in obtaining the postgraduate positions of their choice, and the seeming increasing insensitivity to the special needs and talents of minority applicants. These needs are not so demanding or so special that dedicated academicians and caring educators could not accept, educate, and graduate more of our so-called 334
"less qualified" applicants who have the potential to be caring, licensed, and knowledgeable physicianswith just that little bit of special attention and encouragement to assist them. We, like NAMME, have been active in encouraging the legislation necessary to help improve the current status of minorities in medicine. We are extremely proud that in 1984, the NMA sponsored the first congressional hearing held outside of the continental United States at our Legislative Forum in Montreal. The late Congressman Mickey Leland and Congressman Waxman chaired that hearing, at which time Dr Louis Sullivan, then President of Morehouse Medical School and Chairman of the NMA's Council on Medical Education and Hospitals and now the Secretary of the Department of Health and Human Services, presented problems in health manpower and medical education which were of special concern to NMA members. Some of the concerns discussed at that time included: 1. The critical shortage of blacks and other minority physicians, dentists, veterinarians, nurses, pharmacists, and other providers. 2. The relatively modest progress that had been made in correcting these shortages over the prior 30 years. 3. The continuing critical need for medical student financial aid. As you can see, the same concerns are before us today. We still must face the reduced commitment to affirmative action by too many medical schools, the erosion of the quality of general education of blacks and other minorities in inner city schools, the high tuition costs that make attending medical school less of a possibility for minorities from low income families, the reduced funding in the form of federal grants and scholarships to support minority enrollment in medical schools, and the high levels of indebtedness for far too many minority medical school graduates. Think of the positive impact that the National Medical Fellowships has had 3ver the years in providing financial aid to minority medical students in this country-often the onlv scholarship monies which these students receiveand yet there is a continuing decline in individual, philanthropic, corporate, and foundation support for worthwhile efforts such as NMF. The NMA and NAMME have many areas in which we can combine our efforts. I will mention just a few. The NMA has again strongly expressed our support for the expansion of the Health Careers Opportunity Program (HCOP). This program, as we all well know, JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 82, NO. 5
PRESIDENT'S COLUMN
has been one of the most vital and valuable efforts producing positive results regarding minority medical student preparation, enrollment, and retention in this country. We know that NAMME also joins us in this effort and we must all continue to be vocal and factual
in our support of this office, and the efforts of its director, Dr. Clay Simpson. The NMA has supported the National Health Service Corps and its programs that have helped to provide financial support to minority students enrolled in our medical schools. However, this program no longer provides the comprehensive scholarship assistance it once did. We believe that this shift in federal policy is one of the factors contributing to the increased level of indebtedness of minority medical school graduates, especially those who are enrolled in high-tuition institutions and who plan to practice in underserved areas. The NMA supports efforts to restore comprehensive scholarship assistance to needy medical students under the Corps program, without that restoration decreasing the funds available for other supportive programs.
In addition, the National Health Service Corps too often fails to allow medical graduates to meet their service obligations in urban clinical settings. The NMA is on record as supporting and plans to encourage the federal government to allow medical students to work in urban underserved areas, where there are large aggregates of medically underserved and medically indigent minorities, to meet their obligations. We hope that NAMME will share this concern and work with us to achieve these important changes in the National Health Service Corps Program. The NMA is actively supportive of the StokesKennedy Bill, The Disadvantaged Minority Health Improvement Act of 1989, which has received Secretary Sullivan's endorsement. We are encouraged that this bill is coming forward at this time because this legislation, if approved by Congress, will greatly expand resources to support minorities in the health
professions. The NMA is interested in the Robert Wood Johnson Foundation programs to increase the number of minority medical students, including the Summer Intervention Program for Prospective Medical Students, and observing the outcome of their efforts. Their Minority Medical Faculty Development Program, designed to increase the numbers of well-prepared
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 82, NO. 5
minorities for roles in academic medicine, is among the most laudable innovations in minority faculty development. Both organizations must lend assistance to maximize the eventual results of these programs. There are many important initiatives that must be developed to expand the pool of qualified minority candidates to our medical schools. We are all charged with exploring and implementing new models or reviving programs that proved successful in the past which can help us in our plight. As part of my installation address as President of the National Medical Association, I declared as one of my major priorities an effort by the NMA, in collaboration with other organizations and groups, to look at the declining minority application pool, especially that of the black male, and to attempt to come up with both short-term and long-term resolutions to this escalating problem. This has to be of utmost concern to all of us. My ultimate concern is that the health status of blacks and other minorities not be disparately low but equal to that of any American. I am concerned that the life expectancy of blacks and other minorities be equal to that of any other American. I am concerned that every American have equal access to the preventative modalities and therapeutic regimens which can prolong life and improve the quality of life. I firmly believe that to accomplish my ultimate goals, there must be a continued development of minority health professionals and a continued awareness of the specific needs of the minority, economically disadvantaged and medically indigent. I know that we can all work toward the realization of such goals, and I am pleased that you have given me the opportunity to speak with you about my views on these issues. I invite you, my colleagues and friends, to assist me, to assist NAMME, to assist the NMA, to assist ourselves, our communities, our families, and those who will inherit our legacies, to do our utmost to succeed in our struggle tor equal access to health education careers and for equal access to appropriate health care. Acknowledgments The author wishes to express her appreciation to Dr Ron Hester for his assistance in the preparation of this manuscript.
335
I am very pleased and so honored to have been invited to address the National Association of Medical Minority Educators (NAMME). As a charter member of NAMME, having participated in those many discussions which led to its formation and more importantly to its actualization, I have always been a firm supporter of your ideals and goals. I have been proud of its accomplishments over the years and of its continued growth in membership, participation, recognition, and expansion of activities in which we all have a vested interest-that of continued and improved expansion of opportunities for minorities in the health professions. Now, as President of the National Medical Association, I am pleased to be in a position to assist the continued strengthening of the ties which have existed between NAMME and NMA since its inception. As you are aware, the National Medical Association is the oldest black organization in America. It was founded in 1895, and we shall be returning to Atlanta, Georgia, in 1995 to celebrate our centennial in the city in which we were first organized. It is obvious that our organization, which represents over 16 000 physicians who are predominantly black or other minority, must share the same priorities as do the members and supporters of NAMME because without continued access of minoriStatement of The President of the National Medical Association to the National Association of Medical Minority Educators, Oakland, Calif, September 20, 1989. Requests for reprints should be addressed to Dr Vivian W. Pinn-Wiggins, Department of Pathology, Howard University College of Medicine, 520 W Street, NW, Washington, DC 20059. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 82, NO. 5
ties to medical education and their successful completion of their education and licensure, neither of our organizations will have a future. The NMA House of Delegates in 1979 approved a resolution that stated, in summary: ... that the NMA supports the efforts of the National Association of Minority Medical Educators to develop Health Manpower legislation which will emphasize a higher priority being given to matters which impact upon opportunities for minorities to enter and successfully complete the study for the medical degree in this country.
The NMA also, through a resolution in the House of Delegates in 1980, directed its membership to join "the example set by NAMME by providing both emotional and financial support for the defendants in the Scarpelli vs Rempson case." We have intermittently had representatives of NAMME, both physician and nonphysician, who have actively participated in our meetings, especially those of our Council on Talent Recruitment, Retention, and Financial Aid to Medical Students, but these ties and closer recognizable interorganization efforts need to be developed. We join with you in raising the public's concern about the critical shortage of blacks and minority physicians, dentists, veterinarians, pharmacists, and other health care providers. However, too often our efforts are in parallel and not in concert; we know that strength lies in numbers, and expertise and effectiveness are enhanced through collaborative think333
PRESIDENT'S COLUMN
ing and collaborative action. We should, and must, endeavor to join our collective thrusts, such that together we succeed in our missions of preserving the right for entrance of minorities into the health care arena, assuring that they have the guidance and assistance they need to become health care providers and making it further possible that the medically underserved populations of this country, which are predominantly minority, have access to caring, concemed physicians or other providers who understand and appreciate their cultural heritage, their environmental restrictions, and their wounded pride as well as bodies. I invite you, physician and nonphysician, to become members of the National Medical Association to lend to us your guidance and first-hand knowledge of the everyday problems of the medical education process as it relates to minorities and to lend your support in encouraging more NMA members, who have strong interests in medical education, to join NAMME in its organizational efforts. We need each other because the cries of recognition of the plight of minorities in the educational process and in the health care system today are too often lost to rising political conservatism and backlash to our previous efforts for affirmative action and parity. They are too often lost in the semantics of language and legislation. They are too often disguised as being problems of the economically disadvantaged alone, when we know that, even when considering the economically disadvantaged as a group, minorities still have a lesser health status and a lesser opportunity to achieve their career goals. A demanding reason for not just belonging to NAMME and NMA, but also being an active participant, is that both organizations have as their priorities the interests of blacks and other minorities, and we can be strongly vocal and dedicatedly concerned about minority issues, while other organizations may have varied priorities, membership of diverse political and social inclinations, and other issues that take the forefront of their policy and action agendas. The NMA has expressed its concern about the rising costs of medical school tuition, the decrease in federal loans, the lack of increase in the number of minority medical students who are entering our nation's medical schools, the difficulty which minority medical graduates have in obtaining the postgraduate positions of their choice, and the seeming increasing insensitivity to the special needs and talents of minority applicants. These needs are not so demanding or so special that dedicated academicians and caring educators could not accept, educate, and graduate more of our so-called 334
"less qualified" applicants who have the potential to be caring, licensed, and knowledgeable physicianswith just that little bit of special attention and encouragement to assist them. We, like NAMME, have been active in encouraging the legislation necessary to help improve the current status of minorities in medicine. We are extremely proud that in 1984, the NMA sponsored the first congressional hearing held outside of the continental United States at our Legislative Forum in Montreal. The late Congressman Mickey Leland and Congressman Waxman chaired that hearing, at which time Dr Louis Sullivan, then President of Morehouse Medical School and Chairman of the NMA's Council on Medical Education and Hospitals and now the Secretary of the Department of Health and Human Services, presented problems in health manpower and medical education which were of special concern to NMA members. Some of the concerns discussed at that time included: 1. The critical shortage of blacks and other minority physicians, dentists, veterinarians, nurses, pharmacists, and other providers. 2. The relatively modest progress that had been made in correcting these shortages over the prior 30 years. 3. The continuing critical need for medical student financial aid. As you can see, the same concerns are before us today. We still must face the reduced commitment to affirmative action by too many medical schools, the erosion of the quality of general education of blacks and other minorities in inner city schools, the high tuition costs that make attending medical school less of a possibility for minorities from low income families, the reduced funding in the form of federal grants and scholarships to support minority enrollment in medical schools, and the high levels of indebtedness for far too many minority medical school graduates. Think of the positive impact that the National Medical Fellowships has had 3ver the years in providing financial aid to minority medical students in this country-often the onlv scholarship monies which these students receiveand yet there is a continuing decline in individual, philanthropic, corporate, and foundation support for worthwhile efforts such as NMF. The NMA and NAMME have many areas in which we can combine our efforts. I will mention just a few. The NMA has again strongly expressed our support for the expansion of the Health Careers Opportunity Program (HCOP). This program, as we all well know, JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 82, NO. 5
PRESIDENT'S COLUMN
has been one of the most vital and valuable efforts producing positive results regarding minority medical student preparation, enrollment, and retention in this country. We know that NAMME also joins us in this effort and we must all continue to be vocal and factual
in our support of this office, and the efforts of its director, Dr. Clay Simpson. The NMA has supported the National Health Service Corps and its programs that have helped to provide financial support to minority students enrolled in our medical schools. However, this program no longer provides the comprehensive scholarship assistance it once did. We believe that this shift in federal policy is one of the factors contributing to the increased level of indebtedness of minority medical school graduates, especially those who are enrolled in high-tuition institutions and who plan to practice in underserved areas. The NMA supports efforts to restore comprehensive scholarship assistance to needy medical students under the Corps program, without that restoration decreasing the funds available for other supportive programs.
In addition, the National Health Service Corps too often fails to allow medical graduates to meet their service obligations in urban clinical settings. The NMA is on record as supporting and plans to encourage the federal government to allow medical students to work in urban underserved areas, where there are large aggregates of medically underserved and medically indigent minorities, to meet their obligations. We hope that NAMME will share this concern and work with us to achieve these important changes in the National Health Service Corps Program. The NMA is actively supportive of the StokesKennedy Bill, The Disadvantaged Minority Health Improvement Act of 1989, which has received Secretary Sullivan's endorsement. We are encouraged that this bill is coming forward at this time because this legislation, if approved by Congress, will greatly expand resources to support minorities in the health
professions. The NMA is interested in the Robert Wood Johnson Foundation programs to increase the number of minority medical students, including the Summer Intervention Program for Prospective Medical Students, and observing the outcome of their efforts. Their Minority Medical Faculty Development Program, designed to increase the numbers of well-prepared
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 82, NO. 5
minorities for roles in academic medicine, is among the most laudable innovations in minority faculty development. Both organizations must lend assistance to maximize the eventual results of these programs. There are many important initiatives that must be developed to expand the pool of qualified minority candidates to our medical schools. We are all charged with exploring and implementing new models or reviving programs that proved successful in the past which can help us in our plight. As part of my installation address as President of the National Medical Association, I declared as one of my major priorities an effort by the NMA, in collaboration with other organizations and groups, to look at the declining minority application pool, especially that of the black male, and to attempt to come up with both short-term and long-term resolutions to this escalating problem. This has to be of utmost concern to all of us. My ultimate concern is that the health status of blacks and other minorities not be disparately low but equal to that of any American. I am concerned that the life expectancy of blacks and other minorities be equal to that of any other American. I am concerned that every American have equal access to the preventative modalities and therapeutic regimens which can prolong life and improve the quality of life. I firmly believe that to accomplish my ultimate goals, there must be a continued development of minority health professionals and a continued awareness of the specific needs of the minority, economically disadvantaged and medically indigent. I know that we can all work toward the realization of such goals, and I am pleased that you have given me the opportunity to speak with you about my views on these issues. I invite you, my colleagues and friends, to assist me, to assist NAMME, to assist the NMA, to assist ourselves, our communities, our families, and those who will inherit our legacies, to do our utmost to succeed in our struggle tor equal access to health education careers and for equal access to appropriate health care. Acknowledgments The author wishes to express her appreciation to Dr Ron Hester for his assistance in the preparation of this manuscript.
335
