Keywords

In this book, we describe the presence, activism and leadership of medical students, residents, fellows, physicians, faculty, and medical school staff in enhancing LHS+ diversity, equity, and inclusion in medicine, primarily through LMSA and antecedent organizations, over the past 50+ years. We highlight the changes that have occurred in medicine because we are here to advocate for the LHS+ community. With every year, we become more robust, and with every year we continue to see the ways in which the medical community still needs to change to provide better care and support for the LHS+ learners, faculty, and patients.

Although the future of the LHS+ medical pipeline is bright and built on a strong foundation of the past 50 years, there remain legal and political threats that could stymie progress. The authors in this book have covered in depth the underrepresentation amongst LHS+ physicians and trainees in the U.S. Ongoing developments in the legal and political landscape threaten to exacerbate an already dire situation.

Threats to LHS+ Advancement

Race-Conscious Admissions

At the time of this writing, the U.S. Supreme Court heard consolidated oral arguments for two cases: (1) Students for Fair Admissions, Inc. v. President and Fellows of Harvard College and (2) Students for Fair Admissions, Inc. v. University of North Carolina. Both cases are brought by petitioners who claim that the use of race in higher education admissions practices should be unconstitutional [1, 2]. Petitioners contend that the use of race as a factor in admissions practices is unfairly benefitting Black, Hispanic and Native American applicants to the detriment of White and Asian applicants. The petitioners are seeking to overturn Grutter v. Bollinger where the court upheld the use of race as a factor—amongst a multitude of factors—that institutions of higher education could use when making admissions decisions [3].

Overturning Grutter v. Bollinger and disallowing the use of race-conscious admissions practices would have a negative impact on the pipeline of LHS+ physicians already sorely needed in the U.S. We need only look at states where the use of race as a factor for admissions has been made illegal by state law to anticipate the calamitous results. In California for example, immediately after the 1996 passage of Proposition 209 that forbade the use of race in admissions decisions, there was a 32% decline in underrepresented in medicine (URM) students (inclusive of Main-Land Puerto Ricans and Mexican-American students) matriculating to California medical schools [4]. This decline is consistent when considering other states that have banned race-conscious admissions practices. A 2022 study examining eight states with bans on race-conscious admissions practices found an approximate 37% decline in URM (inclusive of LHS+) student enrollment [5]. Given that the LHS+ population is the largest minoritized group and one of the fastest growing populations in the U.S., a ban on the use of race-conscious admissions will only serve to further deepen the deficit of LHS+ physicians needed to proportionately reflect the U.S. population.

Whether the Court overturns or affirms the use of race-conscious admissions practices, it is imperative to advocate for the legality of race-conscious admissions practices as a tool to strive toward a racially/ethnically concordant physician workforce to care for the growing LHS+ population in the U.S. To this end, LMSA was a signatory to an amicus brief submitted by the Association of American Medical Colleges advocating for the preservation of precedent upheld in Grutter v. Bollinger for the continued use of race-conscious admissions practices [6]. Some key arguments advanced in the brief:

  • Race-linked health inequities exist in the U.S. and require intervention

  • Racially diverse medical teams improve health outcomes for minoritized patients

  • Racially diverse physicians are more likely to work in medically underserved areas with minoritized patients

  • Medical schools have a long history of highly individualized admissions practices

  • Medical schools must consider applicants full background in order to achieve professional and educational aims

A clear need is tied to the diversity of the physician workforce and combating health inequities for minoritized populations including the LHS+ population. LMSA must remain steadfast and vigilant in helping to shape, block, and respond to legal threats that seek to erode and eliminate race-conscious admissions practices.

Deferred Action for Childhood Arrivals (DACA)

DACA was established by President Barack Obama in 2012 to allow individuals who were brought to the U.S. as children—and have known no other country as home—an opportunity to seek higher education or employment without fear of deportation [7]. DACA recipients are generally individuals who were not born in the U.S., but were brought to the U.S. as children, are enrolled or graduated from high school or obtained a general education degree or honorably discharged from the military, and have not been convicted of a felony or serious crime. [8] DACA represents a temporary solution in the absence of legislative action to reform current immigration law that carves out legal standing or a pathway to citizenship for DACA recipients or DACA-eligible recipients. DACA has had a politically charged and tumultuous history illustrated in the timeline below.

Year

Event

2001

DREAM Act (Development, Relief, and Education for Alien Minors Act) was introduced to Congress but fails to become law. DREAM Act would permit certain immigrant students who have grown up in the U.S. to apply for temporary legal status and to eventually obtain permanent legal status and become eligible for U.S. citizenship if they go to college or serve in the U.S. military; and the DREAM Act would eliminate a federal provision that penalizes states that provide in-state tuition without regard to immigration status [9]

2005–2010

Various DREAM Act and DREAM Act-like bills introduced to Congress but fail to become law [10,11,12,13]

2012

Given the inability to pass the DREAM Act in Congress, President Barack Obama issues a memorandum establishing DACA. A deferral of deportation for individuals and work authorization for those who meet criteria and submit an application for DACA [7]

2014

President Obama attempts to expand DACA for parents [14]

2014–2016

States sue and win an injunction to prevent the expansion of DACA to parents [15]

2017

President Trump rescinds DACA [16]

2018

Federal court issues injunction against President Trump’s rescission of DACA [17]

2020

Department of Homeland Security v. Regents of the University of California holds that the manner in which DACA was rescinded was in violation of the Administrative Procedure Act (APA) and therefore unconstitutional, but the President has the authority to rescind DACA so long as it is done in line with the APA [18]

2022

President Biden’s administration completes procedures to satisfy APA regarding DACA creation [19]

2022

Fifth U.S. Circuit Court Appeals court finds DACA creation unlawful and sends Texas v. United States case back to lower court for analysis given President Biden’s administration’s attempted satisfaction of APA regarding DACA creation [20]

Since the inception of DACA, more than 800,000 individuals have received DACA status of which 94% are LHS+ [21]. This large group of DACA recipients represents a contingent of individuals who may seek to enroll in medical school and practice medicine. To illustrate the point, of the estimated 188,000 DACA and DACA-eligible students in colleges and universities, 122,000 are LHS+ [21]. This pool must be tapped to cultivate and assist those interested in attending medical school. According to the American Association of Medical Colleges (AAMC), there are approximately 200 medical trainees and physicians that are DACA recipients [22].

Unfortunately, many medical schools do not currently accept DACA students [23]. Opportunities remain for LMSA to help advocate for the acceptance of DACA recipient applicants at all medical schools.

Until legislative action is taken to reform immigration law, DACA recipients remain suspended in uncertainty and vulnerable to legal challenges. LMSA should continue to advocate local respective medical schools, to state and federal legislators, and in collaboration with other professional organizations to support DACA recipient trainees, prospective trainees, and physicians.

LMSA Today

Truly, LMSA is always looking forward, because that is the only way we can continue to succeed in our mission. Every year, we continue some of our most successful programs and establish new ones to be the support, community, and validation that many of our members need. To tackle one of our top priorities, increasing the number of LHS+ physicians, we take a two-pronged approach: (1) increase recruitment of LHS+ medical students and (2) retention of LHS+ students through medical school.

Recruitment and Retention of LHS+ individuals:

  1. 1.

    Increase the number of LHS+ medical students

    1. (a)

      LMSA+: creation of a pre-medical branch of LMSA

    2. (b)

      Mentorship program: organized pairing of pre-medical LHS+ students to current medical students

    3. (c)

      National Conference: opportunities to present research, meet with mentors in person, and attend essential seminars for succeeding in medicine

    4. (d)

      Monthly seminars through the application cycle: to guide and prepare students for medical school applications

  2. 2.

    LHS+ retention and success in medical school

    1. (a)

      LMSA meetings: regional, quarterly, in-person sessions to meet with members and mentors across the country, establishing a sense of community

    2. (b)

      Discounts/Partnerships with essential resources: including Canopy, Sketchy, and Magoosh for free MCAT prep and discounted study resources

    3. (c)

      Mentorship program with Residents: direct pairing of senior medical students with current residents for guidance through and preparation for residency applications

    4. (d)

      Leadership opportunities: with positions at the local, regional and national level

    5. (e)

      Mentorship and training seminars through Residency applications

In addition to the focus we place directly on the LHS+ trainees across the country, we provide opportunities for the medical community as a whole to gain understanding of LHS+ struggles and, more importantly, provide tools and skills to aid in advocating and providing the support necessary to continue advancing the quality of medical education and health care.

Culturally competent care and improved quality of care to the LHS+ population:

  • Medical Spanish courses with an integrated cultural understanding

  • Policy and Advocacy Leadership Conference

  • Research support

    • Partnership with IDSA

    • Annual Research symposium

    • Research-based scholarships

Finally, one of the ongoing projects is establishing national recognition of the LHS+ struggle in medicine by collaborating with numerous organizations such as AMA, ACGME, AOA, AACOM, AAMC, NHMA, BNGAP, and other organizations. For example, we have been working with the AAMC leadership for their support in publically acknowledging the LHS+ community as historically underrepresented and minoritized in medicine as they have with the Native American and African American populations of the United States. This identification will not only validate the healthcare insecurities and documented underrepresentation of LHS+ medical providers but will also bring awareness to the continued need for support from AAMC and other organizations heavily involved in the recruitment and training of future doctors.

The Next 50 Years

LMSA exists because our country needs it. The LHS+ population is growing and is nearly 19% of the total US population today. The number of doctors that identify as LHS+ does not reflect our country’s population. The care that the Spanish-speaking population within the US receives still fails to meet the same standards as those whose primary language is English [24]. Given the health and healthcare disparities experienced by the LHS+ community, it is paramount that professional organizations such as the AMA, ACGME, AOA, AACOM, AAMC and other organizations center LHS+ needs in their advocacy, strategic planning, and other work toward health equity. Until then, it continues to be our responsibility to advocate for the changes necessary to train our doctors better, have a diverse team of doctors, and provide culturally competent care to our patients.

LMSA is poised to meet the needs of future student trainees. Our vast national network of chapter members and faculty-physician advisors covering every region of the country is a strength to build on. Given the growth and maturation of the LMSA, some areas of opportunity include:

  • Establishment of paid professional staff members to help run the day-to-day operations of the organization

  • Fortification and mentorship in grant writing and management for LMSA trainees

  • Endowed scholarships for LMSA trainees

  • Engagement in and publication of LMSA research and focused development of LHS+ researchers

  • Creation of an LMSA Fellowship program to train future leaders

  • Enhanced pathway program student national database and monitoring system

  • Establishment of a support system for trainees and prospective trainees for success through the educational continuum (e.g. test prep, advising, coaching, shadowing and research opportunities, etc.)

  • Growth and sustained chapter representation at every allopathic and osteopathic medical school in the country

  • Expansion of resources and support to LHS+ international medical graduates

  • Maintaining, expanding, and developing the network of LMSA alumni

Ultimately, the future leaders and members of LMSA will build on and continue to get better at leveraging new technologies, support programs and influencing policy for the betterment of the LHS+ community. Despite the challenges ahead, the 100th anniversary of LMSA promises to be bigger, more diverse and full of passionate individuals prepared to care for our growing LHS+ population.