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The following HTML text is provided to enhance online readability. Many aspects of typography translate only awkwardly to HTML. Please use the page image as the authoritative form to ensure accuracy. cant even after adjusting for income (Samelson, 1994). In a study of U.S. mortality data, African Americans were found to experience higher standardized mortality rates due to asthma than Whites, controlling for income and educational level (Grant, 2000). African Americans and Hispanics who have been in contact with the health care system also tend to report lower satisfaction with medical care than Whites (Blendon et al., 1989; Morales et al., 1999). Physician SupplyOther important indicators of access to quality health care include structural characteristics of the health care system, particularly the availability of physician services. Whether the United States as a whole faces a physician oversupply has been a matter of debate for some time (Schwartz, 1988; Ginzberg, 1989). Whether or not there are “too many” physicians in the country overall, many areas remain underserved. Thousands of areas throughout the country are designated as Health Professionals Shortage Areas by the Health Resource Services Administration (HRSA.gov, 2001). In particular, many predominantly minority communities face shortages of health services. In California, research has shown that physician supply is inversely related to the concentration of Blacks and Hispanics in a health service area, even after adjusting for community income level (Komaromy et al., 1996). This relationship was found in both urban and rural areas. Population projections indicate that by the year 2020, the minority populations of many of these regions are likely to increase substantially. As part of a study to project the numbers of minority physicians needed to achieve a race/ethnicity-specific physician-to-population ratio of 218 per 100,000, Libby and colleagues provide data about the numbers of active physicians in 1990 from the Census Bureau’s Equal Employment Opportunity database (1997). A projection model developed by Libby yielded results indicating that in order to reach 218 physicians per 100,000 persons for each racial/ethnic group, the numbers of first year residents would need to roughly double for Hispanic and black physicians, triple for Native American physicians, and be reduced by two-fifths for white and Asian physicians. Although we do not assert that exact racial and ethnic parity in physician-to-population ratios should be an explicit public policy goal, these numbers and projections illustrate the extent to which Blacks, Hispanics, and Native Americans are underrepresented in medicine relative to their numbers in the population. Although underrepresented minority enrollment increased by 43% after 1986, it peaked in 1994, did not increase in 1995, and actually declined by 5% in 1996 (Carlisle et al., 1998). It is likely that gains made in numbers of underrepresented minorities to enter medicine in the early 1990s, a period that saw a 27% increase in underrepresented minority enrollment (Nickens, 1994), are now being reversed by restrictions in affirmative action programs across the country.
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