The Role of Medical Education in Reducing Health Care Disparities: The First Ten Years of the UCLA/Drew Medical Education Program
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The University of California, Los Angeles (UCLA)/Charles R. Drew University Medical Education Program was developed to train physicians for practice in underserved areas. The UCLA/Drew Medical Education Program students receive basic science instruction at UCLA and complete their required clinical rotations in South Los Angeles, an impoverished urban community. We have previously shown that, in comparison to their UCLA counterparts, students in the Drew program had greater odds of maintaining their commitment to medically disadvantaged populations over the course of medical education.
To examine the independent association of graduation from the UCLA/Drew program with subsequent choice of physician practice location. We hypothesized that participation in the UCLA/Drew program predicts future practice in medically disadvantaged areas, controlling for student demographics such as race/ethnicity and gender, indicators of socioeconomic status, and specialty choice.
Retrospective cohort study.
Graduates (1,071) of the UCLA School of Medicine and the UCLA/Drew Medical Education Program from 1985–1995, practicing in California in 2003 based on the address listed in the American Medical Association (AMA) Physician Masterfile.
Physician address was geocoded to a California Medical Service Study Area (MSSA). A medically disadvantaged community was defined as meeting any one of the following criteria: (a) federally designated HPSA or MUA; (b) rural area; (c) high minority area; or (d) high poverty area.
Fifty-three percent of UCLA/Drew graduates are located in medically disadvantaged areas, in contrast to 26.1% of UCLA graduates. In multivariate analyses, underrepresented minority race/ethnicity (OR: 1.57; 95% CI: 1.10–2.25) and participation in the Drew program (OR: 2.47; 95% CI: 1.59–3.83) were independent predictors of future practice in disadvantaged areas.
Physicians who graduated from the UCLA/Drew Medical Education Program have higher odds of practicing in underserved areas than those who completed the traditional UCLA curriculum, even after controlling for other factors such as race/ethnicity. The association between participation in the UCLA/Drew Medical Education Program and physician practice location suggests that medical education programs may reinforce student goals to practice in disadvantaged communities.
KEY WORDSmedical education health care disparities UCLA/Drew program
We would like to acknowledge the contributions of Lois Colburn, LuAnn Wilkerson, EdD, Deborah Danoff, MD, Carol Hodgson, PhD, Kehua Zhang, Shobita Rajagopalan, MD, Deyu Pan, MS, Magda A. Shaheen, MD, PhD, Elizabeth Mertz, MPA, and the staff of AMA data services for their guidance and assistance. We would also like to thank Dr. Keith Norris for institutional support. Renee Taylor provided administrative assistance. Data analysis and manuscript development was supported by the National Center for Research Resources (P20-RR11145 and G12-RR03026-15), the National Center on Minority Health and Health Disparities (1 P20MD00148-01), the Agency for Healthcare Research and Quality (1R24-HS014022-01A1) and (T 32-HS00046), and the Bureau of Health Professions, Health Resources and Services Administration (U79HP00004). The abstract from this study was presented at the Society of General Internal Medicine 29th Annual Meeting Poster Session, April 27, 2006.
Drs. Edelstein and Heslin are employees of the Charles R. Drew University of Medicine and Science and are faculty members of the David Geffen School of Medicine at UCLA.
Conflicts of interest
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