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THE AMERICAN DOCTOR, INCLUDING THE VA DOCTOR, NOW

HAS FOREIGN ROOTS -- The Norman Rockwell-Marcus Welby

image of the American doctor, an avuncular white man

often in a bow tie, is rapidly disappearing.

 

 

Story here... http://www.mercurynews.
com/news/ci_6055899?nclick_check=1

Story below:

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The American doctor now has foreign roots

By David Brown
Washington Post

WASHINGTON - The six members of Medical Team 4 have a lot in common. Each wears a white coat, has a stethoscope for a necklace and has stayed up late this week. They can all start an IV and work up a solitary lung nodule.

They share something less obvious, too. With one exception, none has a grandparent born in the United States.

Med 4 at the Veterans Affairs Medical Center in northwest Washington is the new face of American medicine. Its members happen to come from Georgetown and George Washington universities, but the team is indistinguishable from similar groups of young doctors and doctors-to-be at many of the country's 125 medical schools.

In the past 15 years, U.S. medicine has seen a huge influx of first- and second-generation immigrants. It follows and augments a different demographic trend that began 30 years ago with the acceptance of increasing numbers of women into medical schools. As a result of that earlier revolutionary change, half of new practitioners today are women.

The Norman Rockwell-Marcus Welby image of the American doctor - an avuncular white man, often in a bow tie - is rapidly disappearing.

Numbers shift

From 1980 to 2004, the fraction of medical school graduates describing themselves as white fell from 85 percent to 64 percent. In that same period, the percentage of Asians increased from 3 percent to 20 percent, with Indians and Chinese the two biggest ethnic groups.

Counted in the "white" category, moreover, are a moderate number of ethnic Persians whose families fled the 1979 Iranian revolution, and a smaller number of more recent arrivals from Eastern Europe and the former Soviet Union. In the "black" category is an unknown number of graduates whose families recently arrived from Africa, predominantly Nigerians and Ghanaians.

"We are seeing more and more kids of foreign-born parents, especially in the last eight to 10 years. I don't think there is any doubt about it," said Milford Foxwell, a physician and dean of admissions at the University of Maryland School of Medicine. In his 18 years on the job, he has reviewed about 75,000 applications.

Reasons behind change

Many forces are sketching this changing portrait of the American medical student. They include a general increase in immigration, a large influx of foreigners trained in scientific and technical professions, and a culture of educational achievement in communities of newly arrived immigrants that prepares their children for the competition and rigors of medical school.

How - or whether - this trend will change the practice of medicine in this country is uncertain.

There is a small amount of evidence that a diverse student body may be more attuned to disparities in medical care than a homogeneous one. A study published in 2004 found that black, Latino and Asian medical students (in descending order) are more likely than white ones to think that U.S. medicine often "treats people unfairly" based on race, ethnicity, insurance status, income or ability to speak English.

In general, though, few are eager to touch on the implications of the new ethnic mix in medical schools. Officials at institutions as different as the University of Vermont and Howard University declined multiple requests to discuss, even anecdotally, the evolution of their student makeup.

In the case of Med 4, its roots stretch to India (two students), Bangladesh (one), Austria (one) and Russia (one). The sole team member without a family narrative of recent arrival is African-American.

The door to the team's office at the Veterans Affairs hospital humorously telegraphs an awareness that the people inside the windowless warren of cubicles, computers, backpacks and water bottles are not quite a random sample of America. Someone has taped on it a page from the supermarket tabloid Weekly World News.

"Your doctor could be an alien! They're working undercover!" shouts the headline. Under it is a photo of four masked-and-gowned physicians - one with dark space-creature eyes - gathered around a supine patient.

Community expectations

Team 4's international coloration includes even its senior physician, Divya Shroff, an assistant professor of medicine at George Washington.

Her father emigrated from India to study chemical engineering in graduate school, returned to India to marry, then came back to the United States with his bride. Shroff and her younger brother and sister grew up in the Chicago suburbs but spent three years in New Delhi in the 1980s. Her brother also is a physician, her sister an investment banker.

"We were never forced into medicine," she said recently in her office at the Veterans Affairs hospital. "But in the Indian community in Chicago, everyone was a professional. Everyone was a doctor or an engineer."

She went from high school into a program at the University of Missouri where students got both a bachelor's degree and a medical degree in six years. Of the 10 people in her group, "maybe one was Caucasian," she recalled. The majority were Indians.

Although the Association of American Medical Colleges asks all medical school applicants and matriculants to describe their race and ethnicity in general terms, there is little published information about national background and none about family history. Anecdotes, however, suggest that immigrants' children are more likely to attend schools on both coasts.

S. Balasubramaniam, a surgeon at Charles R. Drew University of Medicine and Science in Los Angeles who emigrated from India in 1971, recently queried 50 medical schools and calculated that 12 percent of the class that entered in 2006 is of Indian heritage. The highest percentages are in California, Texas, New York, New Jersey and New England.

Na Shen, 25, a second-year medical student at Maryland who was born in Shanghai, calculated that 12 percent of her school's students are from China, Taiwan, South Korea and Japan, and 1 percent from Southeast Asia. When South Asians are included, the Asian portion of the school rises to 21 percent.

In contrast, University of Kansas medical school students since 1996 have consistently run about 10 percent "either born overseas or of parents who were born overseas," said Glendon Cox, the vice dean.

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Larry Scott  --