A California physician training program adds diversity, but where do graduates end up?

Marcus Cummins grew up dreaming of becoming a doctor, but the Central Valley, California, native didn't have Black physicians to look up to. At times he doubted himself, but he credits the determination he developed as a receiver on the University of California-Davis football team to get him through his studies.

"Being a collegiate athlete gave me confidence to apply myself and handle the rigorous schoolwork of medical school," said the 25-year-old husband and father of three. "It was harder because I didn't have any physician role models."

This spring, Cummins will complete his fourth year of medical school at the University of California-San Francisco School of Medicine's regional campus in Fresno. In March, he matched with UCSF Fresno's internal medicine residency program, where he will complete his training.

The campus is home to one of the University of California's Programs in Medical Education, or UC PRIME, which encourage students of color to pursue medical degrees to help diversify the field and ease the physician shortage, particularly in underserved communities. The public university system launched the first training program in 2004, at its Irvine campus, and has since expanded it to all six medical schools, many with an emphasis on medically underserved communities.

Researchers have found that the program has succeeded at diversifying enrollment, but there is not enough long-term tracking to know whether these medical school graduates return to practice in regions where they're most needed. "Little is known about the long-term outcomes of UC PRIME, such as practice location or specialty, in the absence of a longitudinal, summative program evaluation across all UC PRIME programs," researchers with Mathematica wrote last fall after assessing the program through a grant from the California Health Care Foundation. (California Healthline is an editorially independent service of the California Health Care Foundation.)

UC administrators say their data shows promising results. In its March report to the state legislature, the university system found over half of those who have completed their training are serving underserved communities, although the Los Angeles and San Francisco schools were unable to provide complete information. Participating students are trained in specialized coursework and clinical experiences to deliver culturally competent care. Depending on their individual circumstances, they may receive financial aid and scholarships as well as leadership development and mentoring.

"These outcomes demonstrate that UC PRIME programs have a substantial impact on increasing the number of UC medical school graduates who pursue careers devoted to improving the health of the underserved through leadership roles as community-engaged clinicians, educators, researchers, and social policy advocates," the university system wrote.

Deena McRae, interim associate vice president of academic health sciences for the UC Office of the President, said the university will continue to enhance its tracking.

Several years ago, the California Future Health Workforce Commission recommended expanding the program, noting that graduates are likely to be from underrepresented racial and ethnic groups, likely to practice in California, "and more likely to care for underserved populations than physicians who do not participate in similar programs during medical school." The medical training program also seeks to recruit students at an early age. For example, UCSF Fresno's Office of Health Career Pathways runs programs that encourage middle and high school students to pursue careers in medicine.

The state has followed through by increasing support. In 2021, the state allocated almost $13 million in new funding for UC PRIME. That amount will allow the program to grow from 396 students this year to nearly 500 by the 2026-27 academic year, UC predicted.

Sidra Suess, a Pakistani who grew up in Modesto, now practices internal medicine at Kaiser Permanente in Stockton. She completed her undergraduate work and two years of medical school at UC Davis before doing her final two years of medical school at UCSF Fresno through its San Joaquin Valley program.

"Stockton is such a diverse mix and beautiful blend of cultures and languages," Suess said. "I know I made the right choice to be here, and PRIME opened doors for me to do this. The tuition help, scholarships, and other support that PRIME offers can be fundamental to getting students involved and active who can do well."

Last fall, Mathematica found underrepresented medical students at UC schools more than doubled, from 16% in 2000 to 40% in 2021, an increase largely attributed to UC PRIME. Researchers credited the program for "focusing recruitment efforts on individuals committed to serving underrepresented communities."

However, the report cited a lack of long-term data as an obstacle to knowing where these graduates end up practicing. One study of the program's graduates and those from several other community-focused special education tracks from the UC Davis School of Medicine found as many as 62% practiced in an underserved location, but that research relied on secondary sources.

"It takes at least 11 years or more to produce a practicing physician after high school, depending on the specialty," said Kenny Banh, assistant dean of undergraduate medical education at UCSF Fresno. "More time is needed to track outcomes for our graduates."

Banh, an emergency medicine physician, stressed the importance of doctors who speak the same languages and come from the same cultures as their patients. He said rural areas in need often import foreign physicians, sponsoring their visas, but that those doctors aren't necessarily committed to the region. They may accept sign-on bonuses and work for a time then leave.

Meanwhile, more than 80% of his students come from disadvantaged and underrepresented backgrounds, he said. "I went into medicine to open doors for students like myself," said Banh. "Students don't just walk through those alone."

In underserved regions, there tend to be fewer doctors serving patients; hospitals and health facilities likely have a harder time recruiting and retaining clinicians; and patients may have to drive long distances to access care. A 2021 report from the Healthforce Center at UCSF found that the Inland Empire had the lowest ratio of primary care physicians per 100,000 people in California while the San Joaquin Valley had the lowest ratio of specialists per 100,000 people.

Diversifying the field could also be good for patients' health. For example, new research has found that Black people live longer in areas with more Black doctors.

From Selma, then Kingsburg, Inderpreet "Inder" Bal's parents worked as immigrant farmers. She chose to pursue medicine during her third year at Fresno State, she applied to UCSF, and she is now in UCSF San Joaquin Valley PRIME's class of 2024. "It definitely lived up to everything I imagined," said Bal, who is Punjabi Sikh.

Through her mother's journey with terminal cancer, Bal realized that being a doctor didn't mean she could cure everyone, but she strives to give every patient her best. Bal said she's committed to practicing in the Central Valley one day.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.