Can Medical Schools Help Improve Outcomes for Minorities Living with Diabetes?

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In a recent study published in JAMA, a Yale-led team of researchers found 1.63 million excess deaths in the African American population compared with white Americans since 1999, representing more than 80 million excess years of potential life lost. Too many of these lives were lost to diabetes and its complications, including avoidable amputations.

Nearly 12% of African Americans currently live with diabetes. These people are significantly more likely than other racial and ethnic groups to experience complications from the condition, including diabetic retinopathy, end-stage renal disease, vascular disease nand foot ulcers that lead to lower limb amputations.

Rosemay Michel, D.P.M.

Those numbers are likely to increase dramatically as African Americans are among those projected to have a 50% chance of developing diabetes within their lifetime.

To shift the odds of diabetes in African American communities, and minority communities overall that are most impacted by diabetes, the healthcare system needs to take urgent action — and it starts with how we train the next generation of physicians to deliver equitable, inclusive and culturally responsive care.

Our medical schools are underutilized resources for changing the trajectory of diabetes in historically underserved populations. We can no longer afford to live with the “trust gap” that exists between healthcare providers and patients from communities that have been poorly treated for too many years.

Gary M. Rothenberg, D.P.M.

It’s time to invest in training programs that are much more deeply rooted in the communities they serve, programs that can build trust, expand access, and create true partnerships between patients and their care providers.

Put schools in the right places

Geography matters when it comes to attracting a diverse and inclusive class of medical students and helping them establish connections to the regions where they’re most likely to practice.

For example, the University of Texas Rio Grande Valley (UTRGV) School of Podiatric Medicine is the first podiatry school in Texas and the nation’s first publicly funded podiatry school. The location of the school gives students the opportunity to directly address the challenges of Rio Grande Valley communities, where diabetes is prevalent among the Hispanic/Latinx population.

The same strategy could be effective for other racial and ethnic groups as well. Promoting podiatry (a critical specialty for those living with diabetes) within publicly funded university systems, particularly in areas of known clinical and socioeconomic need, could attract more local students who are members of the communities they plan to serve while giving all trainees a new perspective on delivering diabetes care.

Support medical students of diverse backgrounds

The number of African American first-year medical students increased by 21% between 2020 and 2021, but they still only make up 11.3% of this student population. There’s a long way to go before the majority of African American patients have doctors with the lived experiences to deeply connect with people facing systemic barriers to care.

Medical schools need to do a better job of attracting diverse and representative applicants. At the University of Michigan, for example, a recent event gave middle school students from southeast Michigan a glimpse into a future in health sciences. Youth from backgrounds underrepresented in healthcare participated in hands-on simulations and conversations with a diverse team of presenters, making connections to inspire students to consider a path in medicine.

But students need additional support as they work through the medical school process and graduate into a challenging career path. This could include ongoing mentorship opportunities, career guidance services, or financial assistance programs designed to help new physicians get established in areas with increased need.

There are already federal programs that provide loan repayment assistance to health professionals who commit to practicing for a specified length of time in designated provider shortage areas. However, these options are generally geared toward primary care and mental health care providers. Expanding these types of programs to specialty providers, including endocrinologists, nephrologists, podiatrists, and other diabetes-related specialties, could make a dramatic impact on attracting and retaining talent in underserved areas.

Connect medical schools with the community

Professional development leaders need to build community connections early by incorporating outreach into the medical school curriculum. Students must learn what motivates people to make healthy choices in their daily lives, including the influences of schools, faith-based groups, social media and extended family on personal decision-making.

Working closely with community-based groups from the beginning of their education process can provide valuable insight to students. At the same time, openness from the health system is vital for increasing trust, education, and communication among people living with diabetes, those at risk, and those who care for their loved ones.

Encouraging students and providers to participate in community service opportunities, such as providing foot screenings at health fairs, assisting with support groups, running shoe drives, or volunteering at food pantries, is a high-impact way to help students experience what diabetes looks like in the real world while raising the profile of the school or health system they represent.

By shifting our thinking on medical education and integrating medical schools and their students more deeply into the communities they serve, we can close the trust gap and create more effective long-term partnerships for health that change the way minority patients and their communities experience diabetes.

Rosemay Michel, D.P.M., currently practices at the Fayetteville VA Medical Center in North Carolina. She serves as an officer of the American College of Podiatric Medicine, an active committee member of the American Board of Podiatric Medicine, a residency program evaluator for the Council of Podiatric Medicine and a consultant to the University of Texas Rio Grande Valley School of Podiatric Medicine.

Gary M. Rothenberg, D.P.M., currently holds an adjunct clinical faculty appointment within the Endocrinology Division at the University of Michigan School of Medicine in Ann Arbor. He is also the director of medical affairs for Podimetrics, Inc.