Enrollment of first-year Black medical students climbs to historic levels

Danielle Somerville describes it as her most strenuous undertaking: enrolling in medical school.

Somerville, a first-year student at Penn State College of Medicine, is carrying a course load that includes anatomy, biochemistry, microbiology, pathology and pharmacology.

“I think in some ways this is the most challenging thing I’ve done in my life,” said Somerville, of New Wales, just outside Philadelphia. “I’ve been through other challenging times, but this is mostly intense and demanding. So, this is definitely a lot academically, in terms of the volume of information we have to learn very quickly.”

At 24, Somerville, who is Black, is part of a historic class: one that is seeing the highest enrollment ever of first-year Black students in medical school.

The coronavirus pandemic amplified long-standing racial disparities in health care and shone a spotlight not just on issues of access to care, but on the woefully small ranks of Black doctors and medical professionals in this country.

The pandemic may have also spurred positive change.

More Black students enrolled in medical schools last year than any other time in history. New data shows that the number of first-year Black students who enrolled in medical schools amid the pandemic increased 21% over the previous year.

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“It’s very gratifying for me in terms of the work I’ve been doing here at the College of Medicine and knowing we are part of that larger national statistic,” said Sonnya Nieves, director of diversity pipeline programs in the Office for Diversity, Equity and Belonging at Penn State College of Medicine.

“Above all there is the need for more diverse health care providers to mirror the communities they serve. That’s really the bonus in this spike in numbers of Black and African-American students enrolling in medical school.”

The new data shows that last year’s enrollment class nationwide was more diversified than any other class in history, with some 2,869 Latino first-year students enrolling, a 7 percent increase. In particular, though, the number of Black students enrolling in medical schools climbed significantly to 2,562.

Black students made up 11.3% of matriculants in 2021, up from 9.5% the previous year. A 20.8% increase in the number of Black men enrolling was particularly noteworthy. Some medical schools report that the number of first-year Black students tripled.

Penn State College of Medicine, after years of lackluster minority enrollment numbers, last year nearly doubled the number of students from minority communities entering the 2021-2022 medical class.

“This is something that I’ve wanted for a long time,” said Masanga Kiminu, a first-year medical student at Penn State College of Medicine.

Medical settings are practically a natural environment for Canadian-born Kiminu, who was diagnosed with sickle cell disease as a child. Inspired by her childhood caregivers, Kiminu said she always wanted to join the medical field and help others in need.

“I essentially wanted to be like the doctors who were taking care of me,” Kiminu said. “I just wanted to be a part of that.”

For medical professionals the data, in particular the significant increase in numbers of students and the speed of that increase, represents a welcome trajectory for Black communities. The lack of representation of underserved communities has long been recognized as a factor in lower qualities of health care access and delivery for Black people as well as the disproportionately high rates of chronic diseases among Black communities.

“People are finally waking up and finally recognizing that we can’t wait for someone else to come our rescue,” said Dr. Carlos Cream, an internal medicine residency faculty at UPMC Central PA., and director of Diversity for Graduate Medical Education.

“I can’t ask for someone else to care about my community more than I do. We’ve seen what happens when we’ve waited for that to happen. This is where we stand. There’s a new generation that is asking, ‘If not me who?’ As John Lewis said, ‘if not now when? If not us, who?’”

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Cream, who is Black, said the American medical community has long been aware of the chronically low levels of diversity in its ranks, but the response, he said, has been slow in coming.

“This problem is not new,’ Cream said. “This problem is being manifested because of the evidence of long-standing health care disparities leading to inequities in health care and health status chronically. COVID brought to life what was already underneath.”

The COVID-19 pandemic renewed the focus on health disparities, with Black people four times more likely to have died of COVID-19 than white people. In the face of the pandemic, many Black communities found themselves revisiting the legacy of historical medical transgressions that left many hesitating to be vaccinated. The gaps were amplified by the not-so subtle cultural and personal chasm created by a lack of representation among medical health care providers.

“Representation matters,” said Dr. Chavone Momon-Nelson, chair of the ob/gyn department at UPMC Carlisle. “When we are represented and see people who look like us, it helps. It changes things in a magnitude that I can’t find the words to express how much that matters. I’m glad to know the numbers of students of color are increasing. They are needed. They are needed in the health field and for the next generation of students who say they want to be physicians, they need evidence that it’s possible.”

First-year medical students may just be entering an arguably arduous pipeline, but the prospect of increased numbers of Black health care providers is encouraging to established professionals like Cream. According to a report last year out of PennMedicine, Black patients have more favorable experiences and health outcomes when their doctor shares their racial or ethnic background.

“Is the person giving me care from my community?” Cream said. “Do they understand me? How easy is it for them to address my concerns, which are not necessarily spoken but understood? That trust engenders the opportunity to get better outcomes. It does not ensure it and it does not preclude it....but that is why it was recognized almost 20 years ago that this was an issue.”

Historically speaking, Black students have faced overwhelming hurdles and barriers to enrolling in medical schools. Students from underrepresented communities often lacked adequate educational preparation, coming from disadvantaged school districts that weren’t always able to provide the rigorous coursework needed to prepare them for medical school entrance exams. Some students may have lacked the opportunities and networking that opens doors for other students.

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“It’s the remnants of how the system is set up,” Cream said. “We can call it racism. Whatever you want to call it. If you take out racism or race at all...To get into medical school, what is the first barrier? Being a college graduate with a very high GPA. How do you get there? That has to get to preparatory school training. Where are the prep schools and how well functioning were they? Who were the mentors and guidance counselors? Who made sure you had the appropriate curriculum vitae so you had enough exposure to health care so you can say I was an orderly and I did my shadowing with Dr. Smith and he helped me learn how to go about navigating these areas.”

Students from underrepresented communities also navigate cultural barriers, including teachers who dissuade them because of socio-economic concerns. At times, even their own families may stand in the way.

“They may be the first person in their family going to college or graduating from college and attempting to navigate that transition to med school or graduate education of any kind,” Nieves said. “There may be a lack of mentorship or support that their direct family members can’t provide. Sometimes family income has been a conversation. We’ve had students who are trying to navigate working and supporting themselves and family and then trying to dedicate enough study time to prepare for the entrance exam for medical school.”

And the cost is a significant six-figure burden.

According to the Association of American Medical Colleges, the majority of medical degree recipients use student loans to pay for medical school. Last year, the average medical school debt was $215,900. The average medical school graduate owes $241,600 in total student loan debt.

“Medical school is not cheap,” Momon-Nelson said. “I think the burden of just thinking about coming out of school with a couple of hundred thousand dollars in debt can dissuade someone from being a physician. Ultimately when you have a significant amount of people who don’t look like you, it becomes a significant challenge.”

For Momon-Nelson, a pivotal factor in her successful medical training and education as a young student was the mentoring she received from teachers and counselors along the way.

“It was not only the mentorship I received while in college, but even as a young girl from the time I was in high school,” said the Momon-Nelson, a 2005 graduate of the Philadelphia School of Osteopathic Medicine. “My guidance counselor was a Black woman. She knew what my goals were.”

A Black counselor at a summer program, and her professors at her Historically Black College also were instrumental in inspiring her with confidence.

“That was an integral part of why I succeeded,” Momon-Nelson said. “Many African-American men and women are still the first doctor in their family. They don’t have that mentorship. They don’t have that support. They don’t have support from their family because families don’t understand. Then they go to college and they also don’t have that support. I remember going to college and being surrounded by people who had the same goals as me.”

Recognizing the importance of diversity, medical schools and health systems are increasingly putting in place programs to level the playing field for underrepresented students.

WellSpan, which operates major hospital affiliates in York, Harrisburg and Lancaster, for instance, encourages second and third-year residents from underrepresented communities to engage with their local communities to mentor young people who may be interested in the medical field.

WellSpan partners with York College on a scholarship program designed to nurture prospective medical students at William Penn High School, a predominantly Black and brown student demographic school in the city.

“The residents are being mentors to those students,” said Kimberly Brister, VP and Chief Diversity, Equity and Inclusion Officer for WellSpan. “It takes it beyond health care and being able to provide health. It’s actually connecting with students who may be interested in medicine and helping bridge the gap or helping them understand what it took to walk into the field of medicine.”

Debt forgiveness is another tool many employers are using to attract prospective medical professionals from underrepresented demographics.

“It can help alleviate some of that financial pressure,” Brister said. “It can be not only a recruitment tool but a retention tool — offering some kind of loan forgiveness.”

Increasingly, the leveling of the playing field begins at the enrollment stage. More and more schools are subscribing to an increasingly holistic review of admissions to assess prospective students, rather than tipping scales based on standardized test scores, grade point averages and MCAT scores.

Penn State College of Medicine, for instance, no longer weeds out students based on their MCATs or medical school entrance exams score.

“In the past there was a bottom-out score that medical schools would set for a criteria and screen out students who didn’t meet that score,” Nieves said. “The MCAT is one component. They are looking at all aspects. What their road has been like up to this point. What it is they hope to do once they achieve their goal. Are they looking to give back to their community? They are looking at grades and GPA within the context of systemic barriers that students of color and students from underserved communities often have faced and not prioritizing GPA and particular grades, but having a certain level of expectation that students will be able to handle the rigors of medical school.”

As encouraging as the trend is, Momon-Nelson cautions against complacency. Diversifying the student body is just part of the battle.

“When we talk about diversity it’s not just the student body,” she said. “It’s in the faculty. It’s in the staff. People need to see people like them at every aspect.”

Increased interest in medical school among young Black students may be an unexpected consequence of the challenges the pandemic posed for communities of color, but it’s one that Momon-Nelson is happy to embrace.

“There were many things that happened that impacted the Black community, the Latino community and the Asian community,” Momon-Nelson said. “People are trying to insert themselves in many different places. I‘m not surprised. We are making changes and people who look like me are the next generation of future doctors. I think it’s a win. I’m here for it and I ‘m excited for it. I‘m hoping this is not something that is temporary but is lasting and the numbers continue to increase. I hope people who are minorities say, ‘Guess what? All these other people did it. I can too and when they are being discouraged by other people saying, ‘you can’t do it,’ that they can say, ‘yes, I can I can do it.’”

Staff writer Zahriah Balentine contributed to this report.