10
Approaches from Government
This panel featured presentations on strategies to increase diversity of the health workforce from two government agencies and lessons learned.
Elizabeth Ofili, M.D.,1 moderated the panel and opened the discussion by posing a series of questions. She asked,
What do you see as the most innovative approaches in your organization to address the problem of the absence of Black men in medicine and science? How is the impact of those efforts assessed? Are there important learnings to date? What is standing in the way of these efforts or challenges, and what new strategies are needed?
Hannah A. Valantine, M.D., M.R.C.P.,2 described pipeline programs and other approaches to increase diversity in the scientific workforce that the National Institutes of Health (NIH) support. She also proposed engaging the National Collegiate Athletic Association (NCAA) and college athletes as an untapped pool of potential students to enhance the medical school matriculation rates of Black men. Luis Padilla, M.D., FAAFP,3 discussed priorities and programs regarding the health workforce at the Health Resources and Services Administration’s (HRSA’s) Bureau of Health Workforce (BHW). Following the presentations, Ofili moderated a brief discussion.
NATIONAL INSTITUTES OF HEALTH AND ENGAGING NEW PARTNERS
Hannah A. Valantine, M.D., M.R.C.P. Chief Officer, Scientific Workforce Diversity, and Senior Investigator National Heart, Lung, and Blood Institute
Valantine began her presentation by discussing several initiatives at NIH to increase diversity in their workforce. She first discussed the Building Infrastructure Leading to Diversity (BUILD) program, which awarded grants to 10 undergraduate institutions to research and implement innovative approaches to engaging and sustaining interest in students from diverse backgrounds in biomedical research, beginning in 2014.4 Eligibility criteria for the program were that an institution received less than $7.5 million in NIH research grants in the preceding year and that 25 percent
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1 Ofili is professor of medicine, director of the Clinical Research Center, and senior associate dean of clinical and translational research at Morehouse School of Medicine.
2 Valantine is chief officer, Scientific Workforce Diversity, and senior investigator at the National Heart, Lung, and Blood Institute.
3 Padilla is associate administrator of the Health Resources and Services Administration’s Bureau of Health Workforce.
4 For more information on the NIH BUILD Initiative, see https://www.nigms.nih.gov/training/dpc/Pages/build.aspx (accessed March 13, 2018).
of students at the institution receive Pell Grants. The 10 awardees collect data on shared metrics, or “hallmarks of success.” To evaluate the BUILD universities’ innovative approaches to supporting diversity, the programs were implemented as experiments with two comparison groups—an internal control group and external control group from a non-BUILD institution. NIH also created a Center for Coordination and Evaluation to collect and analyze data from these evaluations to identify what works.
In parallel with the BUILD program, NIH also established a National Research Mentoring Network in 2014.5 The network connects mentors and mentees in person and online and also offers mentor training led by researcher Christine Pfund, Ph.D., a scientist at the University of Wisconsin, which teaches “people how to become better mentors including culture-sensitive mentoring.” Valantine explained the need to challenge “the myth that because you are a good and successful researcher, you are automatically a good mentor. The data has been quite clear that this is an incorrect assumption.”
Valantine next described some past NIH programs to promote diversity. She first described the longstanding NIH diversity supplement, an administrative grant supplement that allowed NIH grantees the opportunity to include a person from an underrepresented group, frequently at the graduate or postdoctoral level, to work on the grantee’s project. An analysis of the program found that 60 percent of people supported by diversity supplements were performing well and still working in science. Valantine noted that this was contrary to common assumptions about the program, and thus offered “a lesson to all of us that just because something is not measured and the data is not there, it does not mean it does not work.” Valantine also mentioned the Bridges to the Baccalaureate Program, which supports linkages between 2-year junior or community colleges and 4-year baccalaureate programs, as well as programs to promote diversity at the postdoctoral level.6
In closing, Valantine discussed the possibility of engaging college athletes and the NCAA to address the absence of Black men in medicine and science. Reflecting on her daughter’s experience as a college athlete, Valantine said, “I started thinking about, Where is the pool? Where are all those talented Black men who through their rigorous athletic training have developed the work ethic and resilience needed for success in any field, including science? I argue that these individuals are actually under
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5 For more information on the NIH National Research Mentor Network, see https://www.nigms.nih.gov/training/dpc/pages/nrmn.aspx (accessed March 13, 2018).
6 For more information on current programs in the National Institute of General Medical Sciences Division of Training, Workforce Development, and Diversity, including the Bridges to the Baccalaureate Program, see https://www.nigms.nih.gov/Training/Pages/TWDPrograms.aspx (accessed May 1, 2018).
the auspices of the NCAA.” Valantine reported that, in 2016–2017, there were more than 55,000 NCAA Black male athletes across all divisions, of whom 21 percent reported majoring in science, technology, engineering, and mathematics fields. Additionally, Valantine found that the graduation rate among student athletes is higher than that compared with non-athlete students. Together, this suggested to her that, “There is a robust pool of Black male students able and ready to go into medical school.”
HEALTH RESOURCES AND SERVICES ADMINISTRATION HEALTH WORKFORCE PRIORITIES AND PROGRAMS
Luis Padilla, M.D., FAAFP Associate Administrator, Bureau of Health Workforce Health Resources and Services Administration
Padilla started his talk by describing the issue of increasing representation of Black men in medicine as well aligned with the HRSA mission “to improve health and achieve health equity through access to quality services, a skilled health workforce, and innovative programs.” The BHW, in particular, seeks to “improve the health of underserved and vulnerable populations by strengthening [the] health workforce and . . . connecting skilled professionals to communities in need.” The BHW achieves this through three priorities: preparing a diverse workforce, improving workforce distribution, and transforming health care delivery.
The BHW administers more than 40 workforce programs, which seek to strengthen the “continuum of health profession education” from high school through service and practice. Of these, several aim to increase education and training opportunities for students and clinicians from disadvantaged backgrounds. Some examples include Area Health Education Centers (AHECs), Centers of Excellence, Health Careers Opportunity Program (HCOP), Scholarships for Disadvantaged Students, and the National Service Corps Program.7 These programs are highly diverse. For example, more than 120,000 AHEC trainees were underrepresented minorities and 95 percent of Centers of Excellence trainees in structured programs were underrepresented minorities including 23 percent who self-identified as African American/Black. Twenty percent of HCOP grantees identify as African American, and 26 percent of those supported by the Scholarships for Disadvantaged Students identify as African American. Currently, 13 percent of the clinical workforce in the National Health Service Corps are African American men. In addition to increasing diver-
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7 For information on HRSA’s BHW programs, see https://www.hrsa.gov/about/organization/bureaus/bhw/index.html (accessed March 13, 2018).
sity of the health professions, Padilla noted that these programs “also distribute that workforce across the country effectively . . . with a focus on rural and underserved [areas].”
Padilla finished his presentation by identifying potential strategies for moving forward. First, he emphasized the need to track students who participate in medical education pipeline programs. He argued, “We know that pool of applicants is out there. We just do not know what happens to them as they are going through that pipeline. . . . We need to know that the investments we have put into these programs are effective.” He added that positive outcomes would include entering the health professions, especially primary care, and furthermore, whether program graduates practice in rural and underserved areas. HRSA is building a tool to track alumni of the National Service Corps using the National Practitioner Identifier. Second, Padilla outlined the BHW’s focus going forward on community-based training and longitudinal training.
DISCUSSION
Valerie Montgomery Rice, M.D.,8 concurred with Padilla about the importance of tracking and monitoring students to “understand the impact of all these persons that you have funded.” She described an ongoing effort at Morehouse School of Medicine to develop an Email for Life granted to each student who comes through their National Pipeline Initiative. Morehouse would use this email to give students a career assessment from a young age, as early as middle school, and, with permission, Morehouse would reach out to students each quarter via their Email for Life. Montgomery Rice described, “You really are just teasing them every quarter, but they stay in contact. We can really build a network with that.” In addition, Morehouse would build a national curriculum to pair each career goal with the necessary competences and coursework, such that “when you do these career assessment tests, you know what a kid ought to be doing based on the national standards for K through 12.” In response, Padilla offered that HRSA is looking at piloting efforts to track and monitor students to lessen the work for individual universities and colleges, and proposed continuing a dialogue with Montgomery Rice.
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8 Montgomery Rice is president and dean of the Morehouse School of Medicine.
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