Diversifying California’s Doctors

Cesar Padilla grew up in a low-income neighborhood a half hour drive from Stanford University, but the institution couldn’t have felt farther away. His public high school struggled with overcrowded classrooms and gang violence. He almost didn’t graduate high school because his grades were too low. But he ultimately went to Ohlone College, a community college in Fremont, Calif., in hopes of pursuing a career in medicine, inspired by childhood memories of trips to Mexico, where he would shadow his aunt, a hospital nurse.

Padilla, now a graduate of University of Rochester School of Medicine and Dentistry and a clinical assistant professor at Stanford University School of Medicine, said the community college was a “lifeline” and “fresh slate” for him, but his success didn’t come easily. The path to medical school is rife with financial and structural barriers for community college graduates like him.

“We’re weeding out a lot of students who have vital perspectives in their communities,” he said.

California Community Colleges have no premed track and little formal guidance for students who might be interested in pursuing a medical degree. But a new initiative launched this summer, the California Medicine Scholars program, seeks to change that. California Medicine, a coalition of higher ed officials, medical providers and policy makers working to address health disparities in the state, is creating four regional hubs to coordinate with local community colleges, four-year institutions, medical schools and clinics to create pathways for students, with wraparound supports, from community colleges to medical schools.

These students “don’t know what’s possible,” said Rowena Robles, executive director of California Medicine. “If a student wants to be premed and is at a community college, there is no direct or clear pathway from the community college to medical school.” The plan is to ensure “it’s not just the student navigating on their own. We want to make sure that when they land at the four-year, and they land at the medical school, the pathway isn’t leaking. It’s streamlined and connected.”

The long-term goal of the program is to cultivate a new pool of potential doctors, especially from low-income, first-generation and underrepresented backgrounds, to diversify the medical workforce and fill doctor shortages in certain areas of the state. Six percent of California physicians were Latinx, 3 percent were Black and fewer than 1 percent were Native American in 2020, according to the California Health Care Foundation, an organization seeking to improve health care for low-income Californians. Meanwhile, 39 percent of the state population was Latinx, 6 percent was Black and less than 1 percent was Native American.

“I hope to see many, many students from different backgrounds and from different regions graduating from medical school and completing their residencies and going back to their communities to serve,” Robles said.

A Regional Approach

The regional hubs—located at the University of California, San Francisco’s medical school campus in Fresno, UC Davis School of Medicine, UC Riverside School of Medicine and UC San Diego School of Medicine—each submitted a plan for how they’ll support medical school–bound community college students. As a part of the program, the institutions will receive annual grants of $540,000 for three years to bring their plans to fruition, plus an additional $250,000 in the 2025–26 academic year to sustain their efforts.

The program received $10.5 million in the 2021 state budget signed by Governor Gavin Newsom, a Democrat, and at least $5.2 million from private philanthropic organizations, which will be managed by the Foundation of California Community Colleges.

Robles said the hope is to eventually secure permanent state funding for the program so it exists in perpetuity.

Starting this academic year, each hub plans to recruit a cohort of 50 community college students annually from the surrounding area interested in a career in medicine, so the program will shepherd 600 students in total toward medical school by the end of the third year, Robles said. The supports and programming offered by each hub will vary based on “regional needs.”

Charlene Green, director of admissions, student and resident diversity and student development at UC Davis School of Medicine, said her hub will be working with three local universities and eight community colleges.

The hub will offer students advising to navigate prerequisite course requirements and the medical school application process, free Medical College Admission Test study materials, regular meetings with mentors who are currently doctors and medical school students, and research and clinical internship opportunities to expose students to the field. Students will also receive stipends while they participate in clinical internships and study for the MCAT, she added. The cohort will meet at least once per semester.

“A lot of times students from disadvantaged backgrounds, or low-income backgrounds, they are contributors to their family,” Green said. “They have to work. They have to perhaps care for their younger siblings or parents. We want them to be able to focus on academics with … reduced distractions or other barriers that could prohibit them from being their best self or their optimal self throughout this pathway.”

Green, who also serves part-time as an adjunct counselor at Consumnes River College and a psychology instructor at Sacramento City College, said her community college students with an aptitude for science and math often don’t even think of medical school as a possible career path.

Meanwhile, “to get to medical school is a long road,” she said. “There’s a lot of courses that need to be completed, both at community college and once you transfer, and it’s really hard to go back if you kind of haven’t started on this track. It’s more challenging. It takes a little bit longer. We’re trying to start with students earlier, saying, ‘Hey, this is an option for you. If you want to, let’s do it. We’re going to give you the tools you need to explore that interest.’”

Padilla said too often the costs of going to medical school, including MCAT study materials and tuition payments, derail community college students from considering pursuing a medical degree. He also finds low-income students experience “cultural isolation” when they arrive at medical school and find so few of their classmates come from similar backgrounds, which can make it difficult for them to persist.

As a result, the diversity of would-be doctors is out of step with the diversity of patients, he said. A 2018 report by the Association of American Medical Colleges found that only 5 percent of medical students came from the lowest household income quintile, while 24 percent of medical students were from households with the highest incomes.

“The California Medical Scholars program represents the future of medical training in the United States,” Padilla said. “Because what it’s doing at its foundation is giving us an answer to our crisis in health care. I would argue that the top problems in medicine are disparities where you have unfortunately disadvantaged communities, historically and socioeconomically, who are suffering worse outcomes. The way you circumvent that is you take and you train students from those same low-income communities where the patients are coming from.”