The Senate is preparing to make a big mistake with a small budget item.
On Dec. 20, it will vote on its proposed budget for the 2020 fiscal year. If approved in its current form, the new budget will completely eliminate the Health Career Opportunity Program (HCOP), a nearly $15 million national pipeline program for diversifying the U.S. health care workforce. Enacted in 1972, HCOP is a federally funded grant program that helps students from economically and/or educationally disadvantaged backgrounds develop the skills needed to successfully compete for, enter, and graduate from medical, nursing, and other health professional schools.
Private and public universities can apply annually for HCOP funding to support pipeline programs for K-12 and college students. These programs often include summer research opportunities, test preparation programs, workshops for preparing applications to health professional schools, and more. Since its inception, tens of thousands of students have benefited from the program, many of whom wouldn’t be where they are today without it.
I am one of them.
I was raised by a single mother in Compton, Calif., and am the first person in my family to pursue a career in medicine. Like many HCOP participants, I was educated in public schools from kindergarten to high school. I afforded my tuition at Loyola Marymount University, a private school, through financial aid and scholarships.
As the first in my family to embark on this journey, I often found myself surprised by the “hidden curriculum” of being a premed student. For instance, I was expected to complete hundreds of shadowing hours, when I did not know one person in my community who was a doctor. While summer pipeline programs afforded me the opportunity to gain these experiences, the Medical College Admission Test (MCAT) loomed as another big hurdle.
As I prepared for the test, I remember being stressed not only by the seven-hour exam but also its cost. I didn’t know how I was going to afford the $315 fee to sit for the test or the $294 cost of the Association of American Medical College’s test prep package. Highly coveted test prep courses and private tutors cost up to $2,000. Like many students from financially disadvantaged backgrounds, my family didn’t have the residual income to easily pay for my MCAT prep, so I was stuck.
Then a friend told me about her positive experience at the University of Connecticut’s Health Career Opportunity Programs. I applied immediately and was elated to find out I was accepted.
As an HCOP student, I spent six weeks during the summer at the university. I received a living stipend, one-on-one mentorship, opportunities to observe in the clinic, and a fully funded MCAT test prep course. I was surrounded by more than 50 students of color from across the nation who were interested in careers ranging from public health to dentistry. This program afforded me financial stability over the summer while I studied for the test that would decide if I would be able to fulfill my dream of becoming a doctor. Beyond that, it provided me with lifelong mentors, shadowing opportunities, and a community that became my family.
For many HCOP participants, the program fosters a sense of community that becomes like fictive kin. Through group messages and monthly FaceTime calls, we support one another through the challenging and often isolating journey of being students of color in health care.
While the Senate might see the elimination of HCOP as a drop in the bucket, I see the purposeful obliteration of this pipeline program as a grave error that will have detrimental outcomes for underserved communities and the future of medicine. I believe, as does the Student National Medical Association, that eliminating the Health Careers Opportunity Program would be devastating for efforts to recruit and retain more minority students in the medical profession and improve diversity in health care.
The program helps provide students from disadvantaged backgrounds with the financial and social capital their counterparts often have, easing their ability to navigate the health professional school application process.
Eliminating this program is particularly troubling as the U.S. health care system is suffering from a diversity crisis with no evidence of improvement in the near future. In 1978, 1,410 black men applied to U.S. medical school. This year the number was 1,554, an almost insignificant change compared to applications from white men over that period. Yet studies have shown that black men have better health outcomes when their physician looks like them.
The Department of Health and Human Services’ justification for eliminating HCOP is this: “The request prioritizes funding for health workforce activities that provide scholarships and loan repayment to clinicians in exchange for their service in areas of the United States where there is a shortage of health professionals.” While this may appear to be a noble excuse, it is an incomplete one. It does not justify the disruption of a nearly 50-year-old program for increasing diversity in health-related fields with the only federally funded diversity pipeline program of its kind — especially given the looming shortage of up to 122,000 physicians by 2032.
We should be doing more, not less, to educate a diverse health care workforce that will meet the needs of the ever-diversifying U.S. population.
As a future physician dedicated to advocating for and serving underserved populations, I understand the importance of loan forgiveness programs for those working in underserved and rural areas. But I think that the Senate’s elimination of a program that has helped bolster diversity in health care is misguided and short-sighted.
To meet the needs of underserved communities and to solve the diversity crisis in health care, we need a combination of increased loan forgiveness for health professionals along with sustained support for diversity pipeline programs. Funding one program without the other is simply incomplete. Especially when our economy is at an all-time high, austerity policies should not govern the future of health care in our country. We don’t need to de-fund our future to fund our present.
Senators could change their minds between now and Dec. 20. Take two minutes to send a note to your senator via the Association of American Medical Colleges, which supports keeping the HCOP program. Call or email your state’s senators directly. Join more than 200 students, health professionals, faculty members, deans, and others representing nearly 80 schools, hospitals, and organizations in signing a petition I started. Show support on social media using the #FundHCOP2020 hashtag. If you are an HCOP graduate, use videos, forums, and social media to tell the world how the program has affected you and your career.
I credit the Health Careers Opportunity Program for helping me get into medical school, staying there, and becoming the first-ever black female to be student council president at Harvard Medical School. I want others like me to have these same opportunities. The Senate needs to continue funding this successful and very necessary program.
LaShyra Nolen is a first-year student at Harvard Medical School.