Pathway Programs Deliver Medical Careers

    • October 15, 2012

As early as 1972, when the leaders of the Robert Wood Johnson Foundation (RWJF) defined the issues they hoped to address as part of the Foundation’s commitment to social change in health care, there was an awareness of the need to provide a better path to success for disadvantaged young people interested in careers in medicine.

The statistics of the day illustrated the importance of the issue. In 1970, racial and ethnic minority groups constituted 16 percent of the United States population, but only 2.3 percent of the nation’s medical students and just 5.9 percent of all medical professionals, according to the Association of American Medical Colleges.

In addition, the Foundation realized that in order to be effective, our nation’s health care workforce needed to reflect all of our communities and include people with a broad range of backgrounds and abilities. 

Research has not only shown that minority physicians and dentists are more likely to treat medically underserved populations, some studies also show higher levels of patient satisfaction and better care when there is patient-physician race or ethnic concordance.

By 2003, RWJF pathway (pipeline) program guidelines were also expanded to include socioeconomically disadvantaged students.

In order to address the significant gap between the number of talented young people interested in medicine and the number who were actually able to find the mentoring, role models and support needed to develop careers, RWJF created a series of programs to open doors to a new generation of physicians, nurses, dentists and other health care professionals.

Starting with Undergraduates

RWJF’s first effort to nurture tomorrow’s medical professional was a $13 million project called the Pre-professional Minority Programs initiative (1972–1994). The summer academic enrichment curriculum was designed to prepare promising minority college students to enter medical school. The program model included counseling, tutoring and specially tailored premedical courses.

It was followed by the Minority Medical Education Program, which would be the forerunner for the Summer Medical and Dental Education Program (SMDEP), a highly successful pathway program credited with generating the largest number of RWJF program alumni. Beginning with the summer class of 1989, and continuing to 2011, more than 20,000 students have participated in SMDEP. The program focus expanded to include dentistry training in 2005, in recognition of the link between low access to oral health services and underrepresentation of minority and disadvantaged students in dental schools. By 2012, RWJF had invested more than $67 million in the SMDEP initiative.

SMDEP provides a six-week program at 12 sites across the country, selecting 80 college freshmen and sophomores (per site).  They receive rigorous enrichment courses, labs and preparation for exams and other entrance requirements for medical and dental school.

Throughout the 1990s and 2000s, the Foundation continued to support young medical or nursing students and entry-level health care workers in a variety of ways, including:

▪ Ladders in Nursing Careers ProgramIn response to an extreme nursing shortage in New York City in 1988, RWJF created the Ladders program to support low income and minority

hospital and nursing home employees who wished to become nurses. The $5 million program was eventually expanded to include eight states.

▪ National Medical Fellowships – From 1990-1996, RWJF expanded its scholarship support for minority medical students with this $5 million project.  

The Health Professions Partnership InitiativeThis $7 million, 1994-2008 initiative co-funded by the Kellogg Foundation, established partnerships among health professions schools, undergraduate colleges, K–12 school systems and community-based organizations to prepare students academically for medical school and other health professions schools.

The Sullivan Alliance – Supported with $200,000, between 2007 and 2010, the Alliance was created to increase the number of minorities in the health professions by working with historically black medical colleges and other academic institutions. The project was funded by RWJF, U.S. Department of Health and Human Services, and the Kellogg Foundation. Project goal was to implement report recommendations offered by the Sullivan Commission and the Institute of Medicine.

The Pipeline, Profession and Practice: Community-Based Dental Education Program (also called the Dental Pipeline Program). Over nine years, (2001–2010), RWJF funded dental schools with $23 million in grants to increase access to dental care for underserved populations. The program accomplished its goals through community-based clinical education programs and increasing recruitment and retention of underrepresented minority dental students.

The California Endowment funded the California schools that participated in the program.

▪Developing Rural Health Providers –The Southern Rural Access Program, with an overall goal to improve access to health care services for underserved areas of the South, included the Rural Leaders Pipeline Effort. Under this initiative, undergraduates from rural communities—

including many from economically disadvantaged families—received special assistance at summer enrichment sessions designed to encourage entry into the health professions.

In Mississippi, for example, 162 students participated in a six-week summer course that included math, sciences and test-taking skills. Participants also shadowed health professionals in underserved areas, including a clinic in Mount Bayou, an African-American community near Cleveland, Miss. One participant said of the program, “It made me want to be a nurse more—especially in the Mount Bayou area.” (See Grant Results on the Southern Rural Access Program.)

Continuing a Proud Legacy

Building on the success of these programs, RWJF also created two, ongoing initiatives to help minority and economically disadvantaged health professionals gain greater access and opportunities in post-doctoral health policy fields.

New Connections: Increasing Diversity of RWJF Programming is national program that supports the work of talented medical researchers and research evaluators from historically underrepresented backgrounds. Created in 2004, and funded with a $13 million grant through 2016, New Connections brings these scholars together to lead research projects for the Foundation.

To ensure that historically disadvantaged medical students find needed role models once they reach medical school and increase the number of minority scholars conducting biomedical research, clinical investigation and health services research, RWJF started the Harold Amos  Medical Faculty Development Program (formerly the Minority Medical Faculty Development Program), in 1983. Over 24 years, the Foundation’s $110 million investment in

Harold Amos (named for the first African American to chair a department at Harvard Medical School), has produced scholars (more than 80 percent of graduates are still in academic medicine) who have conducted award-winning research and served in a variety of key leadership roles in the world of medicine Together, these programs represent RWJF’s 40-year effort to diversify the health professions and create a more diverse health care workforce.