The philanthropy panel discussed grant making as a tool to strengthen the medical education pipeline and to promote diversity in the health workforce. Alfred M. Mays, M.S.,1 discussed programs under the Science Education and Diversity in Science portfolios at the Fund. David Blumenthal, M.D., M.P.P.,2 described pipeline programs and programs to improve the health of vulnerable populations that The Commonwealth Fund currently supports and has supported historically. John Lumpkin, M.D., M.P.H.,3 discussed the pipeline programs supported by RWJF and offered ideas to challenge the traditional thinking about these programs.4 Cedric M. Bright, M.D., FACP,5 led a brief discussion following the presentations.
Alfred M. Mays, M.S. Program Officer, Science Education and Diversity in Science Burroughs Wellcome Fund
BWF is an independent private foundation that supports science research and education to advance the biomedical sciences. As the program officer responsible for the Fund’s portfolios on science education and diversity in science, Mays oversees approximately 14 percent of the Fund’s grant making. The mission of the Diversity in Science portfolio is “to increase the number of underrepresented minority scientists within the biomedical and medical research and education community through career enrichment and mentoring support,” he said. The Fund supports several initiatives to achieve this goal. The Postdoctoral Enrichment Program awards $60,000 of supplemental funding for underrepresented minority postdoctoral fellows.6 This funding does not support the awardee’s research position, but rather seeks to support career development through engagement and affiliation with major associations and mentor workshops, including online modules and webinars.
1 Mays is program officer at the Burroughs Wellcome Fund (BWF).
2 Blumenthal is president of The Commonwealth Fund.
3 Lumpkin is senior vice president at the Robert Wood Johnson Foundation (RWJF).
4 For information on BWF, see https://www.bwfund.org (accessed April 30, 2018), The Commonwealth Fund, see http://www.commonwealthfund.org (accessed April 30, 2018), and RWJF, see https://www.rwjf.org (accessed April 30, 2018).
5 Bright is associate dean for inclusive excellence, director of the Office of Special Programs, and associate professor of medicine at the University of North Carolina School of Medicine.
6 For more information on the BWF Postdoctoral Enrichment Program, see https://www.bwfund.org/grant-programs/diversity-science/postdoctoral-enrichment-program (accessed March 12, 2018).
The Graduate Diversity Enrichment Program awards $5,000 over 2 years to support underrepresented minority Ph.D. candidates enrolled in a North Carolina university and who are conducting biomedical research.7 This pilot program seeks to provide similar support as the postdoctoral program, but for students in the graduate level. Key to these programs are effective mentorships. To foster such mentorships, BWF engages the Center for the Improvement of Mentored Experiences in Research to conduct cultural diversity training and mentorship workshops for the BWF Postdoctoral Enrichment Program Fellows in collaboration with the Howard Hughes Medical Institute Gilliam Fellows.8 BWF also funds a range of ad hoc programs to increase diversity in science, including efforts to replicate the Meyerhoff Scholars Program at the University of Maryland, Baltimore County,9 and a Diversity in Science, Technology, Engineering, and Mathematics (STEM) speaker series.
The mission of the BWF Science Education program is “to build systematic reform in science, technology, engineering, and mathematics primarily in North Carolina,” Mays said. This portfolio includes a range of activities covering informal and formal education programs, public policy and research efforts, and capacity and partnership building programs. Mays highlighted several programs, including a STEM Funders Network, a group of approximately 30 funders collaborating to support a national STEM ecosystem, and the North Carolina Science, Mathematics, and Technology (SMT) Center, a nonprofit organization that promotes quality STEM education in North Carolina.
In one initiative, the SMT Center along with other stakeholders identified key attributes of a STEM education, which the North Carolina State Board of Education adopted as the standard measure of quality STEM education programs in the state. This stakeholder group also developed STEM Implementation Rubrics to guide schools to implement quality STEM programs. As a further resource, the SMT Center hosts the North Carolina STEM Learning Network, a partnership with the North Carolina Department of Public Instruction, the Community College System, independent colleges and universities in the state, and others, where educators throughout the state can find and share programs and opportunities related to STEM education.10
7 For more information on the BWF Graduate Diversity Enrichment Program, see https://www.bwfund.org/grant-programs/diversity-science/graduate-diversity-enrichment-program (accessed March 12, 2019).
10 For more information on the North Carolina STEM Learning Network, see https://www.ncsmt.org/programs/nc-stem-learning-network (accessed March 12, 2018).
In closing, Mays described the Fund’s “4-E Strategy” to promote leadership and empowerment among youth, which comprises exposure, enrichment, engagement, and enrollment. He added, “When we build programs, we actually follow that model to expose, to enrich, to engage, and then our metric is the enrollment.” Finally, he underscored BWF’s approach to award grants along the medical educational and career trajectory, its philosophy of “strategies that engage minds,” and the importance of incorporating academic and professional development as tools to aid students in becoming successful leaders.
David Blumenthal, M.D., M.P.P. President The Commonwealth Fund
The Commonwealth Fund is a private foundation that seeks to promote a high-performing health system. Its portfolio focuses on improving the health system for vulnerable populations, which the Fund achieves through two streams of grant making—investing in human capital and delivery system reform. Discussing grant making in the human capital investments stream, Blumenthal first presented three Fund-supported programs to advance the careers of Black men in science and medicine. Since 1949, the Fund has provided grant support to the National Medical Fellowships (NMF). As Esther Dyer, M.L.S., D.L.S.,11 described in the panel on financial barriers to medical education, NMF provides a range of scholarships for underrepresented minorities as they pursue their medical education.12
In 1968, the Fund awarded Meharry Medical College a $700,000 grant (approximately $5 million in current U.S. dollars) to improve graduate-level education in the basic sciences. Finally, in 1996, the Fund established the Mongan Fellowship in Minority Health Policy. As described in detail in the session on current medical pipeline strategies, Blumenthal emphasized that the Fellowship is especially committed to “recruiting and cultivating physicians who are intent on being leaders in the promotion of minority health and the interest of disadvantaged populations.” He elaborated that fellowship alumni have gone on to become not only leaders in academia, but also the public sector, with program graduates becoming directors of state and local health departments.
11 Dyer is president and chief executive officer of NMF.
Blumenthal discussed the importance of thinking about different junctures along the medical educational trajectory, and not focusing solely on increasing the number of Black men in medical schools. He said of the Mongan Fellowships, “It is not about getting people into medical school, but it is about taking the graduates of medical schools to another level where they can become role models for people who would follow them along the way.” Since its founding, the Fund has awarded more than 120 fellowships.13
Blumenthal next briefly presented several Commonwealth Fund initiatives in its delivery system reform stream of grant making. Speaking about the goals of these efforts, he said
[These delivery system reforms seek] to promote the health of minority populations by making sure that the health system serves their needs directly and appropriately. That . . . is our primary way . . . in which we serve the interests, not only of African American males, but also African American females and Hispanics and other minority populations.
He described the Fund’s work on coverage and access, to reduce rates of uninsurance among vulnerable populations, especially with the implementation of the Patient Protection and Affordable Care Act of 2010. Additionally, Blumenthal described supporting work related to Medicaid (and its expansion) and cross-national work that examines “things that we can import to the United States that may be useful for our delivery system.”
John Lumpkin, M.D., M.P.H. Senior Vice President Robert Wood Johnson Foundation
Lumpkin began his presentation by proposing a new way of thinking about the medical education pipeline. He suggested,
We really ought to be moving from pipeline as a metaphor to a funnel. . . . We really have to think about the funnel in two ways. One, it begins to direct people to health professions. And the second thing is that the funnel is circular. Because when we think about people moving through the pipeline, if people can not only reach back and reach down, they begin to engage those before them.
To that end, Lumpkin described the RWJF approach to programs to enhance the medical educational pipeline. RWJF seeks not only to increase the number of underrepresented minorities who enter the health professions, but also to develop individuals to become role models to help guide decision making. He elaborated that, not only will addressing the crisis of the dearth of Black men in medicine require new thinking, but solving the crisis will also require new thinking. Paraphrasing Donald Berwick, M.D., M.P.P., FRCP,14 he said, “Every system is perfectly designed to get the results that it gets.” He expanded,
And what our system does is it has a certain group of individuals in our society who start off behind and they stay behind throughout their life. It is no surprise. These are young African American boys; young people who do not get the opportunity because they enter behind and they stay behind. How do we begin to make a difference? Let’s think about where in this pipeline funnel we begin to think about interventions.
Lumpkin then described RWJF-funded interventions along the pipeline/funnel. These include interventions to address adverse childhood experiences, mitigate lead exposure, provide trauma-informed care in early childhood, and support universal pre-kindergarten. For high school students, RWJF supports the Forward Promise program focusing on at-risk youth in high school that “empowers boys and young men of color to heal, to grow, and to thrive and to enter college and be ready to be successful as potential candidates to go on to medical school and to go into the sciences.”15 Lumpkin also described a past program, the Health Professions Partnership Initiative, that partnered medical schools with inner-city high schools. He described the lesson learned from this initiative that it required commitment from the top. He explained,
If there was commitment by leadership of the top of the medical schools, then these partnerships were successful. But when these partnerships were delegated as far down [the organizational chart] as they could [go, then they] were not successful.
Lumpkin also underscored the importance of high school as an intervention target. He reasoned,
14 Berwick is president emeritus and senior fellow at the Institute for Healthcare Improvement and former administrator of the Centers for Medicare & Medicaid Services.
15 For more information on Forward Promise, see https://www.rwjf.org/en/how-we-work/grants-explorer/featured-programs/forward-promise.html (accessed March 12, 2018).
When you compare a young person at age 25 who has not completed high school with someone who has completed college, the difference in life expectancy is 9 years. . . . An early intervention in the child’s life that helps them be successful and graduate high school and go to college may be the most impactful thing we can do to increase life expectancy in this country.
At the undergraduate level, Lumpkin described the Summer Medical Professions Education Program, which exposes rising sophomores to the health sciences and provides math and science enrichment.16 At the graduate level, RWJF supports a new program called the Health Policy Research Scholars, which provides financial support, education, and leadership for underrepresented minority doctoral students in nonclinical health fields.17 Finally, Lumpkin described the Harold Amos Medical Faculty Development Program, which provides research funding and a stipend to historically disadvantaged physicians, dentists, and nurses to encourage and foster their academic and professional development and to increase the number of health professionals from disadvantaged backgrounds who achieve senior rank in academic medicine, dentistry, and nursing.18
In closing, Lumpkin offered several ideas to challenge the traditional thinking about pipeline programs. First, he proposed increasing partnerships with community colleges. Second, he discussed the need for more research on the role of diversity in improving the medical education experience of all students. Finally, he proposed a new way of thinking about and framing the issue of the lack of diversity in medical education, and the dearth of Black men in particular. He asserted,
Racism is an ideology of division. It splits folks up. As we think about how we are fighting racism, we should be careful about the language that we use. I do not believe that the truth shall set us free. I believe power will set us free. We need to look at the partnerships that we can make in order to have the power to affect the change that we need to see happen. . . . I think we have to be careful about terms such as white privilege and white advantage because I know, while it does exist, [they are not terms that build] unity and power. It helps focus in on the division. . . . We need to think about not only how we address this issue as we understand it, but to begin to use the language that a broader section of the population
uses, those who need to be supportive, not put off, to help us address the challenge of increasing the number of African American men in math, science, and medicine.
Lumpkin finished his presentation by paraphrasing Hillel the Elder, the famous Jewish religious leader, asking the audience, “If not us, who? If not now, when?”
Deborah Prothrow-Stith, M.D.,19 asked the panel how they address sustainability in their funding. Blumenthal acknowledged a fundamental tension for philanthropies and described this challenge, stating,
Sustainability is a challenge for philanthropy because we simply cannot devote ourselves to a couple of programs over centuries and decades. . . . There is a basic dilemma that philanthropy has, which is that it would basically stall as a creative force if it continued to support every program that it funded in any given year.
Mays echoed this challenge, and offered a two-stage approach to giving—first, a phase where a philanthropic organization needs to be able to take risks on initial investments, and second, only moving to support sustainability if those early programs are shown to be effective.
19 Prothrow-Stith is dean of the College of Medicine at Charles R. Drew University.