The Changing Face of Medicine
Rachel Ruiz made herself a promise when searching for medical schools – never again would she feel out of place.
When Ruiz pictured Nashville, images of honky-tonks, cowboy hats and all things “country and western” overwhelmed her. Her perception of Vanderbilt University School of Medicine didn’t fare much better. She thought it would be a private, southern school full of wealthy, white males. Both stereotypes were a far cry from what she was looking for as she pondered where to pursue her medical school education. So how did Ruiz, a Latino who is half Japanese and a longtime Californian, end up at Vanderbilt? “Basically I can’t explain it,” laughed Ruiz, a third-year medical student. “It was a visceral, gut feeling. I knew Vanderbilt was the medical school for me.”
“Vanderbilt had gone from a school that was not on my list to being the top choice. When I began college in New Hampshire, I experienced a huge culture shock that extended beyond its geographical location. Overall, my college experience was very positive, but I felt very misplaced there. I promised myself that I didn’t want to feel that way again in medical school.”
A college adviser from Dartmouth urged Ruiz to apply to Vanderbilt. She is glad she listened.
Her first visit to Vanderbilt surprised her, she said. She vividly remembers how impressed she was by the friendliness of the students and the nurturing environment. Her next visit, during the school’s Second Look Weekend, sealed the deal.
“When I spoke to the students at Vanderbilt, they were happy and felt comfortable,” Ruiz said.
Another critical factor in the decision-making process was the diversity of Nashville.
“I didn’t realize how diverse the greater Nashville community is, especially the Latino population,” said Ruiz, who is president of the Latino Medical Student Association. “There are also large refugee populations throughout the city.
“I feel that diversity, whether cultural, racial, religious or sexual orientation, brings a lot to the table. People view the same story differently. It’s the uniqueness and richness from your environment that you can’t get from a lecture or textbook. That is only found in diverse situations.”
George Hill, Ph.D., Levi Watkins Jr. Professor and associate dean for Diversity in Medical Education, points to an equally important reason for making diversity a priority – the role it plays in establishing excellence in health care.
“If we want to provide an excellent medical education for all students, then the students have to learn in a diverse environment from people who have different points of view,” Hill said. “Our country is becoming more diverse. We will need physicians who are going to be able to take care of these populations.
“Despite the number of medical schools in the United States and all the medical students enrolled, we will never be able to have enough physicians for those who want that concordance – those patients who want doctors who look like them,” he added. “We will never have enough racial diversity among physicians, because there are not enough individuals being educated. That is also why we must have physicians who are culturally competent.”
Casting a Wide Net
Hill’s concerns echo those of the Association of American Medical Colleges (AAMC), which also advocates for a more diverse physician workforce. According to the AAMC, more than 20 years of research shows there are persistent gaps in health care quality that disproportionately impact people from specific racial and ethnic backgrounds. Demographic studies show that the United States will face a shortage of physicians in the next 20 years as the population ages and the need for more physicians from all backgrounds will be needed to meet the growing demand. Public opinion research indicates that many minority students consider careers in medicine because they want to help ensure quality care and access to health care for all.
To help close the gap, change must start with empowering students, Hill said.
Vanderbilt continues to see significant improvement in the diversity of the Medical School student body. The Office of Diversity was created in 2002. Each year since 2003, the number of applications and admissions to VUSM from students underrepresented in medical school (URM) has remarkably increased.
“When I came here, there were only two African-American students (women) in the entering class of 2001,” Hill said. “In 2002, there were five students out of a class of 104. Now, we have 15-20 percent URMs.”
Vanderbilt considers diversity in the broadest sense. The breakdown of terms is as follows:
• Underrepresented in medicine (URMs) are those populations underrepresented in the medical profession relative to their numbers in the general population like African-Americans, Hispanics, Native Americans and other Pacific Islanders.
• Minorities include those groups underrepresented in the general population of the United States. This term would also include those in the URM group.
• Diversity includes all groups in the URM and minority categories as well as economic, rural, sexual orientation, regional and religious.
Hill would like to see 30 percent to 40 percent of the student population comprised of the groups listed above.
“A goal should be 40 percent consistently in the next five years,” he said. “And when it comes to URMs, I would like to see 20 percent.”
Success in recruiting a multicultural student body has a lot to do with who is teaching the classes, Hill said.
“A diverse teaching population is also a part of the equation when students are looking at a school. Not only do we want students in a class sitting next to others from different backgrounds, we want that in our faculty.”
André Churchwell, M.D., associate professor of Medicine and associate dean for Diversity in Graduate Medical Education and Faculty Affairs, leads the charge in attracting not only the best residents, fellows and faculty to Vanderbilt, but also has the task of ensuring the group can provide a multicultural experience for the students and patients.
To that end, Vanderbilt offers a summer diversity clerkship program, a month-long clinical rotation designed to introduce potential residents to VUMC. Each year Churchwell and a team of residents attend the Student National Medical Association (SNMA) meeting to distribute information about the medical school and hospital training programs. The school recently initiated a Second Look Weekend for URM residency and fellowship applicants, which was highly successful.
Churchwell, a nationally-known cardiologist, said acknowledging the role that diversity plays in grooming doctors is a big part of the program’s success.
“We cast a very broad net when defining diversity, and we have been very clear on our mission,” Churchwell said. “We have been very busy over the last year and we have done a better job at getting our message out there.
“If we can continue to build on what we have been able to accomplish, then we will be able to achieve a critical mass of people at Vanderbilt who will see it as a place to train, work and stay. If we can do that, then we will be able to grow from within.”
For the matriculating class of 2010 (class of 2014), the Office of Admissions received more than 5,400 total applications – the highest number in a decade, said John Zic, M.D., associate dean for Admissions.
Another coup – more students from the URM groups were interviewed, which equated to more invitations to URM students. With 105 available spots for the class of 2014, 749 URM applications were submitted and 25 students were admitted, the highest number in the history of the medical school.
“We can never sit back and think we have accomplished our goal,” Zic said. “Rather, we have to continue to re-evaluate our efforts in recruiting students from diverse backgrounds.”
It’s a goal that Vanderbilt, along with most medical schools, struggles to accomplish, specifically in the recruitment of African-American males and Hispanic applicants.
And there is great competition for these students, said Zic.
“The best medical schools in this country are aggressively recruiting the best students from these diverse groups. We also realize that medical school is sometimes thought to be financially out of reach for students from lower income groups. We continue to increase financial aid to make a Vanderbilt medical education a reality for these students.”
The Early Years
The Vanderbilt of today looks nothing like it did some 40 years ago, said John Sergent, M.D., MD ’66, professor of Medicine, vice chair for Education, and Residency Program director in the Department of Medicine. He applauds the change.
A faculty member since 1975 and a graduate of both Vanderbilt University and its School of Medicine, Sergent has a unique perspective on the school’s diversity track record.
“Anyone who has seen what I have cannot help but be impressed with Vanderbilt’s growth,” said Sergent. “We’ve gone from not being open to non-whites, to a place that tolerated minorities but did not openly embrace them, to where we are today. We have created an environment where minorities are truly supported.”
In the fall of 1961, during his senior year at Vanderbilt, Sergent proposed a measure to the Student Senate to desegregate the student body. The bill was defeated by one vote. He then took the proposal to the entire student body, which rejected it. Later that year, the Board of Trust voted to desegregate the school.
The first African-American students were admitted to Vanderbilt University in 1963, and the Medical School followed suit in 1967. Levi Watkins Jr., M.D., MD ’70, was the first African-American graduate of VUSM. He is a professor of Surgery and the associate dean of the School of Medicine at Johns Hopkins University, where he has been a cardiac surgeon since 1978.
Despite Sergent’s push for racial integration, the first big change he noticed in the Medical School was the acceptance of women.
“My medical school class was all white and almost all male,” he recalled. “There were 50 male students and two women, and that was typical of most medical schools at the time. For us the first big change was the wave of women in the ’70s. It wasn’t until after then that the rise in minorities really began.”
Once women entered the profession and were able to serve as role models, the number of females in medicine exploded. Sergent said a similar pattern is occurring with minorities.
“With any change there is lag time,” he said. “We need to do better, but you have to start somewhere. My feeling is, you don’t just turn on a switch and change the nature of your student body. It takes time and a lot of hard work.
“If you look at the traditional growth in any area, you have to start by increasing the number of African-Americans in medical school, then in residencies, and then in fellowships. From there you hope a good chunk will decide to spend their lives here and create a faculty base that can serve as role models for the next group of students.”
Success through Support
Although there are many minority, tenured professors at Vanderbilt, Kevin Johnson, M.D., is the first African-American promoted to this rank from within the School of Medicine.
“This is a classic example of standing on the shoulders of those people who came before me,” said Johnson, who also has a joint appointment in the Department of Pediatrics. “Promotion requires an incredibly supportive environment that nurtures, mentors, protects and doesn’t stifle the process.”
Johnson’s accomplishment is one to be applauded, said Hill, but he doesn’t want the progress to stop now.
“We need to move beyond ‘our first’ because there are many more people here who can achieve this. We cannot rest on our laurels.”
“My promotion should be a reminder to my colleagues at Vanderbilt who are hoping to have a chance to be promoted that it’s within their sights.”
As a full professor he can be a more effective role model not just for the African-American community, but for the gay population as well.
“I may be representative of the most diversity on the campus,” said Johnson. “I’m a black, gay father, in an interracial marriage. To get to a point where I am comfortable saying all of that, I had to get through a lot of hurdles, but I had direction and support.
“I believe that the No. 1 challenge for any minority student is mentoring,” he said. “Getting the right group of people around students who understand where they want to go and making sure they are doing things to ensure their success is key. The same goes for faculty.”
Vanderbilt has reached a degree of diversity that like-minded individuals are able to find each other, Johnson said. More than 40 clubs and organizations are available for students including the Office of Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Life, the Asian Pacific American Medical Student Association, and the Alliance for Cultural Diversity in Research.
“Vanderbilt has lots of policies in place to make sure that there are ample opportunities for all people of all cultures, races, religions and backgrounds. At the institutional level, there is a much more outspoken tolerance,” Johnson said.
Jeff Balser, M.D., Ph.D., vice chancellor for Health Affairs and dean of the School of Medicine, said his definition of diversity for Vanderbilt allows all qualified individuals who want to come to VUSM to be considered equally.
That hasn’t always been the case, he admitted.
“But today we have increasing ethnic diversity and the number of female students continues to grow,” he said. “The recently-endorsed Medical Center-wide diversity plan is one more step in the right direction to develop an environment where people of all backgrounds are accepted and nurtured.
“This plan broadens our focus to include students, residents, fellows, faculty and staff. Diversity is important in medicine because it gives us a wider perspective on how we can better care for our patients and discover cures.”
For students like Ruiz, it’s this commitment to change that attracted her to Vanderbilt.
“What we are doing is impressive because when I tell students from other medical schools that 20 percent of my class is URMs, they are surprised. I am very well aware of the stigmas that are associated with the South, but I also know it will take a while for that train of thought to be reversed.
“I am very optimistic about Vanderbilt’s future,” said Ruiz. “I know that Vanderbilt will continue to do great things.”