SUNY Downstate Medical Center - Iatros Yearbook (Brooklyn, NY)

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1 Ricardo Wilson President Nixon and the American Medical As- sociation have only recently acknowledged the ex- istence of a national health crisis. This crisis just did not nappen. A major force in its development has been a professional elite who have seen to it that the number of medical schools in this country remain constant and that these schools maintained a small enrollment. As a result there has been no substantial increase in the number of physicians trained yearly in this country in more than 50 years whereas tlie population has more than doubled in that time. Furthermore, the educational system of this na- tion was and still is set up in such a way that the quality of education one gets is directly propor- tional to one ' s annual family income. Thus the bulk of the well educated segment of our population comes from the upper and middle classes. Academic excellence has always been the major factor in choosing persons to enter the medical profession. As a result, physicians have continually come from the most highly educated segment of our population; namely, the upper and middle classes. Figures from surveys indicate that .342 of the medical students come from America ' s upper class, i.e., the top 32 of the population, . nother 55? come from the middle class. This group of students will as they have in the past bring with them to the profession the materialistic values of their class. When these values are applied to medicine we see the development of the belief held by the majority of our colleagues that health care is a privilege rather than a right. That health care is a service and like any other service should be placed on the money market, there to be subjected to the laws of supply and demand. The problem is that health care is not like other services. For one thing it has a fixed demand, so that when prices are increased consumers cannot offset such an increase bv purchasing less of the service. This has permitted those members of our profession whose major obje c- tive in life is to become as affluent as possible to inflate the cost of health care to such an extent that often it can be afforded by only the very rich. Such persons have no qualms about selling their acquired knowledge and skills to the highest bidder. As a result the very rich are not affected by this recently declared health crisis. The middle class is just beginning to feel this crisis. However, the poor have always been in a health crisis. The sad fact is that for years in this S(x;iet ' there have been two forms of health care delivery systems. One for the poor and one for everybody else who could pay.

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There is not a socioh politicaL or religious privilege that you enjoy today that was not bought for you by the blood and tears and patient suffering of the minority. John Bartholomew Gough Wluit is a Minority? In America, at least, the female medical student definitely represents a minority. But why female and not woman? Aside from the semantic hairsplitting, there is a somewhat deeper meaning to the above question. Truly, not all females are women (as not all males are men); but in recent years, the majority of those females in medicine are feminine, attractive, womanly. She no longer wears the dowdy business suit, the hair neatly gathered at the base of the neck, the orthopedic oxfords. She had a somewhat delayed entry into the world of modern fashion, but she wears the proverbial miniskirt with the best. One might assume that the hemline elevation was tolerated, if not appreciated. She will also marry in medical school (possibh ' at a rate of 50 or more) often to a fellow student. I believe women find medical school and medical training to be a less traumatic experience than that tolerated by their predecessors. We are accepted, and I would venture, acceptable to the men. Perhaps the situation grows out of the greater confidence we have in our own feminity, perhaps it is merely a re- turn to the natural situation of civil male-female interaction in a professional setting. One wonders why die natural state disintegrated to its depths of absurdit) ' in the past. We grant that certain special- ties impose limits on our choice of career. We are advised to choose those areas with regular hours, and many women do so readily. There are those who still feel the pressure of proving themselves professionally, and perhaps their flamboyant choices of specialties constitute a rather self-defeat- ing arrangement. But it is recognized that women are certainly adequate physicians; some are even exceptional. My own academic experience has been compara- ble to that of my husband, a classmate, except perhaps in surgery, where I was referred to as one of the fellas, and was clamped and sprayed and shoved at the operating table, though no more clumsy than any other fella. Perhaps these are only isolated incid ents, indigenous to the psychic pathology of a few Kings County surgeons and sur- geons in training. The changing face of . merican medicine may see the demise of the female question. With new areas of Adolescent Medicine, of Family Planning, of ex- panded ambulatory facilities reaching into com- munities dealing with patients one to one, the old prejudices may fade. I feel diat patients are die last to reject the woman doctor; and certainly, in medical care, the patients ' concerns must be primary-. Phvllis Selter Rochelle Hainiowitz Gordon Diane Schuller Bette Harig

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A large segment of the poor population in this country is Black, approximately 202, so that if one studies the health care delivery system among Black people one can gain insight into the health care sys- tem among poverty groups in general. Figures cited in the Statistical Abstract of the United States, 1968, Bureau of the Census, p. 23, indicate that although ll7i of this nation ' s population is Black, only 2% of the nation ' s physicians are Black. Or, put another way, among wliite citizens, one American in 560 becomes a doctor; among Blacks, one in 3,800. Thus, one can have the situation such as exists in Roxbury, Massachusetts, where there are only 3 Black primary physicians serving the health needs of over 80,000 Black people. The medical problems of Black people often arise from the most basic needs of sanitation and nutrition, which a progres- sive industrialized nation should have eradicated long ago. While a white baby born today has a life expectancy of 68 years, a Black child can be expect- ed to die 7 years earlier. In 1940 the infant mortality rate among non-whites was 70? greater than for whites, and 22 years later, in 1962, it was 90? greater. Furthermore, in 1950, Black doctors consti- tuted 2% of all Black people in the professions, but by 1960, this figure had fallen to 1.7%. The total enrollment in medical schools is 35,809 and of that only 858, or 2..39?, are Black. Once the two predominantly Black medical schools are taken out of the survey, however, the total enrollment is 35,236 and the Black enrollment is only 328, or 0.93%. In a student body of approximately 800, Downstate has 12 Black students— 1 .5%. These students have the same academic qualifications as white students and have many things in common witli them. For example, we are mainly middle class and if it were not for the racist society in which we live, we also would run to the suburbs upon finishing our residency. The educational system in this nation is of such a nature that tlie number of Black students who reach the academic level of most medical students is small. Thus, by merely searching for such students among the Black population, little is contributed to solving the health crisis in the Black community. Even if you were able to find a substantial number of Black students at such a level, the majority of them would be middle class with middle class values and you would still be denying the poor an opportunity to enter medicine. It was with these facts in mind that Downstate initiated a guaranteed admissions program with Brooklyn College in May, 1969. The primary purpose of the program is to en- courage the application of students from poverty areas to medical schools in an effort to alleviate the critical shortage of Afro-American and Hispanic- American physicians. A secondary purpose is the early identification, recruitment and involvement of promising young undergraduates in the medical school, its personnel and programs in order to mo- tivate these students toward a career in medicine. A joint, six member Downstate Medical-Brooklyn College faculty committee was formed to organize and direct this program. The committee identified and used three selection criteria in addition to the poverty factor, these being intellectual potential, academic potential, and motivation to study medi- cine. The committee also proposed that there should be a preliminary selection process held at the college with screening by college faculty as well as a final selection procedure in which all six members of the joint committee would participate. Students selected to participate in the program were to be chosen from either the Educational Op- portunity Program (EOP) or tlie Search for Educa- tional Elevation and Knowledge (SEEK) programs of Brooklyn College. The EOP program, a special College endeavor, admitted some 200 high school graduates from poverty areas into the College in the 1968-69 academic year under special discretionary admission criteria. There were approximately 450 students at Brooklyn College in 1968-69 who had been matriculated through provisions of the SEEK