UNC Program Builds Rural Care Pipeline of Minority Doctors and Dentists

Aug 1, 2018

Jazmine Walker unzips a blue body bag. A gaggle of students in scrubs and surgical masks surround her. Teams of five crowd around cadavers around the room, about to begin their first dissection of a human body. But these are not medical students − not yet anyway.

They are aspiring doctors and dentists. And many don't have the same background − nor look like − the vast majority of health professionals working today. But they do look like a lot of the patients they one day hope to serve. They are students of the Medical Education Development Program, a training program put on by The University of North Carolina at Chapel Hill's medical school that has been creating a pipeline of minority doctors and dentists for more than 40 years.

This nine-week boot camp helps prospective students get ready to apply for professional school. The competitive program chooses 80 students every summer to take classes on full scholarship. Some are finishing their bachelor's degrees, and others − like Walker − have had a longer journey toward med school. She's taken five years off since graduating with her bachelor's degree from UNC-Chapel Hill, and has worked for a pharmaceutical company and taught high school biology.

Walker's lab mate Gloribel Vanegas also took a few steps to get here. First, she earned a bachelor's degree and became a nursing assistant. Lately, she's been taking more classes and working at a rural medical center in Benson as a medical assistant and Spanish interpreter.

It always touches me when I see a patient who's a farmworker because I know the importance of what they're doing, and also understand the struggles of what they're going through. -Gloribel Vanegas

"Those type of interpreters are very limited in a rural area," Vanegas explains. "So that's part of why I'm staying in the clinic that I am, because I know that I'm an asset."

The clinic's clientele includes many Latino farmworkers. Vanegas says they often remind her of her father, who worked in tobacco fields when he first came to North Carolina from El Salvador.

"It always touches me when I see a patient who's a farmworker, because I know the importance of what they're doing, and also understand the struggles of what they're going through," Vanegas said. "Maybe not fully, but I have an idea."

And that is the idea, that the MED program will help train future doctors and dentists who understand their patients better. Each of the students in this program has been chosen because in one way or the other, they came from a disadvantaged background or are under-represented among healthcare professionals − whether that's based on their race, religion or where they grew up.

Gloribel Vanegas listens to a lecture by Dr. Edward Kernick as part of the Medical Education Development (MED) Program at UNC Chapel Hill on July 5, 2018.
Credit Madeline Gray / For WUNC

MED Boosts Rural Physician Workforce

The MED program serves a vital role in balancing the physician workforce in North Carolina. It's commonly understood among health researchers that North Carolina faces a physician shortage. That's not exactly true. It's more accurate to say North Carolina has a physician distribution problem. Especially in primary care.

Many doctors have clustered around the state's urban areas, leaving provider deserts in rural areas. Consider that there are three counties without even a single dentist, and another four counties with just one. Yet Wake County has 828 dentists, according to the Cecil G. Sheps Center for Health Services Research, housed in the University of North Carolina at Chapel Hill.

For primary care, it's a similar story. Three counties do not have even a single physician, and in another 83 counties, there are fewer than 24 physicians per 10,000 residents, according to Sheps data.

Research from the Cecil G. Sheps Center for Health Services Research finds that physicians in North Carolina are clustered around urban centers.
Credit Cecil G. Sheps Center for Health Services Research

"What we face is shortage of physicians in rural communities; we face a shortage of primary care physicians," said Erin Fraher, who directs the program on health workforce at Sheps who studied the MED program. 

That's why the MED program is so vital. It seeks out students from rural areas, who are more likely to return to their roots to practice. Fraher's research found that nearly 25 percent of MED graduates practice in rural areas, while only 13 percent of non-MED graduates do. Some 19 percent of MED graduates practice in economically-distressed 'Tier 1' counties, while only 8 percent of non-MED graduates do; and 8.2 percent of MED graduates practice in health professional shortage areas, while just 1.4 percent of non-MED graduates do the same.

Research from the Cecil G. Sheps Center for Health Services Research found that MED alumni are more likely to practice in rural and underserved areas.
Credit Cecil G. Sheps Center for Health Services Research / Jason deBruyn

Fraher says she expected to find that MED graduates were more likely to practice in rural areas. But the findings were so stark they surprised even her.

"I crunch data for a living, and I crunch data all the time," she said. "This was one of those times that I looked at the results and was pretty stunned."

The MED program also attracts minorities. While MED alumni make up 1.4 percent of the overall physicians workforce in North Carolina, they represent 12.4 percent of all black doctors and a whopping 36 percent of all American Indian/Alaska Native doctors.

"So clearly this program is making a big impact in diversifying the physician workforce," said Fraher.

Meet North Carolina's Next Wave of Healthcare Professionals

For many students, the MED program could be a big break − a valuable opportunity to get a taste of medical or dental school and boost their chances of getting in.  More than 90 percent of the more than 3,000 students who have completed the program and applied to professional school were accepted.    

The program is made for students who've had some struggles. For example, Vanegas took on a lot of responsibilities as a teenager, interpreting for her parents, and working while in school. Her grades were good, but not perfect.

Students in the Medical Education Development (MED) Program (left to right) Gloribel Vanegas, Jazmine Walker, and Ling Lin put on gloves before starting to dissect cadavers at UNC Chapel Hill on July 5, 2018.
Credit Madeline Gray / For WUNC

"For a long time in undergrad I kept comparing myself to others," Vanegas said. "But then I had to realize, you know, not everyone has the same situation as me."

Many of the MED students are from rural areas or small towns. And most of the students in the program are not white − in a world where relatively few minority doctors and dentists serve a very diverse population of patients.

"Where I live, we have to travel about 30 to 35 minutes to get to an urgent care and to a hospital, and a lot of times whenever we go there … we don't see our race in those positions," Walker explains. "So, there's a lot of mistrust with the black community."

That mistrust can lead to miscommunication. Vanegas knows her ability to relate to her Hispanic patients and interpret for them, is a huge step to better communication.

"Every time I see a Hispanic, they actually light up. And they're like, 'Hey! How are you?'" Vanegas says, "They're like, 'Oh Gloribel's here … so I know I don't have to leave without knowing what's happened, or I can ask all the questions I want to ask.'"

Joshua Walker, who is in the Medical Education Development (MED) Program, prepares a scalpel to dissect of a cadaver at UNC Chapel Hill on July 5, 2018.
Credit Madeline Gray / For WUNC

She says the questions start pouring out, and patients are more honest with her. That doctor-patient communication is important for healthcare. Some studies show patients who are served by a doctor of their same race or culture, have better health outcomes.

For more than 40 years, the MED program has built a pipeline of minority doctors and dentists who now serve underserved populations across the state.

"Many of our African-Americans want to go back into their own community, many of our Latinos want to go back into their own community, happenstance is that many of those communities are rural or economically disadvantaged or as health professionals, what we call shortage areas," says the program's director, Dr. Cedric Bright.

Dr. Cedric Bright is Associate Dean for Inclusive Excellence and Director of the Office of Special Programs at UNC Chapel Hill. Dr. Bright oversees the Medical Education Development (MED) Program which is designed to give students who previously may not have had the opportunity to pursue education in medical fields the experience necessary to be competitive.
Credit Madeline Gray / For WUNC

But first, the program helps students get to the next step. This program brings students to the UNC med school and blasts them with information and tough classes that recreate the rigor of professional school.

"There is no, 'Let's ease their way into it,'" Walker says. "It's like, 'All right five classes on the first day, let's go.'"

The program also gives students lots of resources: test-taking workshops, help with their professional school applications, and role models − former MED participants and current medical students who've been in the same place as they are now. Here's Gloribel on her favorite teaching assistant, Martin Bahena.

"We're first-generation Americans and first-generation college students. We talked a lot about how hard it is to have that pressure on you as an immigrant child, to make sure that everything your parents did gets repaid in some kind of way," Vanegas said.

Her goal is to show her gratitude by continuing to work with Hispanic patients in a rural area.

"I think that's where I belong and I also think that's where I could be the most useful," Vanegas said. 

Meanwhile, Jazmine Walker has her sights set on her hometown, where she'd like to open her own practice.

"I already have it named out. It's going to be Walker Urgent Care, so look out for me in the next ten years or so," Walker said.

The plan is one day, they'll join more than 300 alumni from the program who are now serving as doctors in the communities that need them most.

White coats hang on the Medical Education Development (MED) Program floor at UNC Chapel Hill on July 5, 2018.
Credit Madeline Gray / For WUNC

Below are profiles of some of the students in the Medical Education Program

Gloribel Vanegas
Credit Madeline Gray / For WUNC

Gloribel Vanegas, Sanford

Vanegas is a graduate of Campbell University and current student at Meredith College. She has been working as a medical assistant and Spanish interpreter at Benson Area Medical Center, which serves a sizable Latino population:

"A lot of our Hispanic patients only come maybe like once or twice a year. So they're not coming to a doctor regularly because they're not seeing someone who can understand them like culturally. You know, someone they can open up to and be real about what health concerns they're having and be honest."


Jazmine Walker
Credit Madeline Gray / For WUNC

Jazmine Walker, Bunnlevel

Walker is a graduate of UNC-Chapel Hill. She has worked for a pharmaceutical company and as a high school biology teacher before deciding to pursue medical school:

"The bigger picture is we want minorities across the board to become physicians. We want them in all areas and all walks of life. The United States is so diverse, and we cannot keep everything in a box."


Jacob Locklear
Credit Madeline Gray / For WUNC

Jacob Locklear, Pembroke

Locklear is a student at UNC-Pembroke. He has been a volunteer firefighter and has worked as a laborer in a variety of fields before deciding to pursue dental school:

"I've been a plumbing assistant, I've done electrical work, I've done tile hardwood floors and I've helped frame houses. I work with my hands, that's what I gotta do. Well, what kinds of profession can you be a doctor and work with your hands? A dentist."


Becky Gauthia
Credit Madeline Gray / For WUNC

Becky Gauthia, Hampton

Gauthia is a graduate of Norfolk State University and current graduate student at Hampton University. She is a mother of five and previously served in the U.S. Navy before deciding to pursue dental school:

"I think just the strength and the dynamic in this program comes from its diversity. It's a beautiful thing. And it's 44 years strong, so they're doing something accurate."


Howard Smith
Credit Madeline Gray / For WUNC

Howard Smith, Fayetteville

Smith is a student at UNC-Wilmington:

"If you can identify with someone religiously, culturally, linguistically, you know, ethnically and share their experiences, it opens up the door to give the best care you possibly can. You can know all the things about science and chemistry in the world, but if people won't let you treat them, then it really doesn't matter."


Kamel Alachraf
Credit Madeline Gray / For WUNC

Kamel Alachraf, Raleigh

Alachria is a graduate student at NC State University and also has a bachelor's degree from State. He and his family fled Syria. He says his religious identity as a Muslim will help him better serve patients of the same background:

"For instance, my mom or sister would like to see someone from the same religion or who understands the religion, that way they are being treated properly."