Introduction

The U.S. physician workforce does not reflect the demographic characteristics of the US population. Most U.S. states do not train physicians who are demographically representative of the state population. Diversifying the physician workforce to reflect the U.S. population is key to providing high-quality, high-value, culturally effective care. Studies have shown that the concordance of race and/or language of the physician and the patient – leads to better patient outcomes. Patients who share their language or cultural background with their physicians are more likely to follow their advice and express higher levels of satisfaction.

According to “The Complexities of Physician Supply and Demand: Projections From 2018 to 2033,” the most recent update from the Association of American Medical Colleges (AAMC), the U.S. will see a physician shortage of nearly 122,000 doctors by 2032 because a large cohort of physicians over age 65 are retiring (AAMC Physician Shortages). The US is also expected to face a shortage of primary care physicians ranging from 21,400 to 55,200 by 2033. Primary care physicians act as the ‘gatekeeper physicians’ of medicine. They assist a patient in maintaining health, and they can treat a large number of patient conditions, and can also determine when a condition is at a level that a referral to a specialist is necessary. A shortage of primary care physicians may lead to patients using emergency rooms in hospitals to meet their health care needs, which may jeopardize patient safety and significantly increase costs for the entire health care system as unnecessary lab tests, imaging studies, and referrals may be ordered or repeated. These shortages are likely to be particularly acute in communities already suffering from inadequate access to medical services, such as low-income and rural areas, which are more likely to be served by minority doctors—who are currently underrepresented in the healthcare workforce. Students from underrepresented minority and disadvantaged backgrounds represent an untapped pool of talent that can help fill these gaps, benefitting not only themselves but their communities and the nation as a whole.

According to the Association of American Medical Colleges, only 11 percent of medical physicians in the US come from minority and disadvantaged backgrounds, although they represent nearly 40 percent of racial and ethnic minorities in the U.S. population today (AAMC, 2022; U.S. Census Bureau, 2020). This underrepresentation not only creates an inequity for minorities in the medical professions but can lead to inadequate care for the entire population.

Recognizing this potential and seeking to address the related equity and shortage problems, the MPP Academy was designed to partner with medical schools, medical student organizations, and other stakeholders across the nation to increase the number of high achieving students from diverse backgrounds who are academically and mentally prepared with the social-emotional skills to: 1) complete medical school and 2) become licensed to practice medicine in a medical specialty that provides a sense of purpose and meaning to their lives. The ultimate goal is to address a well-documented disparity in the physician workforce by increasing the diversity among doctors who are underrepresented in the physician workforce from the current rate of 11% to 20% by 2035. The MPP Academy is committed to building a diverse pipeline of future medical students, as early as 4th grade, that is more representative of the U.S. population.

Evidence suggests that minority and disadvantaged students indeed are underrepresented among applicants to medical schools, and those who apply may be a select group. At present, underrepresented minority (URM) students account for about 20 percent of medical school applicants, respectively (AAMC, 2022). Of all applicants (62,386 total applicants) to medical school in the 2021‒22 application cycle, 22.1% of underrepresented minority (URM) students were accepted (9% for Black students, 12% for Hispanic students, and roughly 1% for Native Americans and Pacific Asian, compared with 42.4 percent of non-Hispanic whites (AAMC, 2022). Thus, if the program achieves its short and medium-term goals/expected outcomes, URM students will be more likely to apply and be admitted to medical school (eventually expanding the share of URM students to match their representation in the general population).

In addition to diversifying the physician workforce, MPP Academy hopes to improve health services to disadvantaged populations and underserved areas of the nation (such as urban and rural areas), as minority and disadvantaged students who become doctors will be more likely to return to and serve their communities (AAMC 2021). We also hope to contribute more broadly to the health and scientific workforce through MPP program participants who do not become physicians but instead pursue other health-related careers, such as nursing and research in the sciences, and work with underserved populations or issues affecting them.

To achieve these goals, the MPP program provides comprehensive training and on-going support to help students become better prepared to thrive in the pre-med gateway courses in college, become competitive applicants for medical school, and to keep students on the path to medical school.

Ultimate Goal:

Improve the representation of health professionals of minority and disadvantaged backgrounds to match their representation in the general population
Improve the health care received by minority and disadvantaged populations by increasing the number of professionals from these communities that are trained in health-related fields and return to serve them

**The dosage of the intervention includes a description of the:

frequency of service (how many sessions a week)
intensity of service ( length of each session)
duration of service (total weeks/hours of sessions)

Problem

By 2032, the U.S. will see a physician shortage of nearly 122,000 doctors because a large cohort of physicians over age 65 are retiring (AAMC Physician Shortages).

These shortages will be felt most acutely in underserved communities across the nation as demand for physicians continues to grow faster than supply and fewer medical students are choosing to pursue a medical career as a primary care physician and working in underserved communities.
The major factor driving demand for physicians continues to be a growing, aging population. According to the U.S. Census Bureau, the nation’s population is estimated to grow by more than 10% by 2032, with those over age 65 increasing by 48%. Additionally, the aging population will affect physician supply, since one-third of all currently active doctors will be older than 65 by 2030.
Other factors that contribute to the physician shortage include individual physician burning out before retirement, a lagging supply of medical school seats, and (at least in the US) a low supply of postgraduate training positions.

The U.S. physician workforce does not reflect the demographic characteristics of the US population.

Most states do not train physicians who are demographically representative of the state population.
Diversifying the physician workforce to reflect the U.S. population is key to providing high-quality, high-value, culturally effective care.
Studies have shown that the concordance of race and/or language of the physician and the patient – leads to better patient outcomes. Patients who share their language or cultural background with their physicians are more likely to follow their advice and express higher levels of satisfaction.

Low number of early outreach medical physician preparation pipeline programs that are committed to recruiting and nurturing a diverse pipeline of future medical doctors, as early as 4th grade.

Early outreach pipeline programs serve less than 1% of the American k-12 student population.

Low representation of students underrepresented in medicine (URM) that apply to, enroll in, and graduate from medical schools that are accredited by the Liaison Committee on Medical Education (LCME), which is an accrediting body for medical education programs at schools of medicine in the United States and Canada.

The LCME is sponsored by the Association of American Medical Colleges and the American Medical Association. LCME is recognized by the U.S. Department of Education and World Federation for Medical Education as the reliable authority for the accreditation of medical education programs leading to the MD degree.
Lack of URiM students applying to medical school.
- URMs only comprise about 20% of total medical student applicants and 9–13% of matriculants..

Low representation of URM medical doctors, resident physicians, faculty, and leaders in medical schools, departments, and hospitals.

DEFINITION: UNDERREPRESENTED IN MEDICINE (URM)

“Underrepresented in medicine means those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population (AAMC).”

This lens currently includes students who identify as African Americans and/or Black, Hispanic/Latino, Native American (American Indians, Alaska Natives, and Native Hawaiians), Pacific Islander, and mainland Puerto Rican. The definition also refers to students who come from disadvantaged backgrounds.

WHY IS THIS IMPORTANT?

Better Care for Diverse Populations
A healthcare team should be as diverse, if not more diverse, than the patient base they are treating. This helps ensure that no matter who walks through the door, there is someone on staff who can identify with the patient, communicate with them, and better serve their individual needs.

What are the Risks of Lacking Healthcare Diversity?

Medical Physician Preparation (MPP) Academy

Just as healthcare diversity has its advantages, there are major risks that can be attributed to the lack of diversity.

Communication Breakdown

Be it the result of a language barrier, differences in philosophy, differences in cultural norms (& expectations), or even cultural bias, lack of diversity can lead to communication breakdown with patients. And when patients cannot fully communicate or express their needs, dangerous mistakes can occur.

Limited Perspectives

Lack of healthcare diversity can lead to limited perspective when providing patients with medical care, psychological treatment, and social support. It can stunt innovation and creative thinking, but more importantly, it could impede critical observations surrounding a patient’s diagnosis, medical history, or other socio-economic factors that may affect their health and well-being.

Lack of Role Models

Mentorship plays a critical role in our medical system. Doctors, nurses, medical assistants, and administrative personnel will always need the support of a mentor to guide them in their respective professions. It’s important for physicians and healthcare workers to have role models they can look up to and emulate throughout their careers. A lack of diversity can make it difficult for minority physicians and healthcare workers to find mentors with whom they identify and learn from. In turn, this can thwart their professional growth and their ability to provide the best patient care.

Lack of Future Diversity

Albeit an obvious consequence, it is an important one to the future success of any healthcare organization. The less diverse your medical staff is today, the harder it will be to foster it within your team tomorrow.

Bias

Bias does not always have to be explicitly expressed within a healthcare setting for it to become a problem. Bias can still impact decisions made for patients when it is embedded in the policies and procedures of a healthcare organization. This is referred to as implicit bias within a system. Greater diversity can stymie the destructive effects of implicit bias in patient care.

“If we want to improve the diversity of the physician workforce that reflects the demographic characteristics of the U.S. population, we need more diverse medical schools and graduates. And if we want more diverse medical schools and graduates, we need to increase the diversity of the medical school applicant pool by reaching out to a diverse group of elementary and secondary students in all communities across the country. We then need to work to build their aspirations and interest in pursuing a career in medicine by connecting these students to early outreach pipeline programs such as the MPP Academy (MPP). Building a diverse pipeline of future medical physicians, as early as 4th grade, will help diversify the physician workforce that is more representative of the U.S. population.

Diversity pipeline programs such as MPP provide rigorous academic instruction, clinical experiences, and mentorship to help aspiring medical doctors become a competitive medical school applicant, with the mindset, tools, and resources needed to succeed in medical school and beyond. MPP gives students an inside look at what it would be like to go to medical school and to become a medical doctor. MPP also provides exposure to the medical school application process and helps students understand how they can successfully navigate the admissions process and secure the financial resources needed to pay for medical school.”

– Remarks by Dr. Aaron Smith, Executive Director of MPP Academy

GOALS

Goal 1: Ensure students increase PRE-MED knowledge, skills, and preparation for PRE-MED studies in higher education.

Goal 2: Ensure students gain access to role models, develop support networks, and develop positive identities necessary to pursue and succeed in PRE-MED in higher education.

Goal 3: Prepare students to successfully complete the college admissions process, obtain financial aid, and be accepted to attend a four-year university.

Goal 4: Develop and increase students’ PRE-MED interests, attitudes, and aspirations.

Goal 5: Students will enroll, persist, and graduate with degrees in STEM in higher education at rates higher than the national average.

INPUTS

NAPCA Foundation funding and guidance

Institutional resources and support from participating program site

Individual Donors

Corporate Sponsors

National Program Office (NPO)

MPP Academy Staff

Faculty

Partnership with Local Hospitals and Clinics

Student Participants

University Facilities/Program Sites

In-kind services and contributions for various supporters

MPP Mission

Goal 2035

YEAR-ROUND ACTIVITIES

"Pre, Pre-Med" Summer Intensive Residential Program
(On-Campus | Fully Online via Zoom)

3-4 Summers of Living & Learning on a University Campus offering:

Science and math instruction
Clinical experience
Exposure to health policy issues
Workshops or training in:
- Communication skills (written and oral)
- Interviewing skills – Study skills
- Career planning – Financial planning – Applying to medical/dental school

"Pre, Pre-Med" Academic Year Programming (Hybrid: Monthly On-campus/Online classes)

During the school year, students attend online classes face-to-face with faculty and other program students via Zoom, for 2-3 hours per week, typically on the weekend, for 35 weeks.
Students meet in-person on a university campus, once a month on Saturdays. Students will not meet during holidays.

Academic Preparation for Pre-Med Undergraduate Study and Medical School

Hands-On, Physician-Led Pre-Med Clinical Experience & Simulation Activities

'So You Want to be a Medical Doctor?' Virtual Youth Conference
(Online via Zoom, exclusive for MPP students)

Delivery of a Comprehensive “Pre, Pre-Med” Curriculum for College & Pre-Med Undergraduate Coursework Readiness

The Program Curriculum Contains 9 Key Components:

Pre-Med Foundations: Academic Preparation for University Pre-Med Gateway Courses & Medical School
Career Exploration & Planning: Navigating the Path to Medical School
Academic Skills Development & Writing for College and Career Success
Navigating the Undergraduate & Medical School Admissions Process
College Affordability Planning: Paying for College & Medical School
Social-Emotional Skills & Resiliency Training for College & Career
Readiness
Exposure to College Life
International Experience: Cultural & Global Awareness Programming

MPP Capstone Project:

Students develop a personal strategic action plan (i.e., Pre-Med Roadmap to Medical School)

1 Week International Medicine & Healthcare Study Abroad Trip

Students in the high school and undergraduate program will travel abroad for one summer during an international study abroad immersive experience.

Medical School Tours | Visits to Hospitals & Clinics

Earn Healthcare Industry Certifications

Parent Engagement & Academic Enrichment

Mentoring

Networking events with Physicians & Health Care professionals

Mentored Research Projects

Academic Advising

College and Career Advising

Financial Aid Advising

Academic Tutoring

College Visits

Medical School Tours

Social & Cultural Activities

Exclusive Guest Speakers

Staff Professional Development

Collaborative formative & summative evaluation

OUTCOMES

Short Term Outcomes

The short-term outcomes reflect the knowledge, skills, and attitudes we expect students to acquire after they graduate from our high school program.

Students:

IMPROVED ACADEMIC PREPARATION TO THRIVE IN PRE-MED COLLEGE COURSEWORK

Are scholars learning PRE-MED content knowledge that is necessary to succeed in college level pre-medical coursework which is also required for admission to medical school?

Pre-Med Foundation Knowledge

% of scholars demonstrated significant growth in the PRE-MED Academic Readiness assessment. STO

College Readiness in Science

% of scholars demonstrated an increase in Biology assessment scores over the course of the program.
% of scholars demonstrated an increase in Chemistry assessment scores over the course of the program.
% of scholars demonstrated an increase in Physics assessment scores over the course of the program.
% of scholars demonstrated a statistically significant increase in Pre-Med Science Readiness Assessment (covers Biology, Chemistry, and Physics) scores from pre- to post-MPP.

College Readiness in Mathematics

% of scholars demonstrated a statistically significant increase in the Pre-Med Mathematics Readiness Assessment (covers Biology, Chemistry, and Physics) scores from pre- to post-MPP.
% of scholars demonstrated an increase in Pre-Algebra assessment scores over the course of the program.
% of scholars demonstrated a statistically significant increase in Algebra 1 assessment scores from pre- to post-MPP.
% of scholars demonstrated an increase in Algebra II assessment scores over the course of the program.
% of scholars demonstrated a statistically significant increase in Calculus assessment scores from pre- to post-MPP.

College Writing Readiness

% of scholars demonstrated a statistically significant increase in the College Writing Readiness Assessment scores from pre- to post-MPP.

PRE-MEDICINE ATTITUDES & ASPIRATIONS

INCREASED ASPIRATIONS TO ENTER AND COMPLETE AN UNDERGRADUATE PRE-MEDICINE PROGRAM.

Does scholar engagement in PRE-MED readiness courses increase their interest in pursuing PRE-MED in college?

% of scholars plan or committed to declare an academic major in a STEM field in college. STO
% of scholars plan or committed to enroll and complete a pre-medicine program at a four-year university that provides them with all the required pre-med courses needed to apply for medical school. STO

INCREASED ASPIRATIONS TO PURSUE A CAREER IN MEDICINE & HEALTHCARE.

Does scholar engagement in PRE-MED courses increase their interest in pursuing a career in medicine.

% of scholars committed to pursue to career path in medicine and healthcare.STO

INCREASED ASPIRATIONS TO ENTER AND COMPLETE MEDICAL SCHOOL.

% of scholars plan to apply to medical school to pursue a career in medicine. STO
% of scholars enrolled in medical school to prepare for a career in medicine.LTO
% of scholars completed medical school and earned a doctorate degree in Medicine.LTO

IMPROVED PREPARATION FOR APPLYING TO MEDICAL SCHOOL

Medical School Admissions Knowledge

% of scholars have the knowledge to apply to medical school as demonstrated by the medical school admissions knowledge assessment. MTO

Medical College Admission Test (MCAT) Preparation

% of scholars reported that they feel prepared to perform well on the Medical College Admission Test (MCAT). MTO
% of scholars have registered and taken the Medical College Admission Test (MCAT) at substantially higher rates in comparison with non-participating peers. MTO

Financial Aid Knowledge for Medical School

% of scholars have completed the Free Application for Federal Student Aid (FAFSA) at substantially higher rates in comparison with non-participating peers.
% of scholars have the knowledge to apply for financial aid as demonstrated by the financial aid knowledge assessment.
% of scholars have knowledge about student loans and how to apply for them as demonstrated by the financial aid knowledge assessment.
% of scholars became more confident in their ability to obtain financial aid to finance their college education (__% to 100%).

ACCESS TO ROLE MODELS, NEW FRIENDSHIPS, AND A PEER NETWORK OF SUPPORT & ENCOURAGEMENT

INCREASED SOCIAL CAPITAL AND NETWORKS

Are scholars developing supportive peer and adult networks to guide and support their path to becoming a medical doctor?

% of scholars indicated that they have established professional relationships with medical physicians and other healthcare professionals who have impacted their future college and career goals. STO, MTO
% of scholars reported feeling part of a community of students who are interested in pursuing a career in medicine and healthcare. STO, MTO
% of scholars reported that the new friendships they gained from attending the program provided a peer network of support and encouragement. STO, MTO

INCREASED POSITIVE IDENTITY TO PURSUE A MEDICAL CAREER

Do scholars feel like they belong in and can succeed in the field of medicine as a medical doctor?

% of scholars reported that they believe in themselves to achieve the goal of becoming a medical doctor. STO, MTO

IMPROVED PREPARATION FOR APPLYING A FOUR-YEAR COLLEGE/UNIVERSITY

College Admissions Knowledge

% of scholars have the knowledge to apply to college as demonstrated by the college admissions knowledge assessment. STO

College Entrance Exam Completion

% of scholars reported that they feel prepared to perform well on college entrance exams. STO
% of scholars have registered and taken the SAT or ACT college entrance exams at substantially higher rates in comparison with non-participating peers. STO

Financial Aid Knowledge

% of scholars have completed the Free Application for Federal Student Aid (FAFSA) at substantially higher rates in comparison with non-participating peers. STO
% of scholars have the knowledge to apply for financial aid as demonstrated by the financial aid knowledge assessment. STO
% of scholars have knowledge about student loans and how to apply for them as demonstrated by the financial aid knowledge assessment. STO
% of scholars became more confident in their ability to obtain financial aid to finance their college education (__% to 100%). STO

UC/CSU A-G Subject Knowledge

% of scholars completed the UC/CSU A-G college preparatory coursework required for admission to a 4 year college or university with a grade of B or better. STO
In comparison, 34% of all California high school graduates complete “a-g” coursework with a grade of C or better. STO

College Matriculation

% of scholars enrolled in a four year college or university. STO

Medium Term Outcomes

Individuals:

% of scholars completed pre-med coursework with at least a 3.5 BCPM GPA or higher in all Biology, Chemistry, Physics, and Math (BCPM) courses at a four year university. MTO
% of scholars completed a bachelor’s degree in a Pre-Med or STEM related field. MTO

Increase in number of URM students who are qualified to submit an application for admission to medical school.

Expand the number of qualified URMs and disadvantaged students with adequate preparation to apply to medical school.

Expand the number of qualified URMs and disadvantaged students applying to medical school.

Institutions:

Enhance institutional capacity to attract URMs and disadvantaged students to their medical schools.

Change institutional culture and attitudes regarding URMs and disadvantaged students’ potential to succeed.

Revise policies and procedures to encourage diversity in medical school applicants and enrolled students.

Encourage medical schools to use the MCAT as one part—an important part—of an admissions strategy, but don’t allow it to be the gatekeeper.

Long-term outcomes

Students:

Increase the number of URMs and disadvantaged students graduating from medical school and eventually obtaining employment as a practicing physician, preferably as a primary care physician serving minority and disadvantaged populations.
Increase in number of URM students who enter and complete medical school.
Among those who do not continue on the medical school to pursue a career as a medical physician, we are working to increase the number of students who join the medicine, health care or scientific workforces (through nursing, science, medical research, or other health-related professions)

U.S. Population:

Improve the representation of minority and disadvantaged backgrounds in the physician workforce to match their representation in the general population.
Improve the health care received by minority and disadvantaged populations by increasing the number of professionals from these communities that are trained in health-related fields and return to serve them

Medical Schools & HealthCare Institutions

Increase the number of URM faculty and leadership at medical schools to reflect the diversifying population.
Underrepresentation among faculty and leadership positions at medical schools.

Physician Workforce Goal 2035

Increase the diversity among doctors who are underrepresented in the physician workforce from the current rate of 11% to 20% by 2035.
- Between 2023 and 2035, we are working to increase the percentage rate of underrepresented physicians by 2.25% every 3 years over the next 12 years to reach “goal 2035”.

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