[Senate Hearing 118-199]
[From the U.S. Government Publishing Office]








                                                        S. Hrg. 118-199

                     ROUNDTABLE: HOW CAN WE IMPROVE
                     HEALTH WORKFORCE DIVERSITY AND
                   ADDRESS SHORTAGES? A CONVERSATION
                  WITH HISTORICALLY BLACK COLLEGE AND
                    UNIVERSITY LEADERS AND STUDENTS

=======================================================================

                             FIELD HEARING

                                 OF THE

                    COMMITTEE ON HEALTH, EDUCATION,
                          LABOR, AND PENSIONS

                          UNITED STATES SENATE

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             FIRST SESSION

                                   ON

    FIELD HEARING HELD IN MOREHOUSE SCHOOL OF MEDICINE, ATLANTA, GA

                               __________

                              MAY 12, 2023

                               __________

 Printed for the use of the Committee on Health, Education, Labor, and 
                                Pensions








    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]









        Available via the World Wide Web: http://www.govinfo.gov   
        
                                   _______
                                   
                 U.S. GOVERNMENT PUBLISHING OFFICE 
                 
54-477 PDF                   WASHINGTON : 2024 
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
          COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS

                 BERNIE SANDERS (I), Vermont, Chairman
PATTY MURRAY, Washington             BILL CASSIDY, M.D., Louisiana, 
ROBERT P. CASEY, JR., Pennsylvania       Ranking Member
TAMMY BALDWIN, Wisconsin             RAND PAUL, Kentucky
CHRISTOPHER S. MURPHY, Connecticut   SUSAN M. COLLINS, Maine
TIM KAINE, Virginia                  LISA MURKOWSKI, Alaska
MAGGIE HASSAN, New Hampshire         MIKE BRAUN, Indiana
TINA SMITH, Minnesota                ROGER MARSHALL, M.D., Kansas
BEN RAY LUJAN, New Mexico            MITT ROMNEY, Utah
JOHN HICKENLOOPER, Colorado          TOMMY TUBERVILLE, Alabama
ED MARKEY, Massachusetts             MARKWAYNE MULLIN, Oklahoma
                                     TED BUDD, North Carolina

                Warren Gunnels, Majority Staff Director
              Bill Dauster, Majority Deputy Staff Director
                Amanda Lincoln, Minority Staff Director
           Danielle Janowski, Minority Deputy Staff Director  
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
                            C O N T E N T S

                              ----------                              

                               STATEMENTS

                          FRIDAY, MAY 12, 2023

                                                                   Page

                           Committee Members

Sanders, Hon. Bernie, Chairman, Committee on Health, Education, 
  Labor, and Pensions, Opening statement.........................     1

                           Witnesses--Panel I

Rice, Valerie Montgomery, M.D., FACOG, President and CEO, 
  Morehouse School of Medicine, Atlanta, GA......................     3
    Prepared statement...........................................     6
South-Paul, Jeannette E., M.D., DHL(Hon), FAAFP, Executive Vice 
  President and Provost, Meharry Medical College, Nashville, TN..     8
    Prepared statement...........................................    11
Mighty, Hugh E., M.D., MBA, FACOG, Senior Vice President for 
  Health Affairs, Howard University, Washington, DC..............    15
    Prepared statement...........................................    17
Carlisle, David M., M.D., Ph.D., M.P.H., President and CEO, 
  Charles R. Drew University, Los Angeles, CA....................    18
    Prepared statement...........................................    20
Skorton, David J., M.D., President and CEO, Association of 
  American Medical Colleges, Washington, DC......................    20
    Prepared statement...........................................    23
Cook, Samuel, M.D., Resident, Morehouse School of Medicine, 
  Atlanta, GA....................................................    28
    Prepared statement...........................................    30
Randolph, Sonya, Student, Morehouse School of Medicine, Atlanta, 
  GA.............................................................    31
    Prepared statement...........................................    33
Joyner, Jamil, Student, Morehouse School of Medicine, Atlanta, GA    33
    Prepared statement...........................................    36

                          ADDITIONAL MATERIAL

Statements, articles, publications, letters, etc.
Rice, Valerie Montgomery:
    Opening Remarks..............................................    46
Sanders, Hon. Bernie:
    American Association of Colleges of Osteopathic Medicine, 
      Statement for the Record...................................    46
    American Federation of Teachers..............................    50
    Federation of Associations of Schools of the Health 
      Professions................................................    51
    David K. Wilson, President, Morgan State University, 
      Statement for the Record...................................    52

 
                     ROUNDTABLE: HOW CAN WE IMPROVE 
                     HEALTH WORKFORCE DIVERSITY AND 
                   ADDRESS SHORTAGES? A CONVERSATION 
                  WITH HISTORICALLY BLACK COLLEGE AND 
                    UNIVERSITY LEADERS AND STUDENTS 

                              ----------                              


                          Friday, May 12, 2023

                                       U.S. Senate,
       Committee on Health, Education, Labor, and Pensions,
                                                    Washington, DC.

    The Committee met, pursuant to notice, at 10:08 a.m., in 
Morehouse School of Medicine, 720 Westview Drive, Building A, 
Atlanta, Georgia, Hon. Bernard Sanders, Chairman of the 
Committee, presiding.

    Present: Senator Sanders [presiding].

                  OPENING STATEMENT OF SENATOR SANDERS

    The Chair. The Senate Committee on Health, Education, 
Labor, and Pensions will come to order. This is what we do in 
Washington. I don't know what it means but----

    [Laughter.]

    The Chair.

    [Technical problems]--and a couple of months ago, Dr. Rice 
was in my office, and we chatted about these issues. And I 
said, let's see if we can do something about it. And this is 
the very first field hearing that the Committee has held, and 
this is an official hearing. The transcript will be part of the 
Congressional Record.

    Most importantly, I hope that what I and other Committee 
Members will learn from this hearing will be translated into 
law and will have an impact on how we provide health care to 
minority communities all across this country.

    I don't have--and I want to give a special thanks to 
everybody who is here this morning, but especially to the young 
physicians and those of you who will soon become physicians. 
You are the heroes and heroines of this moment. You are 
devoting your lives to taking care of people who are in need, 
in a very difficult moment for our Country.

    I thank you very much for your entering the profession and 
all of those who are mentoring you as you proceed. I don't have 
to tell anybody up here, this is not a group of people I have 
to explain this to, our current health care system is broken, 
correct? What does that mean? It means that in the richest 
country in the history of the world, we should lead the world. 
People should look to us. In terms of what quality, accessible 
health care is, we are behind many, many other countries.

    In America today, 85 million Americans are uninsured or 
underinsured. We just went through a pandemic when millions of 
people lost their jobs and when they lost their jobs, what else 
did they lose? They lost their health care in the midst of a 
pandemic.

    Meanwhile, we spend, unbelievably $13,000 on health care 
for every man, woman, and child--$13,000. Family of four, 
$52,000. Who can afford that? It is unsustainable. It is twice 
as much per capita as the people of any other country spend.

    We pay the highest prices in the world for prescription 
drugs. And what physicians here know, and younger physicians 
will learn, you are going to write out a script, and your 
patient will not be able to afford it.

    How insane is that? But what happens to the person who 
can't afford the medicine? They get sick or they end up in the 
emergency room at a very expensive cost. Half a million 
Americans go bankrupt in this country because of medically 
related issues. You end up in a hospital, you are $50,000 in 
debt. If you make $30,000 a year, how are you going to pay 
that? You can't.

    Then your credit is destroyed. Your family's life is 
destroyed. We don't talk about it very much. 60,000 Americans 
die every single year because they don't get to a doctor on 
time. I applaud the doctors all across this country.

    How many people walk into their offices very, very sick, 
why didn't you come in when you first felt your symptoms? What 
is the answer? Well, I couldn't afford my co-payment. I 
couldn't afford--I was uninsured. I didn't want charity. Some 
of those people don't make it. So, you are entering a system 
which is broken, and I know that you will work as hard as you 
can every day to treat your patients.

    But I hope we will work together to transform this system. 
Health care is a human right, not a privilege. Then on top of 
all of that, we are just seeing a particular issue today. 
Unbelievable. We spend $13,000, for every man, woman, and 
child. We don't have enough doctors. That is a problem that has 
gone on for years.

    COVID exacerbated that problem. We could talk about that, 
what COVID did to the workforce. We don't have enough nurses. 
We don't have enough dentists. Dental care is a huge issue. We 
don't talk enough about, people can't afford to get to a 
dentist. There is, and the young doctors here will learn this 
soon enough if you don't know it now, there is a major mental 
health crisis in this country, again, exacerbated by COVID, and 
many other things.

    Do we have enough counselors, psychologists, psychiatrists? 
Do we have enough people trained to deal with the terrible 
problem of addiction? No, we don't. But we have to transform 
all of it.

    The midst of all of that, the problem is much worse in the 
African American community, in the Latino community, in the 
Native-American. Unbelievable--unbelievably, today, with a 
population where African Americans are about 13 percent of our 
population.

    About 5 percent of our doctors are black. And even fewer, I 
think, percentage wise are dentists. That is why we are here. 
So what our Committee hopes that I am not making any promise to 
anybody because we got a tough political climate in Washington, 
DC, as you know. You know, in the midst of this, some geniuses 
there want to throw millions of people off the healthcare they 
have, not expand it.

    We are going to do our best to grow the healthcare 
workforce and put a special focus on the need for more black 
doctors, nurses, psychologists, dentists, etcetera. So that is 
why we are here today. And I am just really very thankful to 
Dr. Rice and to everybody here. You know, I am--I don't have to 
tell anybody here how an extraordinary job the HBCUs are doing, 
colleges, the medical school. And it is a story worth telling a 
million times.

    Thank you for what you do. We look forward to working with 
you in the years to come, in the months to come, in the weeks 
to come.

    Again, thank you all very much for being here today.

    Okay, I think we are currently--mic over to Dr. Rice--Dr. 
Rice, thank you very much.

 STATEMENT OF VALERIE MONTGOMERY RICE, M.D., FACOG, PRESIDENT 
       AND CEO, MOREHOUSE SCHOOL OF MEDICINE, ATLANTA, GA

    Dr. Rice. Thank you so much, Senator Sanders. Chairman 
Sanders, we are extremely proud of our accomplishments and 
track record.

    Morehouse School of Medicine and the other HBCU medical 
schools have consistently been ranked at the top or near the 
top of all medical schools and social missions. Our 
institutions have produced the Secretary of Department of 
Health and Human Services, a Director of the CDC's Centers for 
Disease Control and Prevention, and two U.S. Surgeon General.

    Just as importantly, though, numerous physicians and other 
health care professionals who disproportionately and proudly 
serve people of color in medically underserved communities. We 
are doing what needs to be done for the American people in a 
way that is incomparable to other schools.

    Our mission, though, to train culturally competent 
providers willing and eager to serve their community comes at a 
cost. HBCU medical schools do not enjoy the institutional 
financial resources, academic affiliations, and endowments of 
other medical schools.

    But we accept that as a part of our mission, but it leads 
to be disproportionately focused on us securing support from 
Federal programs that are or should be designed to level the 
playing field, and our ability to train health care 
professionals and strengthen our institutions.

    We continue to need your Committee's help and leadership to 
continue to position us to make an outsized contribution to 
improving the health status of minorities and all Americans, 
which is clearly a national priority.

    In recent years, Congress responded to health workforce 
challenges by increasing the number of federally supported 
graduate medical education, GME positions, through Medicare and 
the Teaching Health Centers Program.

    Medical schools in general are grateful for the additional 
positions because they support training opportunities against 
the backdrop of a national physician shortage. Unfortunately, 
though, relative few of these additional GME programs have 
accrued to teaching hospitals or health centers affiliated with 
historically black medical schools.

    If indeed it is a priority to increase the number of 
physicians and communities of color in medically underserved 
communities, there should be specific provisions in each of 
these programs that direct a meaningful portion of these GME 
slots to teach in hospitals and health centers affiliated with 
our HBCU medical--[technical problems].

    We are asking for priority consideration of such hospitals 
and health centers who align with the goals of the GME programs 
and ensure workforce shortages are being appropriately 
addressed in medically underserved communities throughout the 
U.S.

    Representative Terri Sewell of Alabama and Brian 
Fitzpatrick of Pennsylvania have introduced the Resident 
Physician Shortage Reduction Act of 2023, H.R. 2389, which 
would dedicate additional GME positions to teach in hospitals 
affiliated with HBCU medical schools.

    We believe this bill is a good model for the Senate's 
effort on Medicare and teaching health center, GME legislation. 
However, Mr. Chairman, we have not just been sitting idle 
waiting for others to work on our behalf. We have been creating 
partnerships like the More In Common Alliance, focused on 
addressing diversity and the health care provider shortage.

    I would like to take a few moments of my time to describe 
the Morehouse School of Medicine's partnership with 
CommonSpirit Health. This 10-year partnership is the first 
nationwide initiative between two of the country's leading 
health organizations to address the underlying causes of health 
inequities, including under-representation of black clinicians.

    This partnership lays the foundations for patients to have 
more access to black clinicians, and for black medical students 
and graduates to gain community-based experience. It will allow 
Morehouse School of Medicine to expand its enrollment, allow us 
to expand our pipeline initiatives.

    CommonSpirit Health serves some of the most diverse 
communities in this country, and cares for more Medicaid 
patients than any other health system in the United States.

    Leveraging our combined 100-year experience, we believe 
that by opening up five regional medical campuses across the 
country at CommonSpirit sites, and ten graduate medical 
education programs with no less than two specialties, one being 
primary care and another being a specialty area, we believe 
that we can create a pipeline that creates a pathway from 
students from those diverse communities that go back and serve 
in their communities.

    My colleagues--and I have to add, this was seeded by $115 
million gift from CommonSpirit Health to Morehouse School of 
Medicine.

    My colleagues will discuss the importance of other Federal 
programs at the Health Resources Services Administration, HRSA, 
and the National Institutes of Health that will support our 
pipeline programs and research infrastructure at our other 
schools.

    Once again, we are grateful to your Committee for taking 
the time and making the effort to join us today to examine 
these critical issues. Thank you very much.

    [The prepared statement of Dr. Rice follows:]
             prepared statement of valerie montgomery rice
    Chairman Sanders, we are extremely proud of our accomplishments and 
track record. Morehouse School of Medicine and the other HBCU medical 
schools have consistently been ranked at the top or near the top of all 
medical schools in social mission. Our institutions have produced a 
Secretary of the Department of Health and Human Services, a Director of 
the Centers for Disease Control and Prevention, and two U.S. Surgeon 
Generals--and just as importantly, numerous physicians and other health 
care providers who disproportionately and proudly serve people of color 
in medically underserved communities. We are doing what needs to be 
done for the American people in a way that is incomparable to other 
schools.

    Our mission to train culturally competent providers willing and 
eager to serve their community comes at a cost. HBCU medical schools do 
not enjoy the institutional wherewithal, financial resources, academic 
affiliations, and endowments of other medical schools. We accept that 
as part of our mission, but it leads us to be disproportionately 
focused on securing support from Federal programs that are--or should 
be--designed to level the playing field in our ability to train health 
care professionals and strengthen our institutions. We need your 
Committee's help and leadership to continue to position us to make an 
outsized contribution to improving the health status of minorities and 
all Americans--which is clearly a national priority.

    In recent years, Congress has responded to health workforce 
challenges by increasing the number of federally supported graduate 
medical education (GME) positions through Medicare and the Teaching 
Health Centers program. Medical schools in general are grateful for 
these additional positions because they support training opportunities 
against a backdrop of a national physician shortage. Unfortunately, 
relatively few of these additional GME positions have accrued to 
teaching hospitals or health centers affiliated with Historically Black 
Medical Schools.

    If indeed it is a priority to increase the number of physicians in 
communities of color and medically underserved communities, there 
should be specific provisions in each of these programs that direct a 
meaningful portion of these GME slots to teaching hospitals and health 
centers affiliated with our HBCU medical schools. Priority 
consideration of such hospitals and health centers will align with the 
goals of the GME programs and ensure health workforce shortages are 
being appropriately addressed in medically underserved communities 
throughout the U.S.

    Representatives Terri Sewell (AL) and Brian Fitzpatrick (PA) have 
introduced the Resident Physician Shortage Reduction Act of 2023 (H.R. 
2389) which would dedicate additional GME positions to teaching 
hospitals affiliated with HBCU medical schools, and we believe this 
bill is a good model for the Senate's efforts on Medicare and Teaching 
Health Center GME legislation.

    Mr. Chairman, I would like to take a few moments to describe 
Morehouse School of Medicine's partnership with CommonSpirit Health 
(CSH). This 10-year partnership is the first nationwide initiative 
between two of the country's leading health organizations to address 
the underlying causes of health inequity, including underrepresentation 
of Black clinicians. The partnership will lay the foundation for 
patients to have more access to Black clinicians and for Black medical 
students and graduates to gain community-based experience.

    Additionally, it will allow MSM to expand its enrollment--
increasing the pipeline of students recruited from underserved and 
rural communities. As one of the largest nonprofit health systems in 
the Nation, CSH serves some of the most diverse communities in the 
country and cares for more Medicaid patients than any other health 
system in the United States. Together, our two organizations will 
leverage a combined 100 years of experience to address health 
disparities in underserved communities and continue to elevate care for 
vulnerable patients.

    One of the greatest impacts of this partnership is the 
transformation of career opportunities for MSM students within the 
CommonSpirit network of medical facilities. Five remote medical 
campuses will launch as a part of the Morehouse School of Medicine and 
CommonSpirit partnership, enabling third-and fourth year medical and 
second year physician assistant students to complete their respective 
degrees while working in settings that reflect MSM and CommonSpirit's 
commitment to educating students from underserved and rural 
communities.

    Critical to the success of this partnership is the availability and 
targeting of graduate medical education positions to this effort. 
Through this partnership, we are doing our part in the national effort 
to improve the health status of minority Americans. We need your help 
in making this effort an ongoing success.

    My colleagues will discuss the importance of other Federal programs 
at the Health Resources and Services Administration (HRSA) and the 
National Institutes of Health (NIH) that provide institutional support, 
pipeline programs, and research infrastructure at our schools--and are 
critical to our success.

    In my opening remarks, I made reference to our partnership with 
Bloomberg Philanthropies that has been so meaningful to reduce the debt 
burden our students take on to become a physician. More detailed 
information is submitted below for the record.

    Once again, we are very grateful that you and the Committee are 
taking the time and making the effort to join us today to examine these 
critical issues.

    IMPACT of Bloomberg Partnership with Morehouse School of Medicine 
to be submitted for the hearing record:

          Black doctors save more Black lives. Black patients 
        overall have better health outcomes when they are treated by 
        Black doctors. The data overwhelmingly supports this, and 
        better health leads to fewer medical bills and more economic 
        opportunity.

          Medical school debt is a big factor in future Black 
        doctors not getting their degrees or feeling that it's 
        necessary to work outside of their communities and desired 
        specialties when they graduate.

          Bloomberg Philanthropies' $26.5-million investment in 
        the students of Morehouse School of Medicine helps lift the 
        crushing burden of student debt and empowers graduates to work 
        in underserved areas.

          Morehouse School of Medicine has currently awarded 
        almost $19 million in scholarship support from the Bloomberg 
        award.

          The Bloomberg Scholarship program has worked in 
        lowering M.D. student debt. From the two M.D. classes to 
        graduate with the Bloomberg Scholarship, the average student 
        debt was reduced $59K per student ($250K to $191K) for the 
        class of 2021 and $64K per student($250K to $186K) for the 
        class of 2022.

          The Mobile Vaccination component of the Bloomberg 
        Initiative has been instrumental in 2 aspects. The funds 
        allowed for MSM to better serve and protect the community 
        during the Covid pandemic and enhance the training of all MSM 
        students in providing care to the underserved.

          Since receipt of the funds, there has been an 
        emphasis to vaccinate the following communities, 65 and over, 
        Black and Hispanic, and rural communities. MSM used its funding 
        support to extend the institution's outreach to include 
        influenza vaccinations and health screenings. These efforts 
        were further enhanced with the purchase of two sprinters that 
        have been used to provide care and vaccinations to rural 
        communities and provide services in diverse communities in 
        North, Southeast and Southwest Georgia. As a result, the 
        following was achieved:

          12000+ vaccinations

          1000+ health screenings for chronic disease

          175 influenza vaccination

          90+ zip codes served, throughout the State of GA

          Regarding the students, all disciplines have been 
        exposed to the needs of both urban and rural underserved 
        communities. This has allowed development of their clinical 
        skills, educating the community regarding the covid virus, the 
        impact on chronic illness, and in understanding the importance 
        of primary care for the underserved. Many of the outcomes 
        highlighted were the results of students committed to advancing 
        health equity through our student-led clinic, the MSM HEAL 
        Clinic (Health Equity for All Lives) and our mobile team. 
        Additional impact:

          154 students trained to provide POC (point-of-care) 
        health screenings

          100+ students trained to provide covid and flu 
        vaccinations
                                 ______
                                 
    The Chair. Thank you. Thank you, Dr. Rice. Our next 
panelist is Dr. Jeannette South-Paul, Provost, the Meharry 
Medical College. Dr. South-Paul.

 STATEMENT OF JEANNETTE E. SOUTH-PAUL, M.D., DHL(HON), FAAFP, 
EXECUTIVE VICE PRESIDENT AND PROVOST, MEHARRY MEDICAL COLLEGE, 
                         NASHVILLE, TN

    Dr. South-Paul. Thank you so much, Chairman Sanders, for 
inviting the Meharry Medical College to be a part of this 
Committee.

    Thank you, Dr. Montgomery Rice and Morehouse School of 
Medicine for welcoming us here. I am Jeannette South-Paul, the 
Executive Vice President and Provost at Meharry, and I am 
honored to be here today to talk about these critical issues.

    As an academic family physician who has practiced for more 
than 22 years in the U.S. Army, and then in corporate health 
care prior to coming to Meharry, and who has been an active 
volunteer leader of minority faculty leadership programs 
sponsored by the Association of American Medical Colleges for 
more than 30 years, I recognize the value of intertwining our 
academic mission with service to the most vulnerable 
communities.

    These experiences have informed my comments that I will 
share with you today. The health care workforce shortage in the 
United States is a multifaceted problem with significant 
implications for our Nation's health and well-being.

    Our recent and lingering pandemic, declining life 
expectancy for the first time in our lifetimes, burgeoning 
mental health crisis and health care workforce, the struggle to 
stay well and engaged in the middle of these other crises, 
present a call to action for our leaders in Government, in 
health care, and education, and in our--and in corporate 
America to prioritize our most medically vulnerable.

    The physician workforce continues to lag behind the U.S. 
population in terms of race and ethnic diversity, as you have 
heard from our previous speakers. And so, we have many more 
than a third of the population defines themselves as 
underrepresented minorities, but fewer than 7 percent of those 
are physicians, and fewer than 5 percent are those who make up 
other academic faculty.

    These numbers are most acute amongst primary care, family 
physicians, pediatricians, general internists, and OB-GYNs, as 
well as psychiatrists and other mental health providers.

    High quality primary care is a critical foundation for 
preserving the health of our Nation and cannot be achieved 
without investment in those institutions most likely to train 
primary care physicians, so we stand at a critical juncture of 
our Nation's health care landscape.

    At Meharry Medical College, we are working diligently to 
address the health care workforce shortage through a variety of 
innovative programs and initiatives, but we need the unwavering 
support of Congress to carry out this mission. To that end, I 
would like to highlight some of the policy actions that we 
would like Congress to take to support not only Meharry Medical 
College, but our sister HBCU medical schools.

    As part of our comprehensive approach to addressing this 
workforce shortage, and to improve health outcomes in our most 
medically underserved communities, let's consider enhancing the 
infrastructure of our institutions.

    As my colleagues, Dr. James Hildreth, the President of 
Meharry, testified before your full Committee in February, a 
dedicated allocation of $5 billion for improving research and 
development infrastructure for academic health sciences centers 
at historically black graduate institutions and other minority 
serving institutions would represent a monumental commitment by 
bolstering the capabilities of these institutions to conduct 
cutting edge research, develop innovative solutions to pressing 
health issues, and train the next generation of health care 
leaders.

    We recommend increasing that funding with a focus on 
supporting minority serving institutions and their faculty, for 
translational research which is essential for bridging the gaps 
between scientific discoveries and their practical applications 
in health care settings. This investment will enable us to 
advance our understanding of the causes and consequences of 
these health care disparities, and then to develop the targeted 
interventions.

    We know pipeline programs play a crucial role in attracting 
and retaining students from diverse backgrounds who are 
interested in pursuing careers in health care and increasing 
funding and support for pipeline programs such as summer 
education enrichment programs, mentorship initiatives, and 
scholarship opportunities will expose these young people to 
health care careers at an early age.

    Programs such as Meharry's GOALS Program, Go Out and Love 
Science, events in collaboration with the Ascension Foundation 
and the Medical School for Early Acceptance Program, a 
collaboration between Middle Tennessee State University's 
College of Basic and Applied Sciences and Meharry Medical 
College, are examples of innovative initiatives aimed at 
increasing the number of primary care physicians serving 
medically underserved populations in rural Tennessee.

    Federally qualified health centers, something that is very 
close to my heart because I helped to form the first one in a 
major teaching institution in western Pennsylvania, they play a 
vital role in providing access to quality interdisciplinary 
health care for underserved populations.

    We recommend updating Federal regulations to allow academic 
institutions, such as HBCU medical schools, to sponsor FQHCs, 
which can create vulnerable interprofessional health workforce 
training opportunities for students and trainees in physical, 
oral, and behavioral health in the same space so that it is one 
stop shopping for the most vulnerable populations--[technical 
problems]--continue to keep--trying to keep on time.

    Another priority should be building a pipeline for demand--
in demand discipline, such as primary care, behavioral health, 
maternity care, and women's health that our OB-GYN family 
medicine colleagues are so embedded and involved with. And 
general practice and pediatric dentistry.

    We know the need for maternity care services, which are 
essential for the health of women and newborns, and it is 
incredibly urgent, particularly in medically underserved 
communities. This shortage in urban and rural communities can 
lead to increased health risks and complications for the people 
who anchor our families, women and their children.

    It is particularly disturbing in this country where black 
women in the United States are more than three times more 
likely to die in pregnancy, childbirth, and the postpartum a 
year than white women, a gap that persists in spite of income 
or education.

    It is also important to highlight the critical need to 
invest in mental and behavioral health practitioners and 
research. The current workforce in the field is insufficient to 
meet the growing demand, particularly in our communities, where 
the impact of mental health disparities is so profound.

    It is not just about numbers of physicians educated in 
minority serving institutions, but it is about offering 
sensitivity and culturally competent care that understands and 
respects the unique experiences of individuals in these 
communities. GME programs, such as residencies and fellowships, 
are crucial for preparing our health professionals to serve in 
urban and rural communities.

    This is why Meharry Medical College applauds the bipartisan 
Resident Physician Shortage Reduction Act of 2023, as you have 
heard, H.R. 2389 introduced in the House of Representatives by 
Representative Terri Sewell, which adds 14,000 new GME 
positions, and amends and expands the policy to give special 
consideration to hospitals, the trainers who are shared 
graduates from historically black medical colleges and minority 
serving institutions.

    In addition, the Veterans Affairs Graduate Medical 
Education Program offers an unparalleled training ground for 
physicians, behavioral health professionals, and other 
associated health graduates, providing them with the 
opportunity to serve our Nation's veterans, which I am one, and 
of which I have two sons who are serving, while gaining 
valuable experience and a wide array of specialists.

    Finally, we must address rural health disparities in our 
Nation, a critical aspect of overall public health and 
unfortunately is often overlooked.

    I will include some of my comments to be respectful of time 
and say that we are facing significant challenges in training 
and retaining a diverse health workforce, and we are looking 
for support for those us institutions who have demonstrated our 
ability to serve and to train the next gen--not only today but 
the next generation of professionals.

    The journey is long, the work is significant, but we can 
ensure a future where quality health care is accessible and 
equitable overall, regardless of race, ethnicity, or geographic 
location. Thank you for your time, Senator Sanders.

    [The prepared statement of Dr. South-Paul follows:]
             prepared statement of jeannette e. south-paul
    Chairman, Ranking Member, and distinguished Members of the Senate 
HELP Committee, thank you for inviting Meharry Medical College to be a 
part of this Committee field hearing to discuss the vital role 
Historically Black Colleges and Universities (HBCUs) play in addressing 
the healthcare workforce shortages in the United States. My name is Dr. 
Jeannette South-Paul, Executive Vice President and Provost of Meharry 
Medical College, and I am honored to be here today as a representative 
of our institution along with my fellow HBCU medical school colleagues.

    As you may recall my colleague, Dr. James E. K. Hildreth, President 
of Meharry Medical College, testified before this Committee in February 
2023, highlighting the critical role HBCUs play in addressing the 
healthcare workforce shortage and the need for additional resources and 
support to enhance our ability to train the next generation of 
healthcare professionals. Today, I am here to provide an update on our 
progress and to present specific policy recommendations for your 
consideration as you develop future legislation aimed at addressing 
this pressing issue.

    The healthcare workforce shortage in the United States is a 
multifaceted problem with significant implications for our Nation's 
health and well-being. The shortage is particularly acute in rural and 
medically underserved communities, where access to quality healthcare 
is often limited. HBCU medical schools are uniquely positioned to 
address this shortage, given our long-standing commitment to training 
healthcare professionals from diverse backgrounds who are dedicated to 
serving in these underserved areas.

    Our recent and lingering pandemic, declining life expectancy for 
the first time in our lifetimes, burgeoning mental health crisis, and 
healthcare workforce that has struggled to stay well and engaged in the 
middle of these crises present a call to action for our leaders in 
government, policymakers, health care and educational institutions, and 
industry leaders to prioritize our most medically vulnerable. The 
physician workforce continues to lag behind the U.S. population in 
terms of racial and ethnic diversity with only 10.8 percent of active 
physicians identified as an underrepresented minority (URM) and just 
6.8 percent of academic faculty identified as URMs, while URMs make up 
33 percent of the U.S. population. These numbers are most acute among 
primary care (family physicians, pediatricians, general internists, and 
obstetrician/gynecologists) and psychiatrists and other mental health 
clinicians. High quality primary care is a critical foundation for 
preserving the health of our Nation and cannot be achieved without 
investment in those institutions most likely to train primary care 
physicians and clinicians (Jetty A, Hyppolite J, et al. 
Underrepresented Minority Family Physicians More Likely to Care for 
Vulnerable Populations. J Am Board Fam Med 2022;35:223--224.; Milbank 
Fund February 2023 Report. The Health of U.S. Primary Care: A Baseline 
Scorecard Tracking Support for High-Quality Primary Care. The Health of 
U.S. Primary Care: A Baseline Scorecard Tracking Support for High-
Quality Primary Care (aafp.org)).

    The data are equally disturbing with respect to the representation 
of dentists with numerous communities having no one serving their oral 
health needs. Studies have demonstrated that physicians and dentists 
identifying as URM are more likely to practice in medically underserved 
communities (both urban and rural) and provide care to people 
experiencing profound health and healthcare disparities.

    At Meharry Medical College, we are working diligently to address 
the healthcare workforce pipeline shortage through a variety of 
innovative programs and initiatives. These efforts include:

          Enhancing our medical and dental education programs 
        to ensure that our students are well-prepared to serve in urban 
        and rural medically underserved communities upon graduation.

          Expanding our research enterprise to focus on health 
        disparities and minority health issues, which are critical 
        components of our mission as an HBCU medical school.

          Strengthening our partnerships with local healthcare 
        systems and other academic institutions to provide our students 
        with a wide range of clinical training opportunities and 
        resources.

          Developing and implementing pipeline programs to 
        recruit and support students from underrepresented backgrounds 
        who are interested in pursuing careers in healthcare.

    As we continue to refine and expand our programs, we believe that 
targeted policy interventions can further enhance our ability to 
address the healthcare workforce shortage and improve health outcomes 
in underserved communities. To this end, we propose the following 
policy recommendations for your consideration:

          I. Significant and meaningful investments in infrastructure. 
        As part of our comprehensive approach to addressing the 
        healthcare workforce shortage and improving health outcomes in 
        medically underserved communities, we must consider the 
        significant need for enhanced infrastructure at our 
        institutions. As Dr. Hildreth testified in February, a 
        dedicated allocation of $5 billion for improving research and 
        development infrastructure for academic health science centers 
        at Historically Black Graduate Institutions (HBGIs) and other 
        minority-serving institutions would represent a monumental 
        commitment to bolstering the capabilities of these institutions 
        to conduct cutting-edge research, develop innovative solutions 
        to pressing health issues, and train the next generation of 
        healthcare leaders. These funds would be used to modernize 
        laboratories, improve technology, and enhance other critical 
        facilities. By doing so, we could foster an environment that 
        not only supports current research endeavors but also fuels 
        future innovation. This improved infrastructure would 
        undeniably have a direct impact on the quality of education and 
        training we provide and allow us to expand programs that we 
        know help grow and diversify the healthcare workforce. For 
        example:

            Funding for Translational Research Programs. Translational 
        research is essential for bridging the gap between scientific 
        discoveries and their practical application in healthcare 
        settings. Research that targets conditions that 
        disproportionately affect low and middle income and minority 
        communities and can take those discoveries from the bench to 
        the bedside to the community as rapidly as possible is 
        critical. We recommend increasing funding for these 
        translational research programs, with a focus on supporting 
        minority serving institutions and their faculty. This 
        investment will enable us to advance our understanding of the 
        causes and consequences of health disparities and to develop 
        targeted interventions that improve health outcomes for 
        minority populations.

            Increase and accelerate investments in HRSA Title VII 
        workforce diversity programs. Pipeline programs play a crucial 
        role in attracting and retaining students from diverse 
        backgrounds who are interested in pursuing careers in 
        healthcare. We recommend increasing funding and support for 
        pipeline programs, such as summer enrichment programs, 
        mentorship initiatives, and scholarship opportunities, which 
        target underrepresented students and expose them to healthcare 
        careers at an early age. Programs such as Meharry's #GOALS (Go 
        Out and Love Science) events, in collaboration with the 
        Ascension Foundation, exemplify our dedication to fostering 
        interest and competency in the medical sciences among young 
        learners. These community-focused initiatives provide hands-on, 
        engaging educational experiences that inspire the next 
        generation of healthcare professionals and underscore the 
        importance of scientific exploration in improving health 
        outcomes. The Medical School Early Acceptance Program (MSEAP), 
        a collaboration between Middle Tennessee State University's 
        College of Basic and Applied Sciences and Meharry Medical 
        College, is another example of an innovative initiative aimed 
        at increasing the number of primary care physicians serving 
        medically underserved populations in rural Tennessee. Students 
        selected for the program receive tuition aid from the State of 
        Tennessee in exchange for a commitment--after completing 3 
        years of undergraduate premedical curriculum they transition 
        into medical school study with the intent, upon graduation, of 
        serving residencies in rural and underserved areas. Physicians 
        tend to stay in the communities where they spend their 
        residencies, marking a significant milestone in growing access 
        to quality care in rural communities. Only by challenging young 
        minds through such pipeline programs and supporting those who 
        teach and serve in these programs and the institutions and 
        communities that sponsor them can we propel these young people 
        through middle and high school to even dream of and then pursue 
        careers in medicine, dentistry, and other critical health 
        professions.

            Allowing and Expanding Funding for Academic Institutions to 
        Sponsor federally Qualified Health Centers (FQHCs): FQHCs play 
        a vital role in providing access to quality, interdisciplinary 
        healthcare for underserved populations. By allowing academic 
        institutions, such as HBCU medical schools, to sponsor FQHCs, 
        we can create valuable interprofessional health workforces 
        training opportunities for students and trainees in physical, 
        oral, and behavioral health while simultaneously expanding 
        access to care in underserved communities. We recommend 
        updating Federal regulations to enable HBCU medical schools to 
        sponsor and operate FQHCs, thereby facilitating the integration 
        of clinical training, research, and service in these critical 
        healthcare settings.

            Enhance Opportunities for Loan Forgiveness Programs as 
        Incentive to Work in Rural and Underrepresented Communities, 
        Specifically Non-Contiguous States: The burden of educational 
        debt is a significant barrier for many students pursuing 
        careers in healthcare, particularly those from low, middle 
        income, and historically underrepresented backgrounds. We 
        recommend expanding opportunities for loan forgiveness 
        programs, such as the National Health Service Corps, for 
        students who commit to serving in rural and underrepresented 
        communities. By providing financial incentives for service in 
        these areas, we can help attract and retain a diverse 
        healthcare workforce that is committed to improving health 
        outcomes in underserved communities.

            Prioritize programs that build the pipeline of healthcare 
        workers in demand disciplines such as primary care, behavioral 
        health, maternity care and women's health (Obstetrics and 
        Gynecology (OBGYN) and Family Medicine) and General Practice 
        and Pediatric Dentistry. The need for maternity care services, 
        which are essential for the health of women and newborns, is 
        incredibly urgent, particularly in medically underserved 
        communities where access to comprehensive women's health 
        services is often limited. This shortage in urban and rural 
        underserved areas can lead to increased health risks and 
        complications for women and newborns--evident in the 
        particularly disturbing high rate of maternal morbidity and 
        mortality among women of African descent in the United States. 
        Black women in the U.S. are more than three times more likely 
        to die in pregnancy, childbirth, and the postpartum year than 
        White women--a gap that persists regardless of income or 
        education (Petersen EE, Davis NL, Goodman D, Cox S, et al. 
        Vital signs: pregnancy-related deaths, United States, 2011--
        2015, and strategies for prevention, 13 states, 2013--2017. 
        MMWR Morb Mortal Wkly Rep. 2019;68(18):423--9).

            The importance of specialized programs, such as Pediatric 
        Dentistry, cannot be overstated, especially when we consider 
        the significant oral health disparities that exist in our 
        Nation. Children in underserved communities often lack access 
        to quality dental care, leading to preventable dental 
        conditions that can adversely impact their overall health and 
        well-being. Moreover, it is essential to highlight the critical 
        need to invest in mental and behavioral health practitioners 
        and research. The current workforce in this field is 
        insufficient to meet the growing demand, particularly in 
        underserved communities where the impact of mental health 
        disparities is most profound. By investing in education, 
        training, and research in the mental and behavioral health 
        field, we can cultivate a robust and diverse workforce capable 
        of addressing these disparities. It is not just about numbers, 
        physicians educated in minority-serving institutions can offer 
        sensitivity and culturally competent care that understands and 
        respects the unique experiences of individuals in these 
        communities.

          II. Additional Funding for Graduate Medical Education (GME) 
        Programs with an emphasis on minority-serving institutions: GME 
        programs, such as residencies and fellowships, are crucial for 
        preparing healthcare professionals to serve in urban and rural 
        underserved communities. That is why Meharry Medical College 
        applauds the bipartisan Resident Physician Shortage Reduction 
        Act of 2023 (H.R. 2389) introduced in the House of 
        Representatives which adds 14,000 new Medicare-supported GME 
        positions. We support Medicare's GME policy being amended and 
        expanded to give special consideration to hospitals that train 
        a large share of graduates from historically Black medical 
        colleges and minority serving institutions. This additional 
        funding will enable us to expand our GME offerings, providing 
        our students with a wider range of training opportunities and 
        experiences in medically underserved areas.

            Expand the number of VA GME slots allocated with an 
        emphasis on minority serving institutions. The expansion of the 
        Veterans Affairs Graduate Medical Education (VA GME) program is 
        another critical piece in our efforts to address health 
        disparities and healthcare workforce shortages. The VA system 
        offers an unparalleled training ground for physicians, 
        behavioral health professionals and other associated health 
        graduates, providing them with the opportunity to serve our 
        Nation's veterans while gaining valuable experience in a wide 
        array of specialties. By expanding this program, we can 
        increase the number of well-trained healthcare professionals, 
        particularly in specialties where shortages are most acute, 
        ultimately reducing health disparities and improving access to 
        quality care for all, including our deserving veterans.

          III. Prioritize addressing disparities in oral health. 
        Addressing oral health disparities is a critical aspect of 
        overall public health that unfortunately is often overlooked. 
        These disparities disproportionately affect underserved 
        communities and can lead to significant health complications if 
        not properly addressed. Minority-serving institutions, 
        including HBCU dental schools, are uniquely positioned to 
        tackle these disparities due to their historical and ongoing 
        commitment to serving these populations. It is well established 
        that a person's health care improves and their trust in the 
        medical community grows when they are seen by a provider of 
        their own race. Currently, only 4 percent of our Nation's 
        dental workforce is Black. That means of the 202,000 dentists 
        in the U.S., only 8,000 are Black. That is barely one Black 
        dentist for every major city in the United States. And 27 
        percent of those dentists were educated at Meharry. Through 
        dedicated oral health programs, including dental residency and 
        pediatric dentistry programs, these institutions can expand and 
        diversify the oral healthcare workforce, equipping it to better 
        serve communities with high oral health needs. By investing in 
        oral health programs at minority-serving institutions, we not 
        only improve access to care but also help to reduce oral health 
        disparities, leading to healthier communities overall.

            Expand General Practice Residency (GPR) Programs. GPR 
        programs provide valuable training for dental graduates, 
        particularly in the areas of comprehensive and emergency dental 
        care. We recommend increasing funding for GPR programs and 
        encouraging the establishment of new GPR programs at HBCU 
        dental schools. This support will enable our institutions to 
        better prepare dental graduates to serve in urban and rural 
        underserved communities, where access to dental care is often 
        limited.

    In closing, it is evident that we stand at a crucial juncture in 
our Nation's healthcare landscape. We face significant challenges in 
training and retaining a diverse healthcare workforce that has a direct 
and negative impact on health disparities and inequities if 
unaddressed. Yet, in the face of these challenges, minority-serving 
institutions, and particularly Historically Black Colleges and 
Universities continue to train clinicians dedicated to the most 
vulnerable but can only effectively forge ahead in this critical work 
with continued Federal support through transformed policy and increased 
funding as described.

    Our institutions have a rich history and proven track record of 
cultivating a diverse, culturally competent, and community-responsive 
healthcare workforce. We are uniquely positioned to address these 
issues head-on, given our deep understanding of the communities we 
serve and our commitment to their health and well-being. However, we 
cannot accomplish this monumental task alone.

    We call upon Congress to acknowledge and support our mission and 
the significant role we play in the nation's healthcare system. Through 
increased funding for expanding our knowledge of those conditions that 
most impact the health of minority, urban and rural populations through 
translational research, expanded training through pipeline programs, 
undergraduate and graduate medical education, and infrastructure 
development, along with policy initiatives that promote loan 
forgiveness and sponsorship opportunities, we can continue to expand 
and diversify the healthcare workforce.

    We are willing and eager to continue this work, but we need the 
focus, dedication, and support of Congress to continue to address and 
lead on these issues. The journey is long, and the work is significant, 
but together, we can ensure a future where quality healthcare is 
accessible and equitable for all, regardless of race, ethnicity, or 
geographic location. Thank you for your time and consideration, and we 
look forward to your support as we continue this vital work.
                                 ______
                                 
    The Chair. Dr. South-Paul, thank you very much. Our next 
panelist is Dr. Hugh E. Mighty, Senior Vice President for 
Health Affairs at Howard University.

  STATEMENT OF HUGH E. MIGHTY, M.D., MBA, FACOG, SENIOR VICE 
PRESIDENT FOR HEALTH AFFAIRS, HOWARD UNIVERSITY, WASHINGTON, DC

    Dr. Mighty. Good morning and thank you, Chairman Sanders. 
And thank you to all my colleagues for what is going to prove 
to be an eloquent discussion on improving the diversity of the 
Nation's health workforce.

    Our HBCU medical schools are the backbone of training black 
doctors in this country, where black doctors make up only 5 
percent of all American physicians. The value of our HBCU 
medical schools is more important now than ever before. Howard 
University has a 156-year history of training minority 
physicians in this country.

    More than 50 percent of these graduates return to work in 
underserved communities nationwide. Howard also has the 
distinction of having a college of dentistry, a school of 
pharmacy, a school of nursing and allied health, and a school 
of social work.

    Together, these schools provide a diverse solution to many 
of the health care challenges faced in the Nation. As the 
problem of black physician shortages rise within the general 
context of physician workforce shortage, many communities of 
need will continue to be underserved.

    Our medical school and our HBCU colleagues have witnessed a 
surge in the number of applicants for medical school with a 
limited capacity to accept more. Barriers to growing programs 
often reside in the high cost of medical school education.

    These issues faced at the medical school graduation are 
just as significant because there are fewer funded residency 
program positions than there are graduates. Highly trained 
physicians who can provide critical medical help for the most 
underserved communities struggle to find residency programs.

    The GME dollars are only available for some who graduate. 
Clinical research is yet another area where HBCUs have been 
underfunded and therefore restricted in their ability to expand 
the movement of solutions to communities of color, where 
trusted voices would lead to better participation in clinical 
trials.

    Howard also has a robust undergraduate pipeline via its 
STEM Scholars Programs, which continues to send more black 
graduates to medical school each year than any other school in 
the Nation.

    While addressing physician shortages is one path to solving 
health care disparities in the Nation, we at Howard also 
believe that leveraging a team-based approach of training and 
deploying physicians, nurses, and advanced practice nurses, and 
pharmacists, and working units can do much to extend care 
within communities, cost effectively and efficiently.

    Without continued support for these programs, it is 
unlikely that any of us will be able to meet the country's 
physician shortage challenge and needs for inclusive health 
care. In closing, I would like to certainly echo what my 
colleagues have said and which, again----

    [technical problems]--to say.

    One is that we would urge Congress to prioritize and 
designate graduate medical education physicians for teaching 
hospitals affiliated with HBCU medical schools through Medicare 
and the Teaching Health Centers Program. Legislation introduced 
in the House of Representatives, the Residents Physician 
Shortage Reduction Act, H.R. 2389, is a good model for this 
effort.

    It designates GME positions by health professionals' 
shortage areas and prioritizes slots of teaching hospitals 
affiliated HBCU medical schools. An increase in funding and 
accelerating funding for HRSA VII health workforce diversity 
programs, particularly with a focus on Centers of Excellence 
and the Health Career Opportunity Program.

    Both programs are currently funded at less than they were 
in Fiscal Year 2005. Right sizing these programs will allow 
more schools to build meaningful diversity training programs 
and establish and maintain workforce pipeline programs that 
help professional skills.

    We should accelerate investments in the programs of the 
national institutes of minority health and health disparities, 
that improve the research capacity and infrastructure of 
minority serving health professional schools.

    Both the NIMHD, research centers at minority institutions, 
the RCMIs, and the research endowment programs are short 
funded. The budgets for the RCMIs and the research endowment 
program should reflect a national commitment to level the 
research infrastructure playing field at minority health 
schools compared to those other nationwide. Thank you for your 
time.

    [The prepared statement of Dr. Mighty follows:]
                  prepared statement of hugh e. mighty
    Thank you, Chairman Sanders, and thank you to my colleagues for 
their eloquent discussion on improving the diversity of the nation's 
healthcare workforce. Our HBCU medical schools are the backbone of 
training Black doctors in this country, where Black doctors make up 
only 5 percent to 7 percent of American physicians. The value of our 
HBCU medical schools' work is more important now than ever before.

    Howard University has a 156-year history of training minority 
physicians in this country. More than 50 percent of these graduates 
return to work in underserved communities nationwide Howard also has 
the distinction of having a College of Dentistry, a School of Pharmacy, 
a School of Nursing and Allied Health, and a School of Social Work. 
Together these schools provide a diverse solution to many of the 
healthcare challenges faced in the nation

    As the problem of Black physician shortages rises within the 
general context of the physician workforce shortage, many communities 
of need will continue to be underserved in the future. Our medical 
school and our HBCU colleagues have witnessed a surge in the number of 
applicants to medical school with a limited capacity to accept more. 
Barriers to growing programs often reside in the high cost of medical 
school education The issues faced after medical school graduation are 
just as significant because there are fewer funded residency positions 
than there are graduates. Highly trained physicians who can provide 
critical medical help to the most underserved communities struggle to 
find residency programs. The GME dollars are only available for some 
who graduate.

    Clinical research is yet another area where HBCUs have been 
underfunded and therefore restricted in their ability to expand the 
movement of solutions to communities of color, where trusted voices 
would lead to better participation in clinical trials.

    Howard also has a robust undergraduate pipeline via its STEM 
scholars programs which continues to send more Black graduates to 
medical school each year than any other school in the nation.

    While addressing physician shortages is one path to solving 
healthcare disparities in the nation, we at Howard also believe that 
leveraging a team-based approach of training and deploying physicians, 
nurses and advanced practice nurses, and pharmacists in working units 
can do much to extend care within communities cost-effectively and 
efficiently. Without continued support for these programs, it is 
unlikely that any of us will be able to meet the country's physician 
shortage challenges and needs for inclusive healthcare. In closing, I 
would like to echo the sentiments of my colleagues and:

          (1) Urge Congress to prioritize and designate graduate 
        medical education (GME) positions for teaching hospitals 
        affiliated with HBCU medical schools through Medicare and the 
        Teaching Health Centers program. Legislation introduced in the 
        House of Representatives, the Resident Physician Shortage 
        Reduction Act, H.R. 2389, is a good model for this effort It 
        designates GME positions for Health Professions Shortage Areas 
        (HPSAs) and prioritizes slots at teaching hospitals affiliated 
        with HBCU medical schools.

          (2) Increase and accelerate funding for HRSA Title VII health 
        workforce diversity programs--with a particular focus on 
        Centers of Excellence and the Health Careers Opportunity 
        Program. Both programs are currently funded at less than they 
        were in fiscal year 2005. Right-sizing these programs would 
        allow more schools to build meaningful diversity training 
        programs and establish and maintain workforce pipeline programs 
        at health professions schools.

          (3) Accelerate investments in the programs of the National 
        Institute on Minority Health and Health Disparities (NIMHD) 
        that improve the research capacity and infrastructure at 
        minority-serving health professions schools. Both the NIMHD 
        Research Centers at Minority Institutions (RCMI) and the 
        Research Endowment Program are short-funded. The budget for the 
        RCMI and the Research Endowment programs should reflect a 
        national commitment to level the research infrastructure 
        playing field at minority health schools compared to other 
        health schools nationwide.
                                 ______
                                 
    The Chair. Thank you, Dr. Mighty. Dr. David Carlisle is 
President and CEO at Charles R. Drew University. Dr. Carlisle, 
thanks so much for being here.

STATEMENT OF DAVID M. CARLISLE, M.D., PH.D., M.P.H., PRESIDENT 
      AND CEO, CHARLES R. DREW UNIVERSITY, LOS ANGELES, CA

    Dr. Carlisle. Thank you, Chairman Sanders, and thank you 
for convening this important forum. And thank you to President 
Montgomery Rice for hosting us here this morning. I bring you 
greetings from the faculty, the trustees, the students and the 
alumni of Charles R. Drew University.

    We are the only historically black institution of higher 
education west of Texas and the great Western part of the 
United States. You know, the main job of the medical school is 
to train physicians to treat patients in various health care 
settings.

    As my colleagues have stated, our four schools have and 
continue to serve a unique role in training blacks and other 
minorities for careers as physicians, and we do it better than 
any other set of institutions.

    A key element in building a diverse and capable health care 
workforce and to study health conditions that just 
disproportionately impact our communities is through the 
research enterprise that is associated with our medical 
schools.

    Collectively, our HBCU medical schools advocated for the 
establishment of the National Institute on Minority Health and 
Health Disparities, NIMHD, at the National Institutes of Health 
to heighten the importance of research and innovation on 
minority health and status disparities. Initially, NIMHD was 
established as a center in the year 2000, and then elevated to 
an institute in 2010, thanks to the work of Senator Sanders' 
HELP Committee.

    My colleagues have stated, the challenges that face HBCU 
medical schools, in terms of resources, endowment, and 
financial wherewithal, these challenges extend to our research 
capabilities as well, and the NIMHD has several programs 
designed to address improving research infrastructure at 
minority serving health professionals schools.

    NIMHD's research centers at minority institutions, RCMIs, 
and the Resource Endowment Program, REP, are two critical 
initiatives designed to build research infrastructure at 
minority serving institutions. Both programs have been short 
funded in recent years.

    RCMI is not growing at the same rate as NIMHD's overall 
rate of increase during the last several years. The RCMI 
program has provided the resources needed for our schools to 
build a research infrastructure comparable to non-minority 
institutions, allowing us to attract world class researchers, 
expand research facilities, and support cutting edge 
investigation into questions about health disparities and how 
to improve and eradicate them.

    We urge Congress to prioritize support for the RCMI program 
and resize the RCMI program to a proportionate level of the 
NIMHD's budget.

    In the last Congress, the bipartisan John Lewis NIMHD 
Resource Endowment Revitalization Act was passed into law. 
Thanks to our local Congresswoman Nanette Barragan, and to the 
HELP Committee, and Ranking Member Senator Cassidy of Louisiana 
for their sponsorship of this legislation.

    The Research Endowment Program helps our institutions build 
a research endowment that is comparable to the average 
endowment of all medical schools. The new Research Endowment 
Program is supported by only $12 million annually, when 
historically it had been supported upwards to $50 million per 
year.

    More funding for this program is needed to accelerate the 
pace of strengthening our institutions. Thank you again, 
Chairman Sanders, for your leadership and interest in our 
views.

    [The prepared statement of Dr. Carlisle follows:]
                prepared statement of david m. carlisle
    Charles R. Drew University of Medicine and Science (CDU) in South 
Los Angeles was founded in 1966 in the wake of the historic Watts 
Rebellion to cultivate diverse health professional leaders who are 
dedicated to social justice and health equity for underserved 
populations. CDU has an ambitious yet attainable vision of a future 
with excellent health and wellness for all in a world without health 
disparities. Having diversity across all health care, including 
researchers, practitioners, administrators, educators, and 
policymakers, is an essential component in making this vision a 
reality. CDU's participation in education, research, clinical service, 
and community engagement indicates certain strategies will support 
achieving this goal.

    Providing quality health professions education opportunities to 
students of color will ensure and expand a pipeline of diverse and 
diverse-minded nurses, doctors, dentists, physician assistants, and 
technicians, who create a more equitable and culturally competent 
health care landscape. This can be attained through the continued or 
increased support for Historically Black Medical Schools. These 
institutions hold a unique and valuable position within the medical 
profession by providing opportunities for those who have historically 
been denied equal access to higher education.

    Investing in the health and growth of America's Historically Black 
Medical Schools is investing in the health and growth of our most 
underserved communities across the Nation. As non-profit institutions, 
we rely on the support of the government, philanthropist, corporations, 
partners, and the community to pursue our mission, build our 
endowments, support hard scale construction, and provide the best 
learning experiences for the next generation of the medical workforce.

    Addressing the shortage of graduate medical education slots/
residency positions must also be a priority. Every year, thousands of 
aspiring physicians are unable to find a residency opportunity. Most 
will have to wait an entire year to reapply to practice medicine, 
preventing them from filling the physician shortage.

    Innovative initiatives like the National Health Service Corps, of 
which I am an alumnus, provide scholarships and loan repayment 
opportunities for new medical professionals. These programs increase 
access to quality health care in communities every day and deserve 
whatever support can be mustered to maintain and grow them.

    In undergraduate education, funding summer programs, increasing 
scholarships, and supporting stipends for work study efforts would go a 
long way towards decreasing the dropout rate among minority populations 
that is bottlenecking the supply of medical school candidates. 
Providing resources and support to expand the scope and number of pre-
med and undergraduate medical education programs at colleges and 
universities in communities of color would also increase the flow of 
students into 4-year medical programs, and ultimately into the 
workforce.

    It is our hope at CDU that these ideas and initiatives can be 
provided the support they need from the highest levels of our 
government in order to move them forward in a timely manner so the 
issue of the health professional shortages and health workforce 
diversity can be meaningfully addressed.
                                 ______
                                 
    The Chair. Dr. Carlisle, thank you very much. Our next 
panelist is Dr. David G. Skorton, President and CEO of the 
Association of American Medical Colleges. Dr. Skorton.

    STATEMENT OF DAVID J. SKORTON, M.D., PRESIDENT AND CEO, 
    ASSOCIATION OF AMERICAN MEDICAL COLLEGES, WASHINGTON, DC

    Dr. Skorton. Thank you, Chairman Sanders, for this and for 
all you do. Thank you, Dr. Montgomery Rice, for this and for 
all you do. And to all my colleagues leading these incredibly 
important institutions that we are proud to have as members of 
the AAMC.

    Thank you for the learner for giving us our future. I am 
going to try very hard, Chairman Sanders, not to repeat things 
that you have already heard about, but just to endorse them.

    The physician shortage that you mentioned, Chairman 
Sanders, we estimate by 2034 will be 124,000 physicians. And if 
your vision for the future came to pass, that everybody had 
access to medical care, we would right now be, right now 
180,000 positions short. So, this is a real crisis. It is not 
getting any better.

    Since the Flexner Report, the HBCUs have been fighting back 
valiantly to return from a very low point, to distinguish 
things that they are doing now. And I am very proud of these 
four schools. I learn so much from their leaders all the time. 
I mean that quite sincerely.

    We are also looking forward as AAMC to Xavier University of 
Louisiana and Ochsner Health opening a College of Medicine, and 
I also want to recognize--[technical problems]--and also want 
to recognize, Chairman Sanders, that Morgan State University in 
Baltimore will open a College of Osteopathic Medicine--
[technical problems].

    All these added up, the HBCUs are less than 3 percent of 
all M.D. granting institutions, and as Dr. Montgomery Rice 
said, produce more than 50 percent of all black medical 
graduates. Make no mistake about it, we have been going nowhere 
in our work to increase blacks, and especially black men in 
medicine, except for the HBCUs.

    My first faculty appointment in January 1980 and last year, 
the very same proportion of matriculants were black men across 
America. That is a record that I am not proud of.

    Through our action collaborative for black men in medicine, 
Chairman, which is a joint effort between the AAMC and the 
National Medical Association, and through an additional facet 
of our strategic plan, we are starting to see some improvement 
in these areas, and a lot of it is due to the leaders you see 
before you today.

    I want to switch gears and mention that in the coming weeks 
the U.S. Supreme Court is going to decide on two cases about 
the use of race as one factor among many in higher education 
admissions, including but not limited to medical schools.

    An adverse ruling by the Supreme Court would be very 
detrimental to addressing physician diversity. In the states in 
the United States where the use of race conscious admissions 
has been banned, there has been a 37 percent reduction in 
diversity of the classes going forward, and we are here today 
to say publicly that no matter the ruling of the Supreme Court 
of the United States, we will continue to push forward for 
diversity in our--[technical problem].

    In addition to our endorsement of the bipartisan Resident 
Physician Shortage Reduction Act, which is H.R. 2389 and S. 
1302, I want to talk a little bit more about the HRSA programs 
that have been brought up by our other colleagues.

    As was mentioned, those funds have not gone up. They have 
gone down actually over the last couple of decades. And we 
support doubling funding for a broad range of HRSA Title VII 
and VIII workforce. We are urging Congress, Mr. Chairman, to 
provide at least $1.51 billion combined across Title VII and 
Title VIII programs.

    We also encourage publicly today increasing Federal 
investment in minority serving institutions, including HBCUs, 
including predominantly black institutions, including Hispanic 
serving institutions, and very importantly, tribal colleges and 
universities. Of all the many underrepresented in our Country 
in medicine, the Native Americans and Alaska Natives were the 
only group, Chairman, in the last 2 years where the applicants 
went up and the matriculants went down, so we need to work on 
that issue as well.

    We also support the Expanding Medical Education Act, which 
would authorize HRSA grants to establish or expand medical 
schools, including regional branch campuses, and would 
prioritize HBCU's, NSIs, or those institutions that propose to 
establish or expand schools in medically underserved 
communities.

    Also, the Pathway to Practice proposal and National Medical 
Corps Act scholarship programs introduced in 117th Congress 
H.R. 9105 would help address the high financial debt for 
students represented--underrepresented in medicine. This is a 
daunting thing to look at, especially from early in the 
education cycle.

    I want to talk very briefly, Chairman, about learner and 
physician burnout. We know that burnout and stress on our 
learners and physicians is real. We have to create a more 
supportive environment for current and future physicians.

    I would like to highlight the Dr. Lorna Breen Health Care 
Provider Protection Act, LBA, P.L. 117-105, which passed in 
2022 but has not been funded. We urge support for this. We also 
urge support for immigration programs that continue to bring 
physicians and other health professionals to underserved areas.

    We need those excellent physicians and health care workers 
in this country. There is a backlog of green card applications 
and also J-1 waivers that can be used to bring more physicians 
not only to the United States in general, but also to 
underserved areas.

    In closing, I want to thank you, Chairman Sanders. I want 
to thank Dr. Montgomery, President Montgomery Rice, and all 
here. We have a lot of work to do. Let's get on with it. Thank 
you.

    [The prepared statement of Dr. Skorton follows:]
                 prepared statement of david j. skorton
    The AAMC appreciates the opportunity to participate in the 
Roundtable on Historically Black Colleges and Universities (HBCU) 
medical schools and health care workforce diversity, held at Morehouse 
School of Medicine, one of our member institutions.

    The AAMC is a nonprofit association dedicated to improving the 
health of people everywhere through medical education, health care, 
medical research, and community collaborations. Its members are all 157 
U.S. medical schools accredited by the Liaison Committee on Medical 
Education; 13 accredited Canadian medical schools; approximately 400 
teaching hospitals and health systems, including Department of Veterans 
Affairs medical centers; and more than 70 academic societies. Through 
these institutions and organizations, the AAMC leads and serves 
America's medical schools and teaching hospitals and the millions of 
individuals across academic medicine, including more than 193,000 full-
time faculty members, 96,000 medical students, 153,000 resident 
physicians, and 60,000 graduate students and postdoctoral researchers 
in the biomedical sciences. Following a 2022 merger, the Alliance of 
Academic Health Centers and the Alliance of Academic Health Centers 
International broadened the AAMC's U.S. membership and expanded its 
reach to international academic health centers.

    The need for a more diverse health workforce is clear, and the need 
for Black physicians cannot be underestimated. A recent study found 
that Black people live longer in places with more Black doctors. \1\ 
Looking at primary care physician supply and population health at the 
county level, greater Black representation among physicians was 
associated with higher life expectancy for Black individuals, and 
inversely associated with all-cause Black mortality and mortality rate 
disparities between Black and White individuals. We know physician 
workforce diversity is in the best interest of the health of people 
everywhere. We all should work on policies and partnerships that move 
toward this goal.
---------------------------------------------------------------------------
    \1\  Snyder, John E.; Upton, Rachel D.; Hassett, Thomas C.; Lee, 
Hyunjung; Nouri, Zakia; & Michael Dill. 2023. Black representation in 
the primary care physician workforce and its association with 
population life expectancy and mortality rates in the U.S.. JAMA 
Network Open. 2023; 6(4):e236687. DOI:10.1001/
jamanetworkopen.2023.6687.
---------------------------------------------------------------------------
                           The Flexner Report
    In 1910, Abraham Flexner published what would be known as the 
Flexner Report,2 which held as its thesis ``that the country needs 
fewer and better doctors.'' While the stated intention was to normalize 
medical education for the majority of physicians and there were 
significant problems in medical education, the actual result was that 
the Flexner Report was weaponized to severely limit opportunities for 
Black Americans pursuing medical education and as a result, deepened 
health inequities for Black Americans for decades. When Flexner 
traversed the country in 1909 and visited 155 medical schools, he 
advocated for the closing of almost 80 percent of all the contemporary 
programs in what he labeled as, ``medical sects'' including 
chiropractic, osteopathy, homeopathy, and physical therapy programs. 
Flexner included professional requirements that brought about the 
closure of many medical schools, and the report was particularly 
harmful to the existence of Black medical schools. Unfortunately, 
institutions in the Midwest and the South bore the brunt of these 
closures, and the largely underserved and rural communities in those 
locations were left with even fewer local medical resources.

    Flexner pushed to close for-profit medical schools, which had 
filled the need to educate Black people for medical training. During 
the time of the report, white institutions would not admit Black 
students to train as physicians or treat Black patients. In 1910, there 
were seven medical schools that filled this unmet need and admitted 
Black students who then became physicians. I list them in this 
testimony to honor their contributions to society, which were truncated 
or scaled back following the Flexner Report:

          1. Howard University Medical School (est. 1868, remains in 
        existence today)

          2. Meharry Medical College (est. 1876, remains in existence 
        today)

          3. Leonard Medical School / Shaw University (est. 1882, 
        closed in 1915)

          4. New Orleans University Medical College (est. 1887, closed 
        1911)

          5. Knoxville Medical College (est. 1895, closed 1910)

          6. Chattanooga National Medical College (est. 1902, closed 
        1908)

          7. University of West Tennessee College of Physicians and 
        Surgeons (est. 1904, closed 1923)

      Key Statistics and Factors Demonstrating the Need for Change
    The lack of sufficient physicians and insufficient diversity in the 
physician population continues to affect the health of the population 
today amid a complex and multifactorial landscape of challenges.

          1. The U.S. will face a projected physician shortage of up to 
        124,000 physicians by 2034. The AAMC continues to project that 
        physician demand will grow faster than supply (primarily driven 
        by a growing, aging U.S. population) leading to a projected 
        total physician shortage of up to 124,000 physicians by 2034. 
        Within this total, we project a shortage of up to 48,000 
        primary care physicians and a shortage of up to 77,100 non-
        primary care specialty physicians (e.g., psychiatry, infectious 
        disease, and general surgery) by 2034. These shortages build on 
        existing measured shortages of behavioral health and primary 
        care providers. Moreover, the AAMC's ``Health Care Utilization 
        Equity'' scenario finds that if underserved populations were to 
        experience the same health care use patterns as populations 
        with fewer barriers to access, the U.S. would need up to an 
        additional 180,400 physicians just to meet current demand. \2\ 
        Make no mistake--these shortages in the physician supply have 
        real impact on patients, particularly those living in rural and 
        other underserved communities.
---------------------------------------------------------------------------
    \2\  The Complexities of Physician Supply and Demand: Projections 
From 2019 to 2034, Prepared for the AAMC by IHS Markit Ltd., June 2021.

          2. The number of HBCU medical schools has not rebounded since 
        the Flexner Report. Today, there are four HBCU medical schools: 
        Howard University College of Medicine, Meharry Medical College, 
        Morehouse School of Medicine, and most recently, the Charles S. 
        Drew College of Medicine. These institutions comprise less than 
        3 percent of all M.D.-degree granting institutions, but are 
        responsible for producing more than 50 percent of all Black 
        medical graduates. They also train other racial and ethnic 
        groups who become physicians. We are looking forward to Xavier 
        University of Louisiana and Ochsner Health opening a College of 
        Medicine. We also acknowledge that Morgan State University in 
        Baltimore will open a college of osteopathic medicine in 2023. 
        Collectively, the HBCU medical schools have the potential to 
        train more physicians, including underrepresented physicians, 
        but those institutions must be supported to execute their 
---------------------------------------------------------------------------
        important mission.

          3. Black male physician totals have remained relatively 
        stagnant over 40 years. In 1978, there were 1,140 Black male 
        applicants to medical schools across the country, with 542 
        Black male matriculants in that same year. In 2014, the number 
        of Black male applicants stayed relatively the same--1,137--but 
        resulted in 515 Black male matriculants for 2014. In essence, 
        for more than 30 years, the number of Black male applicants and 
        matriculants at institutions across the country were stable or 
        on the decline. This was the sounding of an important alarm, 
        and groups like the AAMC have leaned into this problem to come 
        up with solutions. Through the Action Collaborative for Black 
        Men in Medicine, a joint effort between the AAMC and the 
        National Medical Association, and through one core facet of the 
        AAMC's recently adopted strategic plan, Action Plan 4: Increase 
        Significantly the Number of Diverse Medical School Applicants 
        and Matriculants, \3\ we are starting to see improvement in 
        these areas. 1A\4\ Programs that have demonstrated impact on 
        exposing historically excluded racial and ethnic groups to 
        careers in medicine and that support the pathway to becoming a 
        physician must be funded and replicated.
---------------------------------------------------------------------------
    \3\  For more information on the Action Collaborative, please visit 
Action Collaborative for Black Men in Medicine--AAMC. The AAMC Action 
Plan 4 updates can be accessed at Action Plan 4: Increase Significantly 
the Number of Diverse Medical School Applicants and Matriculants--AAMC.
    \4\  In 2020, there were 1,457 Black male applicants to medical 
school and 2020 Black male matriculants. In 2021, there were 1,895 
Black male applicants to medical school and 813 Black men matriculants. 
These represent some of the highest totals since the data has been 
collected. For additional data, please visit https://www.aamc.org/data-
reports/students-residents/interactive-data/2021-facts-applicants-and-
matriculants-data

          4. A United States Supreme Court decision not allowing race 
        as one factor to consider in medical school admissions would be 
        detrimental to addressing physician diversity. Longitudinal 
        studies in states that have bans on race-conscious admissions 
        demonstrate significant decreases in the number of 
        underrepresented minority medical school matriculants. Should 
        the Supreme Court's opinion result in greater restriction or 
        prohibition of race-conscious admissions, it is foreseeable 
        that similar decreases in diversity will be experienced 
        nationwide, ultimately reducing the overall diversity of the 
        physician workforce. In that scenario, it will be even more 
        important for Congress to support programs, noted below, that 
        are designed to increase the diversity of our Nation's 
---------------------------------------------------------------------------
        healthcare workforce.

    Legislative Priorities and Policies to Increase Health Care 
Workforce Diversity. There are programs that will have a positive 
impact on health care workforce diversity and the training of more 
diverse physicians. We urge the enactment of legislation and the 
funding of programs to ensure the success of these efforts that will 
deliver meaningful results.

          1. Expanding the Workforce and Graduate Medical Education. 
        The AAMC strongly supports the bipartisan Resident Physician 
        Shortage Reduction Act of 2023 (S. 1302 / H.R. 2389) which 
        would gradually add 14,000 new Medicare-supported GME positions 
        over 7 years. These positions would be strategically targeted 
        at a wide variety of teaching hospitals, including those 
        affiliated with HBCU medical schools, helping to strengthen and 
        diversify the health care workforce and improve access to care 
        for patients, families, and communities across the country. 
        AAMC strongly supports the expansion of Medicare support for 
        GME and urges the inclusion of additional GME positions in any 
        health care legislation.

          GME programs administered by the Health Resources and 
        Services Administration (HRSA), including Children's Hospitals 
        GME and Teaching Health Centers, are important complements to 
        Medicare GME that help to increase the number of residents 
        training in children's hospitals and community health centers, 
        respectively. Funding for HRSA programs specifically targeting 
        GME at children's hospitals and teaching health centers will 
        help alleviate physician workforce shortages in those settings.

          2. Investing in HRSA Title VII and Title VIII Workforce 
        Programs and the National Health Service Corps. The AAMC 
        supports doubling funding for a broad range of HRSA's Title VII 
        & VIII workforce development and diversity pathway programs to 
        help shape the workforce to meet patient needs, including:

          Y  Centers of Excellence (COE), student support and minority 
        health training programs at health professions institutions;

          Y  Health Careers Opportunity Program (HCOP), K-16 diversity 
        pathway programs;

          Y  Scholarships for Disadvantaged Students (SDS), 
        scholarships for minority and/or disadvantaged health 
        professions students; and

          Y  Faculty Loan Repayment (FLRP), loan repayment program for 
        minority health professions faculty to serve as mentors.

    The HRSA Title VII diversity programs are smaller today than they 
were two decades ago ($115 million in 2002, compared to $106 million 
for 2023). The AAMC calls on Congress to adequately fund these programs 
in order to address the imperative to improve our commitment to 
diversity.

    Many medical schools aim to identify potential candidates from 
rural and under-resourced communities and encourage them to pursue a 
career in medicine. 1A\5\, 1A\6\ Additional Title VII programs support 
these and other efforts to help address gaps in the workforce. For 
example:
---------------------------------------------------------------------------
    \5\  Attracting the next generation of physicians to rural 
medicine, Peter Jaret, Special to AAMCNews, Feb. 2020.
    \6\  To facilitate new rural residency programs, the HRSA Office of 
Rural Health Policy provides technical assistance and startup funding 
to rural hospitals under the Rural Residency Planning and Development 
programs.

          Y  HRSA Title VII Area Health Education Centers (AHECs) 
        specifically focus on recruiting and training future physicians 
        in rural areas, as well as providing interdisciplinary health 
---------------------------------------------------------------------------
        care delivery sites; and

          Y  HRSA Title VII Primary Care Training and Enhancement 
        (PCTE) and Medical Student Education (MSE) programs support 
        education and training programs for future primary care 
        physicians.

    The AAMC urges Congress to provide at least $1.51 billion combined 
for all Title VII and Title VIII programs in the fiscal year 2024 
spending bill. Additionally, the AAMC looks forward to working with the 
HELP Committee and the full Congress to reauthorize these programs 
before they expire at the end of fiscal year 2025.

    Additionally, the National Health Service Corps (NHSC) in 
particular has played a significant role in recruiting primary care 
physicians to federally designated Health Professions Shortage Areas 
(HPSAs) through scholarships and loan repayment options. Despite the 
NHSC's success, it still falls far short of fulfilling the wide-ranging 
health care needs of all HPSAs due to growing demand for health 
professionals across the country.

    Supporting Title VII, Title VIII, and the NHSC not only would help 
address pervasive gaps in the health workforce, it also would encourage 
a whole health care, team-based approach to health care so the entire 
system can be fortified.

          3. Expanding Medical Schools at Minority Servicing 
        Institutions, Historically Black Colleges and Universities, and 
        in Underserved Communities. The AAMC encourages increasing 
        Federal investment in minority serving institutions (MSIs), 
        including Historically Black Colleges and Universities (HBCUs), 
        Predominantly Black Institutions (PBIs), Hispanic Serving 
        Institutions, and Tribal Colleges and Universities. The AAMC 
        supports the Expanding Medical Education Act, which would 
        authorize HRSA grants to establish or expand medical schools, 
        including regional branch campuses, and would prioritize HBCUs, 
        MSIs or those institutions that propose to establish or expand 
        schools in medically underserved communities or areas with 
        shortages of health professionals where no such schools exist.

          4. Reducing or eliminating financial obstacles to medical 
        education. Medical education costs can be a significant 
        deterrent for individuals interested in medicine and can impact 
        the physician pathway. \7\ The ``Pathway to Practice'' proposal 
        and National Medical Corps Act scholarship programs introduced 
        in the 117th Congress (H.R. 9105) would help address the high 
        financial debt for students who are underrepresented in 
        medicine. Importantly, the Pathway to Practice program would 
        prioritize applicants who attended HBCUs or MSIs, as well as 
        those who participated in certain HRSA pathway programs.
---------------------------------------------------------------------------
    \7\  Physician Education Debt and the Cost to Attend Medical 
School: 2020 Update.

          Public service loan repayment programs offered by HRSA, the 
        National Institutes of Health, Department of Veterans Affairs, 
        the Department of Defense, and the Indian Health Service are 
        effective, targeted incentives for recruiting physicians and 
        other health professionals to serve specific marginalized 
        populations. Increasing Federal investment in these programs is 
        a proven way to increase the supply of health professionals 
        serving HPSAs, nonprofit facilities, and other underserved 
---------------------------------------------------------------------------
        communities.

          In addition, continued access to income-driven student loan 
        repayment plans and the Public Service Loan Forgiveness (PSLF) 
        Program ensure payments commensurate with salary and foster 
        engagement in critical public service careers. The PSLF program 
        is an essential tool for nonprofit and government facilities to 
        recruit and retain first-generation and underrepresented 
        students to medical schools, encouraging physicians to practice 
        at nonprofit facilities, and incentivizing physicians to become 
        our next generation of medical researchers.

          5. Addressing learner and physician burnout. The AAMC is 
        grateful to Congress for enacting the Dr. Lorna Breen Health 
        Care Provider Protection Act (LBA, P.L. 117-105) in 2022, to 
        support initiatives to address the mental health and well-being 
        of aspiring and practicing health professionals. Demand for 
        such funding far outpaces the limited resources that HRSA has 
        been able to provide for such programming, and the AAMC urges 
        lawmakers to fully fund the LBA in fiscal year 2024.

          6. Supporting immigration programs that continue to bring 
        physicians and other health professionals to underserved areas. 
        Immigration must be mentioned as we consider health workforce 
        shortages. The U.S. health workforce has been bolstered by 
        individuals who have come from other countries to our Nation. 
        Over the last 15 years, the State Conrad 30 J-1 visa waiver 
        program has brought more than 15,000 physicians to underserved 
        areas--comparable to (if not more than) the NHSC, at no cost to 
        the Federal Government. Bipartisan legislation that would allow 
        Conrad 30 to expand beyond 30 waivers per state would be 
        useful, as well as recognizing immigrating physicians as a 
        critical element of our Nation's health care infrastructure. In 
        addition, the U.S. should address the backlog of green card 
        applications by lifting per country caps that are impeding 
        physicians and other healthcare professionals entering the U.S. 
        from certain countries. To break these backlogs, the bipartisan 
        Healthcare Workforce Resilience Act would authorize the 
        recapture of unused immigrant visas and redirect them to 25,000 
        immigrant visas for professional nurses and 15,000 immigrant 
        visas for physicians. These visas would be issued in order of 
        priority date, not subject to the per country caps, and premium 
        processing would be applied to qualifying petitions and 
        applications.
                    Next Steps for Action and Change
    The responsibility of increasing diversity in health care, 
especially among physicians, does not rest solely on the government. We 
offer here a few suggestions for many stakeholders interested in 
increasing physician diversity.

          1. Support innovative approaches and public-private 
        partnerships for medical education and residency training. 
        Addressing the nation's physician workforce shortages in both 
        primary care and among needed specialists requires a 
        multipronged, innovative, public-private approach beyond just 
        increasing the overall number of physicians, such as 
        implementing team-based care and better use of technology. 
        While we believe that increasing Federal support for GME is an 
        important component to any comprehensive workforce strategy, we 
        are open to, and in fact ask for, these and other innovative 
        solutions to address health workforce shortages.

          2. Support the role of HBCUs, minority serving institutions 
        (MSIs), and all other institutions to train a diverse 
        workforce. We must support the important role of HBCUs--
        undergraduate schools, medical schools, and other allied health 
        schools--in producing the future generation of Black scholars 
        with the funding and infrastructure to have innovative and 
        expanded physical facilities, excellent faculty to teach the 
        latest medical techniques and to conduct groundbreaking, NIH-
        funded research, and to remain a trusted resource situated in 
        their local communities. We should not overlook the importance 
        of other minority serving institutions, which have been noted 
        as an underutilized resource that is available to help create a 
        diverse STEM workforce. \8\ Tribal colleges and universities 
        should receive additional Federal support and be brought into 
        conversations about training future physicians and others in 
        the health care workforce. Hispanic-serving institutions are 
        yet another group of institutions that are able to help meet 
        the diverse physician goals we describe above. When thinking 
        about diversifying the workforce, an inclusive approach must be 
        pursued.
---------------------------------------------------------------------------
    \8\  National Academies of Sciences, Engineering, and Medicine 
2019. Minority Serving Institutions: America's Underutilized Resource 
for Strengthening the STEM Workforce. Washington, DC: The National 
Academies Press. https://doi.org/10.17226/25257.

          While recognizing the strong influence of HBCUs and MSIs in 
        producing a diverse workforce, there is an important role for 
        all other institutions in contributing to the diversification 
        of the health care workforce as well. Instead, all institutions 
        should be supported in their efforts to develop and to execute 
        a plan to help increase workforce diversity, understanding that 
        diversity will take on many different forms.
                               Conclusion
    We at the AAMC are committed to working with the entire Senate HELP 
Committee to move the Nation forward in efforts to diversify the 
physician and health care workforce and to ultimately to achieve better 
outcomes for our Nation. If you have any further questions, please 
contact AAMC Chief Public Policy Officer Danielle Turnipseed, at 
[email protected].
                                 ______
                                 
    The Chair. Thank you, Dr. Skorton. The next panelist is Dr. 
Samuel Cook, Internal Medicine Resident Physician here at 
Morehouse.

 STATEMENT OF SAMUEL COOK, M.D., RESIDENT, MOREHOUSE SCHOOL OF 
                     MEDICINE, ATLANTA, GA

    Dr. Cook. Good morning, everyone. To the Morehouse 
students, faculty, and staff, for all those from the 
historically black medical schools to the President of the 
AAMC, and all the community members who came out today, thank 
you so much for coming out for this vitally important 
conversation.

    I am Dr. Samuel Cook, PGY2 internal medicine resident here 
at the Morehouse School of Medicine, and I was asked to share 
some of my story so you all can get a better idea of what it is 
like to come up as a resident through the current system. 
Senator and Chairman Sanders, I come to you today as a fellow 
American, born and raised in New York City. I grew up in the 
Bronx.

    New York, born to loving parents who instilled in me a 
passion and need to serve my surrounding community at all 
costs. On my father's side of the family, I was the first Cook 
to graduate from college.

    While attending the Johns Hopkins University, I quickly 
began volunteering at a sliding scale medical clinic in a low-
income area of Baltimore aimed solely at providing low cost the 
free medical care for families who had limited access to it.

    However, I struggled to get my foot in the door of more 
established medical institutions, even with my academic 
pedigree, because I lacked the familial connections to medicine 
that so many of my white counterparts had in spades.

    Nevertheless, I moved forward. I served as a community 
resource coordinator in East Baltimore, specifically addressing 
the social determinants of health we so readily take for 
granted, access to food, shelter, water, electricity, and 
employment, all necessary components of health, recognizing 
that true health is not the mere absence of disease, but a 
total state of physical, mental, and spiritual well-being.

    After being told by my undergraduate advisor that my 3.4 
GPA at one of the top ten universities in the Nation was not 
strong enough to support a medical school application, I 
listened and took a delayed route to my medical education, 
eventually matriculating to the Drexel University College of 
Medicine in Philadelphia, Pennsylvania, where I won academic 
awards and published my medical research.

    I dove even deeper into medically centered service work and 
mentorship of young black STEM students across the Nation, 
ensuring that they would never have to face a lack of 
supportive guidance or feet in the doors of credible medical 
institutions.

    We are here today for such a great purpose. We ultimately 
want more black Americans in white coats, but how do we do 
this? I believe the right approach is what barriers to entry do 
we have to dismantle?

    How is it right that I am tasked with providing our 
community high quality health care while struggling to provide 
for my own family? Why am I struggling financially as a 
resident physician when I could make a greater hourly wage as a 
line cook, and I know because I have? And why am I hundreds of 
thousands of dollars in student loan debt, $320,000, to be 
exact, when my parents scratched and saved to fully cover my 
undergraduate tuition?

    It is because our system is broken, and we as resident 
physicians are not fairly compensated for our time spent saving 
lives by sacrificing our own well-being. For far too long, we 
have fallen through the cracks of a health care system that 
blatantly and openly abuses our binding investments into this 
field, and it is high time that our side is heard, appreciated, 
and acted upon.

    Today I submit to you that the greatest barrier to entry 
for burgeoning black positions is the immense and seemingly 
insurmountable financial risk waiting to shackle all those who 
pass through the gates of medical education. These costs are 
equally shared for everybody, but the burden they pose is not.

    It is an equitably distributed as one of many sequelae of 
generational and institutional wealth inequity. So, when the 
COVID pandemic hit, we physicians of color were asked to run 
headfirst into a largely unknown crisis, putting our lives, our 
livelihoods, and the health of our families in the path of 
imminent danger.

    As always, we delivered upon our Hippocratic Oath. I am 
here today to advocate for my fellow physicians of color, those 
with less than half the general racial wealth of our white 
counterparts. We, the resident physicians of color who have no 
financial safety net should a career in medicine not pan out 
for any reason.

    We, the resident physicians of color who have been 
historically underrepresented, underestimated, and underpaid. 
It is time for change, and it is time for change today. It is 
time, Chairman Sanders, for us to get our due so the aspiring 
physicians in our Country may see that they will be fairly 
treated and protected should they ever choose a career in 
medicine.

    It should not be such a financially perilous journey to 
want to save the lives of others. It should be a decision that 
is celebrated with words, with actions, and with support, from 
the community level all the way up to our U.S. Government. We 
are not asking for a silver spoon, and we are certainly not 
seeking handouts.

    We are simply asking for medical school loan cancellation, 
free medical tuition for the next generation, and the fair 
compensation that we are due. Thank you very much.

    [The prepared statement of Dr. Cook follows:]
                  prepared statement of samuel d. cook
    Senator and Chairman Sanders, I come to you today as a fellow 
American born and raised in New York City. I grew up in the Bronx, NY, 
born to two loving parents who instilled in me a passion and need to 
serve my surrounding community at all costs. On my father's side of the 
family, I was the first Cook to graduate from college. While attending 
the Johns Hopkins University, I quickly began volunteering at a 
sliding-scale medical clinic in a low-income area of Baltimore, aimed 
solely at providing low-cost to free medical care for families who had 
limited access to it. However, I struggled to get my foot in the door 
of more established medical institutions, even with my academic 
pedigree, because I lacked the familial connections to medicine that so 
many of my white counterparts had in spades. Nevertheless, I moved 
forward. I served as a Community Resource Coordinator in East 
Baltimore, specifically addressing the social determinants of health we 
so readily take for granted: access to food, shelter, water, 
electricity, and employment--all necessary components of health; 
recognizing that true health is not the mere absence of disease, but a 
total state of physical, mental, and spiritual well-being.

    After being told by my undergraduate advisor that my 3.42 GPA at 
one of the top-10 universities in the Nation was not strong enough to 
support a medical school application, I listened and took a delayed 
route to my medical education, eventually matriculating to the Drexel 
University College of Medicine in Philadelphia, PA, where I won 
academic awards and published my medical research. I dove even deeper 
into medically centered service work and mentorship of young, Black 
STEM students across the country. Ensuring that they would never have 
to face a lack of supportive guidance or feet in the doors of credible 
medical institutions.

    We are here today for a great purpose. We ultimately want more 
Black Americans in white coats. So how do we do this? I believe the 
right approach is, ``What barriers to entry do we have to dismantle?''

    How is it right that I am tasked with providing our community high 
quality health care while struggling to provide for my own family? Why 
am I struggling financially as a resident physician, when I could make 
a greater hourly wage as a line cook (and I know, because I have)? And 
why am I hundreds of thousands of dollars in student loan debt, when my 
parents scratched and saved to fully cover my undergraduate tuition?

    It is because our system is broken, and we, as resident physicians, 
are not fairly compensated for our time spent saving lives while 
sacrificing our own well-being. For far too long, we have fallen 
through the cracks of a healthcare system that blatantly, and openly, 
abuses our binding investments into this field, and it is high time 
that our plight is heard, appreciated, and acted upon. Today, I submit 
to you that the greatest barrier to entry for burgeoning Black 
physicians is the immense, and seemingly insurmountable, financial risk 
waiting to shackle all those who pass through the gate of medical 
education. These costs are equally present for all, but the burden they 
pose is not. It is inequitably distributed as one, of many, sequelae of 
generational and institutional wealth inequity.

    When the Covid pandemic hit, we physicians of color were asked to 
run head-first into a largely unknown crisis, putting our lives, our 
livelihoods, and the health of our families in the path of imminent 
dangers. As always, we delivered upon our Hippocratic oath. I am here 
today to advocate for my fellow physicians of color, those with less 
than half the generational wealth of our white counterparts. We, the 
resident physicians of color, who have no financial safety nets should 
a career in medicine not pan out for any reason. We, the physicians of 
color, who have been historically underrepresented, underestimated, and 
underpaid. It is time, Chairman Sanders, for us to get our due so the 
aspiring physicians in our Country may see that they will be fairly 
treated and protected should they choose a career in medicine.

    It should not be such a financially perilous journey to want to 
save the lives of others. It should be a decision that is celebrated; 
not with words, but with actions and support: from the community level 
all the way up to our U.S. government. We are not asking for a silver 
spoon. We are certainly not seeking handouts. We are simply demanding 
medical school loan cancellation, free medical tuition for the next 
generation, and the fair wages that we are due.
                                 ______
                                 
    The Chair. Thank you, Dr. Cook. Next panelist is--hey, you 
put a big burden on this young lady. Be nice to her too, all 
right? Sonya Randolph is a Medical Student, year 3 here at 
Morehouse School of Medicine.

   STATEMENT OF SONYA RANDOLPH, STUDENT, MOREHOUSE SCHOOL OF 
                     MEDICINE, ATLANTA, GA

    Ms. Randolph. Definitely a tough act to follow.

    [Laughter.]

    Ms. Randolph. Good morning, Chairman Sanders. Thank you for 
having us here today to listen to us. I just want to tell a 
little bit about my story.

    For some, the topic of black representation in the medical 
field may seem like a trivial matter, but for others it may 
mean the difference between the life of a loved one. For a 
young black couple who presented to the hospital to an all-
white health care team with concerns that their 5-year-old son 
was ill, this topic is of particular importance.

    This couple trusted their son to be cared for by a capable 
group of physicians that they believed would render quality 
medical care for him. How could they have known it would be--he 
would be misdiagnosed with a 24-hour virus instead of his 
actual diagnosis of bacterial meningitis, which proved to be 
fatal the next day?

    Why weren't their concerns taken seriously? Why did he not 
receive the appropriate standard of care? Could this outcome 
have been any different if he were attended to by a black 
physician? The couple in this story are my parents and the 
young child was my brother Bryce, and the reason I aspire to be 
a physician today.

    Senator Sanders, it is imperative that we as a country 
understand the significance of black physicians providing care 
for black patients and other patients as well.

    Studies show that when black patients are treated by black 
doctors, they are more satisfied with their health care, more 
likely to have received the preventive care they needed in the 
past year, and more likely to agree to recommended preventive 
care.

    Though the AAMC reports an increase in black or African 
American medical matriculants in 2022 and 2023, we have even 
greater work to do. With key factors such as student loan 
forgiveness, increased exposure and visibility, and mentorship 
for students aspiring to be in health care, we can increase the 
number of Black Americans in the medical field and subsequently 
improve health outcomes for Black Americans.

    According to an article written in the New England Journal 
of Medicine, children from underrepresented or disadvantaged 
backgrounds who aspire to be physicians are more likely than 
their peers to drop their aspirations before the 12th grade, in 
part due to lack of exposure, and cultural, structural, and 
racial biases in society.

    Efforts to inspire students from underrepresented 
backgrounds to pursue a career in medicine should begin at the 
grade school level. Through pipeline programs, college 
readiness initiatives, and mentoring opportunities that provide 
guidance and proctored hands-on activities for students, we can 
inspire these future leaders to attain their aspirations, 
despite any obstacles encountered along the way.

    With persistent exposure to careers in health care, we will 
see a significant increase in the number of Black Americans in 
the medical field. The cost of American medical education has 
increased substantially over the past decade. Attending medical 
school without a scholarship can result in hundreds of 
thousands of dollars of debt.

    Despite this, students continue to aspire to be--to have a 
career in medicine. These aspirations are thwarted when 
students are not able to afford housing, food, and other 
necessities while at school. The burden of accumulating debt 
while attending school works to deter potential students from 
this rewarding career.

    Learners need student loan debt forgiveness, increased 
funding for scholarships, and more financial support for our 
HBCU Medical School to be able to afford to continue their 
education.

    We can achieve this goal with a substantial increase--of a 
substantial increase in Black American representation in the 
medical field, but it will take more individuals like you, 
Senator Sanders, and the HELP Committee, to achieve--thank you.

    [The prepared statement of Ms. Randolph follows:]
                  prepared statement of sonya randolph
    It is imperative that we as a country understand the significance 
of Black physicians providing care for Black patients. Studies show 
that when Black patients are treated by Black doctors, they are more 
satisfied with their healthcare, more likely to have received the 
preventive care they needed in the past year, and are more likely to 
agree to recommended preventive care. Though the AAMC reports an 
increase in Black or African American medical school matriculants in 
2022-23, now making up 10 percent, we have even greater work to do. 
With key factors such as student loan forgiveness, increased exposure 
and visibility, and mentorship for students aspiring to be in 
healthcare we can increase the number of Black Americans in the medical 
field and subsequently improve health outcomes for Black Americans.

    According to an article written in the New England Journal of 
Medicine, children from underrepresented or disadvantaged backgrounds 
who aspire to be physicians are more likely than their peers to drop 
those aspirations before 12th grade in part due to a lack of exposure 
and structural and racial biases in society. Efforts to inspire 
students from underrepresented backgrounds to pursue a career in 
medicine should begin at the grade school level. Through pipeline 
programs, college readiness initiatives, and mentoring opportunities 
that provide guidance and proctored hands-on activities for students, 
we can inspire these future leaders to attain their aspirations despite 
any obstacles encountered along the way. With persistent exposure to 
careers in healthcare we will see a significant increase in the number 
of Black Americans in the medical field.

    The cost of American medical education has increased substantially 
over the past decade. Attending medical school without a scholarship 
can result in hundreds of thousands of dollars of debt. Despite this, 
students continue to aspire a career in medicine. These aspirations are 
thwarted when students are not able to afford housing, food, and other 
necessities while in school. The burden of accumulating debt while 
attending school works to deter potential students from this rewarding 
career. Learners need student loan debt forgiveness, increased funding 
for scholarships, and more financial support for HBCU medical schools 
to be able to afford to continue their education.

    For some, the topic of Black representation in the medical field 
may seem like a trivial matter, but for others it may mean the 
difference in the life of a loved one. For a young Black couple who 
presented to the hospital to an all-white healthcare team with concerns 
that their 5-year-old son was ill, this topic is of particular 
importance. This couple trusted their son to be cared for by a capable 
group of physicians that they believed would render quality medical 
care for him. How could they have known he would be misdiagnosed with a 
24-hour, instead of his actual diagnosis of bacterial meningitis which 
proved to be fatal the next day. Why weren't their concerns taken 
seriously? Why did he not receive the appropriate standard of care? 
Could this outcome have been any different if they were attended to by 
a Black physician? The couple in this story are my parents and the 
young child was my brother, Bryce, and the reason I aspire to become a 
physician. I want my patients who look like me and those who don't look 
like me to both receive the same excellent care in an equitable manner.

    We can achieve the goal of a substantial increase in the Black 
American representation in the medical field, but it will take more 
individuals like you, Senator Sanders, and the HELP Committee to 
achieve this goal.
                                 ______
                                 
    The Chair. Last but not least--and thank you, Sonya. Dr. 
Jamil Joyner, who is a medical student here at Morehouse.

    STATEMENT OF JAMIL JOYNER, STUDENT, MOREHOUSE SCHOOL OF 
                     MEDICINE, ATLANTA, GA

    Mr. Joyner. Good morning, everyone. Thank you, Senator 
Sanders. Thank you all of my co-panelists. All of your words 
beautiful and you give me a great chance to close this out 
tonight. I don't know if I will be as eloquent, but I will try 
to be as pointed.

    I mean, as directly to what I believe the solution is for 
how we increase diversity and ultimately health outcomes for 
our black, Latino, and underrepresented communities.

    Myself, I am the third generation HBCU graduate, soon to be 
a HBCU graduate in a week or so, so I don't know if there is 
anyone that could tell you all anymore how vital HBCUs are as a 
cultural and economic pillar, not only within the communities 
that reside in the West end, but in the black community at 
large.

    Studies continue to show that HBCUs are disproportionately 
responsible for producing black educated graduates, as well as 
black professionals, disproportionate to the size of their 
position within the larger college party, as well as their 
proportion of black students that they education.

    That shows that these institutions are not only vital to 
the number of black students that they produce, but they are 
better at it--we are better at it. And we are better at it for 
obvious reasons. While answering the question of how to improve 
black health outcomes is multifaceted, and we know that one 
answer is increasing the number of black providers, and we know 
that the place that produces the most black providers are 
HBCUs.

    Not only do black providers or black patients do better 
with black providers. We know that black providers are more 
likely to go into primary care specialties, as well as practice 
in underserved areas of need.

    I believe that black schools, HBCUs are the key to 
increasing the number of black providers, as has been 
mentioned, due to their unique capability, commitment to 
educating these providers, as well as the relative feasibility 
of increasing their capacity to do so.

    In 2018, 2019, the AAMC published that roughly about 1,250 
black or African American identifying students graduated from 
U.S. Memphis schools. Out of roughly 150 of those U.S. medical 
schools, three, and now four or five, or hoping more as we go, 
are HBCUs.

    We are talking to about 2 percent of the total schools. But 
that year, they produced roughly 250 to 300 of those black 
educated students out of that 125. We are talking about 2 
percent of the schools producing roughly 20 percent of the 
physicians, not just historically 50 percent total, but to this 
day, these institutions right here, as was mentioned, without 
them, there would be no progress. There would be no retaining 
of our status quo, which--[technical problems].

    These facts aren't just the law of how great these 
institutions are. It is to show the potency of what resources, 
finite resources that we all are very familiar with that we 
have, can do at these institutions. We are talking about 
potentially increasing these institutions' incoming classes by 
50 percent, having a total 10 percent increase in the yearly 
production of black physicians, let alone other providers.

    Dollars here go further than dollars everywhere else, 
because what we do here is better than what they do everywhere. 
Every year, thousands of capable applicants to medical school 
are denied, hundreds of which are black.

    While a universal increase in the number of medical schools 
matriculants is needed, we know that HBCUs--increases at HBCUs 
would one, translate most directly to an increase in black 
physicians and black providers, as well as again two, require a 
relatively small amount of capital and infrastructure support.

    Improving black health outcomes begins with increasing 
black representation within health care, and most effective way 
to do that is to support the growth of HBCU medical schools 
through direct capital funding for physical infrastructure 
expansion and increased operating expenses.

    Thank you.

    [The prepared statement of Mr. Joyner follows:]
                   prepared statement of jamil joyner
    HBCUs serve as vital cultural and economic pillars of not only the 
communities they reside in but the African American community at large. 
Studies continue to show the prowess of HBCUs in educating a 
significant percentage of Black professionals, disproportionate to 
their representation among the total # of colleges and universities and 
to their proportion of Black students enrolled. As a proud double HBCU 
alum, I can attest to the impact and importance these institutions have 
on the development of leaders equipped to go out into the Black 
community and work toward positive change and equity.

    While the answer to improving Black health outcomes is 
multifaceted, we know that one answer is to increase the number of 
black healthcare providers educated. Not only do Black patients have 
better health outcomes when cared for by Black providers, Black 
providers are more likely to go into primary care specialties and to 
practice in underserved areas of need. I believe that HBCUs are the key 
to increasing the number of Black healthcare providers do their unique 
capability and commitment to educating these providers as well as the 
relative feasibility of increasing their capacity to educate more 
providers. In 2018-2019 the AAMC published that roughly 1,250 Black or 
African American identifying students graduated with a U.S. M.D. from 
roughly 150 accredited Medical Schools. That same year Morehouse School 
of Medicine, Meharry Medical College, and Howard University College of 
Medicine graduated roughly 250 Black M.D.s. 3 Schools, accounting for 
?2 percent of all medical schools, producing ?20 percent of all Black 
graduates. These facts clearly show the potency of resources directed 
toward HBCU Medical Schools and their production of Black physicians.

    Every year thousands of capable applicants to Medical, hundreds of 
which are Black, are denied admission because of limited capacity. 
While a universal increase in the number of Medical School matriculants 
is needed, we know that at HBCUs these increases would (1) translate 
most directly into an increase in Black physician produced and (2) 
require a relatively small allocation of funds compared to the 
resulting increase. A 50 percent increase in the graduating classes of 
the 3 aforementioned institutions represents a potential 10 percent 
increase in the yearly production of Black Physicians, while only 
carrying a price tag in the lows 8 figures.

    Improving Black health outcomes begins with increasing the Black 
representation within healthcare, and the most effective way to do that 
is to support the growth of HBCU Medical Schools through direct capital 
funding for physical infrastructure expansion and increased operating 
expenditures.
                                 ______
                                 
    The Chair. Thank you, Jamil. What I want to do now is kind 
of open it up. And if it is okay with you, what I would like to 
do is ask you guys some questions and then you can ask me 
questions as well. But let me say this, and I might get in 
trouble for saying this, but--I often get in trouble, but this 
has been really one of the more extraordinary panels that I 
have been involved with.

    Now, I will tell you why, frankly. You know, Harvard and 
Yale are great medical schools, and we appreciate all that they 
do. But at the end of the day, speaking just for myself, what 
we need in this country are medical schools and doctors who are 
prepared to go out and serve people who are in need. I am sure 
that they need more plastic surgeons on Park Avenue in New York 
City.

    But I can think of many other parts of this country where 
there are zero doctors, where people are dying, women are 
traveling 100 miles to see a doctor when she is giving birth. 
And we need doctors who are prepared and medical schools who 
are prepared to train those who are going out serving the 
underserved.

    Now, this panel has raised just a whole lot of questions, 
and just one point I want to touch on, why we must 
significantly increase the number of doctors. We didn't talk 
about nurses--nurses, dentists, got to do all that.

    Medical health councils, mental heatlh counselors, got to 
do that, all right, with a special focus on Black, and Latino, 
Native Americans, American, and medical health personnel. We 
have got to answer questions like you raise, Dr. Cook, the 
issue of the determinants that results in life expectancy, 
lower life expectancy.

    It is not just health care. So, if you are going to be 
treating somebody who does not eat or at least have a decent 
diet, somebody who is working 60 or 70 hours a week with 
minimum wage what the likelihood is that that person is going 
to have a significant lower life expectancy than somebody who 
has money.

    Here is a statistic that goes beyond race. This is a 
statistic that is absolutely shocking. While life expectancy is 
declining in America, the difference between the people on top 
and working class Americans is 10 years. Poverty in itself is a 
death sentence.

    I mean we have an enormous amount of work to do. This is 
the wealthiest country in the history of the world. People, we 
should not have half a million people who are homeless, 
etcetera, etcetera, all right.

    I want to thank this panel. It has been a great panel. And 
we are going to take your testimony and do our best, I am not 
making any promises, but we are going to do our best to 
incorporate your ideas into legislation. Okay, let me start off 
my question, and you ask me a question.

    We have heard the issue of student debt. Does anybody think 
it is vaguely sane that at a time when we desperately need more 
physicians, especially black and Latino physicians, that we are 
asking people to leave school, medical school, $300,000, 
$400,000 in debt?

    All right, who wants to talk in the audience about student 
debt, what it means to whether or not young people are going to 
become physicians, where they are going to practice as 
physicians, and the stresses on your family?

    Who wants to talk about that for a moment? Don't be shy, 
guys. I see a hand right here.

    Ms. Shasanmi Ellis. My name is Rebecca----

    The Chair. Rebecca, speak closely into the mic, please.

    Ms. Shasanmi Ellis. My name is Rebecca Shasanmi Ellis. I am 
a graduate of Morehouse Medicine, M.P.H., 2009. Student debt. 
Having been someone who came into the health field knowing that 
I was committed to underserved communities, I went out and I 
served in North Philadelphia.

    I have served globally. Student debt still follows me 
today. I am a nurse, and I am even faculty at one of the top 
nursing schools in the country, but student debt still follows 
me. What needs to be done about student debt?

    Some of what is facing us right now, like the legislation 
to forgive debt for those who have been serving in nonprofit 
and even public service positions, that needs to be pushed, 
that needs to be pushed back, that it is time--it is time to 
recognize that those who have been historically 
disenfranchised, those who come from minority and even low 
income backgrounds, they need relief from the debt so that we 
can keep doing the good work that we have begun.

    I think another thing that was raised by the panel is that 
supporting pipeline programs. Pipeline programs are so key. It 
prepares young people to understand what is the road ahead. It 
helps them to understand the varied field of health care. So 
medical education is one part, nursing education is one part, 
going to dental education, etcetera, etcetera, etcetera.

    Even mental health is another part. And then the other part 
of it is financial literacy. I think a lot of the programs need 
to build in--and even updating the capacity of minority serving 
institutions and HBCUs to talk about financial literacy with 
their students.

    How do I make it--how can I remain in underserved 
communities working and still have the wherewithal to pay down 
my student loan debt?

    The Chair. Rebecca, thank you very much. Okay, somebody 
have a question for me, which I will try my best to answer or 
push on to somebody else who might have a better answer? Yes.

    Dr. McCoy. Thank you very much, Senator Sanders, for being 
here, and the panel who are here. So, your question has to do 
with what is it like to finish medical school free of debt?

    Well, I stand as one of those individuals who, as my cap 
shows, is from University of Texas Medical Branch in Galveston. 
And when I finished medical school and did my residency there, 
and graduated, I had $5,000 back in now 50 years ago, in the 
bank. I had no debt.

    What it did for me at that point was to allow me to go to 
Mombasa and serve at the Southern Baptist Mission without 
thinking about paying debt.

    I spent a year and a half with the University of Nairobi, 
teaching in the surgery department free of debt, to come to 
Morehouse School of Medicine, Atlanta, Georgia as a person 
without debt to give lovingly, and kindly, and empathically to 
the patients that I saw and to the students that I taught, to 
the learners that I taught.

    What it means? It means that I had no debt, therefore, I 
could give freely what had been given to me. Thank you.

    The Chair. Another question--somebody raised the issue of 
salaries for residents. I spoke to residents at the University 
of Vermont Medical School. They were telling me they were 
working 70, 80 hours a week.

    I hadn't realized how residents were really almost 
maintaining the local hospital. Didn't know that. So, when you 
get elected to the Senate, you actually began learning things.

    They were making, as I recall, something like $62,000 a 
year. So, if you worked, was that roughly what you got?

    Dr. Cook. Spot on.

    The Chair. Pardon me?

    Dr. Cook. Yes.

    The Chair. Okay. All right. So, what does it mean if you 
have a family, and you are working very long hours and you are 
making $62,000 bucks? What impact does that have on your life 
and your ability to go forward? Who wants to address that one? 
Yes.

    Dr. Ivonye. Thank you for your visit, Senator Sanders. I am 
Dr. Ivonye and a--[technical problem]--of GME, over the--
[technical problems]. Thank you. Over all our--training 
programs. I would say I live with this precedent.

    I know what they feel. PGY1 make about $50,000. PGY2s about 
$63,000. And it goes up by about $2,000. Some of the residents 
have families. They have relatives. They have student loan. 
They have other obligations. Inflation--and inflation, every 
day is affecting our residents. They walk long hours taking 
care of our patients, the more vulnerable.

    Talking to them, they are not earning livable wages to 
sustain what they do. I appear to you to please take the 
message back to the Senate that our residents deserve better 
compensation to live well.

    You said poverty is a disease, and a threat to long life 
and prosperity. Thank you.

    The Chair. Okay. Anybody wants to ask about myself or 
anybody up here on the panel a question? Okay.

    Public Speaker. Thank you. Thank you for being here, 
Chairman Sanders, and hosting it, Dr. Montgomery and the 
panelists. It is a question in regards to the residents, but 
not so much about the payment. Anyone in the panel can answer 
it.

    It is--I have been hearing and we have all been hearing a 
good amount about how you guys? plan to pretty much increase 
the number of students in medical institutions and having 
regional places as well in different states.

    But I was hoping you guys can reiterate what are we going 
to do, or what do you guys? plan to do about these available 
spots in the residency programs? What point is it to increase 
the amount of students in medical institutions if the spots are 
still limited in their residency programs?

    The Chair. Thank you. The answer is, as you have heard, 
every year there are thousands of students, and somebody up 
here correct me, who graduate medical school who cannot find a 
residency spot, which is--at a time where we are in desperate 
need of doctors, that gets slightly insane.

    Welcome at the U.S. Congress.

    In Build Back Better, which was a major piece of 
legislation which would have dealt with many of the issues we 
are talking about here today, which lost by two votes, we 
substantially increased the number of GME slots, I think by 
about 14--what was it, 1,400? 2,000, which would have gone a 
long way to address this issue.

    The other thing that we are trying to do with graduate 
medical education slots is to put an emphasis on primary care. 
We want to encourage medical schools to graduate students who 
are prepared to serve in underserved areas. There is a major 
crisis in doctors in general, especially in primary care, so we 
wanted to address that as well.

    I hope that within the midst of the GME issue, we can deal 
with the issue of salaries for residents as well. The other 
thing we are doing, there is a program called the Teaching 
Health Center Program, which will allow right now residents 
usually attached to large medical facilities, hospitals, what 
we want to do is give residents the opportunity to get their 
education and get early qualified health centers as well.

    That is in community health centers and primary care. So 
that is a program that is expanding. We want to substantially 
expand it. One program we did not talk about, in the American 
Rescue Plan, we tripled funding for the National Health Service 
Corps.

    Is that something you guys are familiar with? All right. 
And that is a model that says if you are prepared to serve, I 
think it is 5 years or so, in an underserved area, we will 
forgive your student debt.

    We want to substantially increase funding for that again. 
But the bottom line here is I think everybody has said, at a 
time when we desperately need physicians, we especially need 
African American and Latino physicians, we need to have 
physicians in underserved areas, the idea that people are 
graduating medical school hundreds of thousand dollars in debt, 
which prevents them from doing the work--you heard the previous 
gentleman talking about his ability to go to places he wanted 
to go. He couldn't do that if he was--$500,000 in debt.

    There is a lot of work to be done, and that is some of the 
issues that we will be addressing. Okay. Other questions? 
Comments? Yes. I am sorry----

    Mr. Chambers. Hey, how is it going, Senator Sanders.

    The Chair. Good.

    Mr. Chambers. My name is Ty Chambers. I am an artist and an 
entrepreneur. I am currently in the M.P.H. program here at 
Morehouse School of Medicine. And I just wanted to ask a 
question about universal health care. Gavin Newsom over in 
California has been doing some great work----

    The Chair. Pull the mic a little bit closer to you.

    Mr. Chambers. Gavin Newsom in California is doing some 
great work as far as getting health care to Americans in that 
state and also undocumented immigrants.

    I just wanted to know, as a sitting U.S. Senator, how soon 
do you see something like that in the single player health care 
system come into to fruition federally?

    The Chair. Oh, boy. On Wednesday, this coming Wednesday in 
D.C., I will be meeting with, I think, several hundred doctors 
and nurses to announce that we will be introducing legislation 
for a Medicare for all single payer program.

    But I want to, and I think it is important--look, I have 
enormous respect, unbinding respect for the people up here and 
you who are devoting your lives to serving the underserved, and 
that is what you are going to have to do. But I am even asking 
more of you than that.

    You can knock your brains out 24 hours a day, doing 
fantastic work, saving lives, and yet if you have a system that 
is totally broken, the situation overall is not going to--we 
have got to change the system. But what are the basic tenets? 
And this--what I am telling you now and what you all know is 
not a radical idea, all right.

    We spend twice as much per person on health care as any 
other country. With the amount of money we spend, every 
American, child, elderly person should have quality health 
care. That is what we should do. You asked me that question, 
all right. It is a very political question.

    That is all right, we are allowed to be involved in 
politics here, too. I do that occasionally. What does it mean? 
The system today, the health care system today is working 
really good, for the insurance companies and for the drug 
companies.

    They are making tens of billions of dollars a year. It 
ain't working so well for working people, for low-income 
people, people of color, young doctors. But what we need to do, 
and I am not going to give you a 3-hour speech on this--could 
because I believe in this passionately--what we need to do is 
very simply.

    Create a health care system designed to provide quality, 
affordable health care to all as a human right, not a system 
designed to make huge amounts of money for insurance companies 
and drug companies. This is not a radical idea, all right. You 
will all understand--I want you to understand. You practice in 
Canada, all right.

    Do you know how much people have to take out of their 
wallet to walk into your practice? Zero. They go to a hospital, 
they got a serious illness, are in a hospital for a month. They 
walk out, no bill at all, all right. And yet they spend half as 
much per capita as we spend on health care, all right.

    As we go forward and as you do the enormously important 
work you do taking care of your patients, we also need to 
understand that we have to change the system. But the 
opposition there is enormous. The people who are making the 
money want to maintain the status quo. It is working for them.

    If I could, as a politician, talk about this 24 hours a 
day, you as physicians will have more impact on this debate 
than I will have. You will say that you want to treat all the 
patients who walk at your door, not just those who have the 
money, right.

    You don't want to see people walking in the door who should 
have walked in the door 6 months before because they didn't 
have insurance. We need your help on that. Yes, ma'am.

    Dr. Day. Good morning. My name is Shaila Day. I am an 
internal medicine physician. I am one of the faculty members 
for the GME program.

    But my question is to Dr. Skorton and also the leaders of 
the HBCUs here on the panel. I think one of the things that we 
need to address in terms of making physicians more culturally 
competent is getting rid of the racist medical education that 
exists.

    What is being done about change in the curriculum? Because 
I feel like even as someone who is black, what I learned in 
medical school was inherently racist, if we are going to be 
honest. And even growing up as a black person, I can't change 
that. But what I was taught sort of changed my thinking 
sometimes.

    I will tell you, there has been times when I have had bias 
that I really couldn't believe because I am like, well, it is 
in conflict with who I really am, but that is the education 
that I was given. So, what is being done about that curriculum 
or how can we address that? Because I think that is also 
important.

    Dr. Skorton. Thank you very much for raising this. And 
before I answer real quick, I just want to say, Senator, 
everything can't be on you. We have to work with you in the 
private sector to make this work. You can't do everything 
yourself in Washington.

    This is unbelievably important, and this is what we are 
trying to do about it. Obviously, we are not getting the job 
done yet. Out of our strategic plan, we have a specific plan 
based on this. If you grab me right afterwards, I will tell you 
how to find out more about that. Get involved, criticize it, 
write to me, and so on.

    That is one thing. Second, periodically, very periodically, 
the AAMC will send out a suggestion to all 157 medical schools. 
We don't tell them what to teach. Those curriculums are 
developed appropriately by the faculty locally.

    But we will say here are some competencies that we think 
are so important, that we would like you to consider putting 
them into practice. And just a few months ago, we sent out 
diversity, equity and inclusion, anti-racism competencies. If 
you haven't had a chance to see them yet, I will also tell you 
how to find them if you want to have some fun.

    I introduced those competencies in an Op-Ed with the Dean 
of the University of Miami School of Medicine, Ari Ford, and 
the editorial board of the Wall Street Journal, who came after 
us saying that this was all baloney. There is no such thing as 
embedded racism and so on.

    If you want to have some fun at my expense, read that 
exchange that we had. But we are beginning to work on it. It is 
unbelievably important to do that. Since I have gone to the 
floor, two more quick things, Chairman. One is about the 
residents? situation. Are the residents employees? Are the 
residents trainees? And the answer is yes.

    We have--always have a resident on the board of the AAMC. 
At our last board meeting, we had a long 74 slide presentation 
by the residents, three of them from the organization of 
resident reps that gave us basically what Dr. Cook gave us but 
wasn't limited by that little clock going off in red. And we 
are just starting to tackle and figure out what that is.

    The last thing, about the debt is, I was a college 
President twice, and somehow every curriculum, whether it is 
English literature or physics, takes 4 years. It can't just be 
a coincidence. This is just sort of the way things have always 
been. And there are experiments going on, Chairman, with 
different ways of medical training.

    Tuesday of next week I will be on Long Island giving a 
commencement to the second graduating class of a 3-year medical 
school where everybody does primary care.

    I am not saying everybody can do that, but that kind of 
experimentation--we can't leave the whole thing on the back of 
the U.S. Congress. Thank you for the question.

    Dr. Rice. I want to comment also on this. And so, Dr. 
Skorton said something very important early in his talk. 
Regardless of what happens with SCOTUS, we are going to 
continue to work to diversify the health care workforce.

    Regardless of what the Wall Street Journal and others say, 
we are going to ensure that we have a curriculum that helps us 
to move through our conscious and unconscious biases, which 
really do begin early on. And so many times we happen to 
unravel once we get into medical school.

    We are trying to make sure that we expose our learners to 
all of the opportunities to ask that question based on who 
sitting in front of me, what is possible. And it does mean that 
you have to deal with diversity, equity, inclusion, and racism 
because that is what this country has been founded on. And so, 
we have to begin to unravel.

    On match of this, and then I will just ask you all to 
believe that there is hope. You all remember the NAA--what is 
it, the basketball. They all love the sports, right.

    These college athletes have made a lot of money for 
colleges and universities. And they finally are starting to 
recognize, right, that that was in there. And so, we are 
recognizing that we are paying our residents for a service that 
doesn't align with their efforts.

    I know that Congress is going to work with us to be 
creative in how we can increase the wages. And that is what we 
need to do, because you should make a living wage that is 
reflective of you being able to live and care for your family 
and not incur all of the debt.

    We also have to recognize we have to create more programs 
to forgive debt, offer debt to be relieved based on the service 
that you have----

    The Chair. Okay. Two points. No. 1, I--my staff mentioned 
to me that we would have increased our GME slots by 14,000 over 
7 years. That was the number that I wanted.

    No. 2, I have got a plane to catch. Maybe two more 
questions, and I apologize for that, but we are not going to be 
able to take all the questions. So just the first two people. 
Yes, ma'am.

    Dr. Mallett. Good morning, Senator Sanders and panel. I am 
Veronica Mallett. I am the Chief Administrative Officer for 
this historic partnership between the Morehouse School of 
Medicine and CommonSpirit Health to increase the diversity in 
the health care workforce.

    My question is a follow-up to our previous questioners in 
the panel about what we can do as citizens in light of the 
pending decision and in this current political climate where 
there is a denial and an attack on fact.

    Given that, what can we do as citizens, and what would be 
your recommendation? Because, again, you can't do this alone. 
So, how can we help? How can we advocate?

    The Chair. Well, I think you know the answer. And by the 
way, let me thank the people of Georgia for giving us two 
excellent United States Senators. I would not be here as 
Chairman of the Committee if the people of Georgia had not done 
what they did. And that is what we have to do all over the 
country.

    Georgia actually is doing better maybe than any other 
states in this country in bringing people who often do not get 
involved in the political process. Lower income people, people 
of color standing up and fighting back. We have got to do that 
in Texas. We have got to do that in many, many states in this 
country.

    The ideas that we are talking about, which are being 
livestreamed. I suspect 200,000 people may watch it. People say 
nothing radical about this. This is what we should be doing. 
But so many people have given up on the political process. You 
know them, you see them every day. They don't vote.

    They don't--you know, they say, nobody cares about me, why 
would I want to vote? And we have got to bring those people 
into the process. You got to elect people who are going to 
stand up and fight for them, make a difference in their lives 
to show people that actually democracy can deliver for ordinary 
Americans.

    That is the challenge that we face. But thanks to the 
question. As to individuals who lie all of the time, I will not 
name any names, will not mention Presidents who have been 
pathological liars. I wouldn't do that.

    Oh, but, I mean, this is this whole thing, and artificial 
intelligence is going to make it worse. It really is. It is one 
thing to debate facts, right, difference of good knowing 
somebody is lying all the time pops up. But I am not mentioning 
any names. Yes, ma'am.

    Public Speaker. Good morning, Senator Sanders. Dr. 
Montgomery Rice and the panel, and every white coat in this 
building, I want to say thank you for your service.

    I am the product of the Morehouse pipeline and to the 
Health Informatics Master's Program. So, I want to say thank 
you for that opportunity. My question is for the panel.

    In light of what Senator Sanders just said with AI and the 
increase of technology in the medical profession, how do health 
programs that train health informatics, master's degree 
students, and health administrators and policy thought leaders 
figure into the funding that you all have mentioned here?

    Dr. Rice. I think my colleague who spoke to research 
infrastructure--I mean, I want to give you the opportunity to 
speak to that. I think that is where the key is. So, it is not 
just about getting you in the door. It is the, what is going to 
be the experience when you get there.

    Dr. South-Paul. I would love to comment that informatics, 
as we know, anchors everything we do in health care because it 
is the beginning of how we gather data, and data provides us 
the facts that allow us to appropriately look forward toward 
how we can make a difference.

    At Meharry Medical College, we have a new school, the 
School of Applied Computational Sciences. And that is a school 
that is now prioritizing how we manage data and integrating 
with their Enterprise Data Analytics Center, how we then gather 
the data, especially for populations that are most underserved.

    I think that inextricably linking those two things together 
is important. I was fortunate to just recently co-chair the 
National Academy of Medicine VA Whole Health Committee, and 
what we are trying to do is get whole health, comprehensive, 
not just physical, behavioral, spiritual, integrative health 
in--and implemented not only for veterans but for all of our 
populations.

    One of the anchoring things was having an electronic data 
system that will allow us to have the data we need. So, there 
are many efforts going on to show how important what you do is 
to allow us to--if we don't measure it, we can't change it. If 
we don't measure it, we don't know what is going on. So, all of 
those are so important for our vulnerable populations.

    The Chair. All right. Let me just thank Dr. Montgomery Rice 
for hosting this event. Let me thank the representatives of the 
great HBCU medical schools who are here, the students, the 
faculty, let me thank all of you.

    I think what we--this has been a great panel that at least 
I have enjoyed. It has been a great discussion. And the 
American people want us to succeed on this, all right. They 
perceive the crises that we are talking about today. So let us 
go forward.

    Let's work together. Let's bring the kind of change in this 
issue and so many others that the American people want to see. 
Thank you all very much for being here. Thank you. Any Senators 
listening in who wish to ask additional questions, our 
questions of the record will be doing ten business days on May 
26 at 5.00 p.m.

    Finally, I ask unanimous consent--I am the only person, I 
think I will get it--to enter into the record four statements 
from stakeholder groups related to the conversation today.

    [The following information can be found on pages 46 through 
52 in Additional Material.]

    The Chair. The Committee stands adjourned. Thank you all 
very much.

    Dr. Rice. And if I can just say on behalf of the Morehouse 
School of Medicine, the four historically black medical 
schools, the AAMC, and to all of you all, thank you, Senator 
Sanders, for showing us continuously what leadership looks 
like, for being our voice when others are not listening, always 
speaking louder than others.

    We appreciate that. And more importantly, though, we 
appreciate what you have to say because it leads to action, and 
it needs to change.

    Doctor, I can tell you that when I look at the doctors here 
and the to be doctors, and the to be M.P.H. students, and all 
of the students, they are relying on us to institute change 
that is going to be a better future for them, but more 
importantly, a better future for the American public.

    Thank you for your leadership, and we look forward to 
creating more partnerships.

    We are adjourned.

                          ADDITIONAL MATERIAL

               opening remarks of valerie montgomery rice
    Please allow me to welcome all of you to this very important 
roundtable meeting of the Senate Health, Education, Labor, and Pensions 
Committee to examine topics related to diversity in the healthcare 
workforce and addressing workforce shortages, hosted by Morehouse 
School of Medicine and the nation's three other Historically Black 
Medical Schools--Meharry Medical College, Charles R. Drew University of 
Medicine and Science, and the Medical School at Howard University. 
Historically and collectively our four schools have trained 
approximately half of the Black physicians in the country--so we know 
our stuff in this space!

    We are very grateful to HELP Committee Chairman Sanders, Ranking 
Member Cassidy, and all Members of the Committee for your interest in 
and focus on national health workforce challenges and your willingness 
to hear from the leaders of our institutions, view our campus--and most 
importantly--see the students that are the future of health care in the 
United States. We are proud of everything we do, but our students, 
graduates, and faculty are the crown jewel of each of our institutions.

    Notwithstanding the big contributions to the healthcare workforce 
by our four schools and others, we are facing broader social challenges 
that are expressed in our enrollment. Black males now represent less 
than 40 percent of medical school matriculants, and together, Black 
males and females represent only about 8 percent of all medical school 
matriculants--only about half of where we should be given that Blacks 
are approximately 13-15 percent of the U.S. population. Significant 
financial barriers exist for the very students from economically 
challenged backgrounds that we are trying to recruit. Consequently, 
Federal support for programs, and that of philanthropic organizations 
such as our scholarship partnership with Bloomberg Philanthropies are 
exponentially meaningful to our students and schools.

    Our institutions are poised to be at the vanguard of the national 
effort to improve diversity in the healthcare workforce and increase 
the sheer numbers of minority physicians. We stand ready to lead the 
way and set an example for all the medical schools in the country, 
because we four institutions can't do it alone. We need all the 
nation's medical schools to redouble their efforts to increase the 
enrollment of people of color, provide support programs, and renew 
their commitment to this purpose. Consequently, we are very pleased to 
be joined today by Dr. David Skorton, President and CEO of the 
Association of American Medical Colleges, which represents all U.S. 
medical schools and teaching hospitals.

    To all of today's participants, I can't stress enough that now is 
the time to act! The nation is emerging from a devastating pandemic 
that shone a harsh light on how people of color and medically 
underserved communities are disproportionately impacted by a lack of 
access to qualified and culturally sensitive health care providers. At 
best, we can learn from this experience and do something meaningful to 
reverse this sobering national tragedy. The worst thing we can do is 
take no action and wish it were better.

    Legislators like Senator Sanders and his colleagues, our four 
schools, every other U.S. medical school, and health care systems 
throughout the Nation, have the power to make change happen. 
Collectively, we must also have the will to do so.

    Today, we will have the opportunity to share with Senator Sanders 
and his Committee our successes, plans, and challenges--and make 
specific recommendations for improving diversity in the healthcare 
workforce and strengthening our institutions.

    We are very grateful for this opportunity.
                                 ______
                                 
   American Association of Colleges of Osteopathic 
                                          Medicine,
                                        Bethesda, MD 20814,
                                                      May 10, 2023.
Senator Bernie Sanders, Chairman,
Senator Bill Cassidy, Ranking Member,
U.S. Senate Committee on Health, Education, Labor, and Pensions,
Washington, DC 20510.

    Chairman Sanders, Ranking Member Cassidy and esteemed Committee 
Members, as you examine our Nation's healthcare workforce shortages, 
especially in Black and other minority communities, the American 
Association of Colleges of Osteopathic Medicine (AACOM) believes that 
the physicians trained at our Nation's colleges of osteopathic medicine 
(COMs) are an important part of the solution. We commend you for 
holding today's field roundtable and appreciate you permitting AACOM to 
offer this written testimony for the record. AACOM stands ready to work 
with you and your Senate colleagues to advance policies and programs 
that will help ensure our Nation has the healthcare workforce we need 
for the patients of today and tomorrow.
                  About AACOM and Osteopathic Medicine
    AACOM is the leading advocate for osteopathic medical education 
(OME) and its commitment to improving public health. Founded in 1898 to 
support and assist the nation's osteopathic medical schools, AACOM 
represents 40 accredited COMs--educating more than 35,000 future 
physicians, 25 percent of all U.S. medical students--at 64 medical 
school campuses in 35 states, as well as osteopathic graduate medical 
education professionals and trainees at U.S. medical centers, 
hospitals, clinics and health systems.

    Osteopathic medicine encompasses all aspects of modern medicine, 
including prescription drugs, surgery and the use of technology to 
diagnose and treat disease and injury. Osteopathic medicine also 
confers the added benefit of hands-on diagnosis and treatment of 
conditions through a system known as osteopathic manipulative medicine. 
Doctors of Osteopathic Medicine (DOs) are trained in medical school to 
take a holistic approach when treating patients, focusing on the 
integrated nature of the various organ systems and the body's 
incredible capacity for self-healing. DOs are licensed in all 50 states 
to practice medicine, perform surgery and prescribe medications. The 
osteopathic medical tradition holds that a strong foundation as a 
generalist makes one a better physician, regardless of one's ultimate 
practice specialty--which is the reason why more than half of DOs 
currently practice in primary care. \1\ In excess of 7,300 DOs were 
added to the U.S. physician workforce in 2022, adding to the 141,000 
DOs already in practice. \2\
---------------------------------------------------------------------------
    \1\  National Resident Matching Program, 2021 Main Residency Match, 
available at https://www.nrmp.org/wp-content/uploads/2021/08/Advance-
Data-Tables-2021--Final.pdf
    \2\  American Osteopathic Association, 2022 report tracks increased 
growth in the osteopathic profession, available at https://
osteopathic.org/about/aoa-statistics/

    AACOM and its member institutions have made a concerted effort to 
promote training in diverse healthcare settings, such as community 
hospitals and healthcare facilities located in underserved parts of the 
country. Sixty percent (60 percent) of osteopathic medical schools are 
located in a federally designated Health Professional Shortage Area 
(HPSA), and 64 percent require clinical rotations in rural and 
underserved communities. Our research shows that the location of 
medical education and residency training directly impacts practice 
location, so the osteopathic community training model leads to more 
physicians in underserved areas.
    AACOM and our Colleges of Osteopathic Medicine Are Committed to 
Increasing Medical Student Diversity and Ensuring Medical Education Is 
                           Accessible to All
    It is AACOM's goal to enhance the diversity of osteopathic medical 
students to contribute to the development of a culturally competent 
healthcare workforce. Underrepresented minority students currently 
account for 12.1 percent of matriculants across the nation's COMs. 
AACOM is committed to positively impacting these rates while increasing 
the number of qualified applicants pursuing osteopathic medicine.

    In 2021, AACOM member institutions unanimously released a Consensus 
Statement on Diversity, Equity and Inclusion acknowledging that the 
American education system is affected by systemic inequities that 
impact the diversity of the applicant pool to osteopathic medical 
schools. \3\ The statement also outlines model strategies to improve 
and support diversity, equity and inclusion across osteopathic medical 
education, as well as opportunities to reframe and expand diversity, 
equity and inclusion efforts.
---------------------------------------------------------------------------
    \3\  AACOM, Consensus Statement on Diversity, Equity and Inclusion, 
available at https://www.aacom.org/docs/default-source/old-documents/
old-to-sort/consensus-statement-final.pdf

    AACOM created a new program for its member colleges to advance 
diversity by supplementing instruction around health equity and health 
disparities--AACOM's Academic Recognition Program. \4\ Launched in 
2022, this program is available to second-and third-year medical 
students at every COM in the United States. The program's initial 
course is focused on inequities and disparities, while subsequent 
courses enhance the student's ability to recognize and understand 
circumstances that may contribute to inequities.
---------------------------------------------------------------------------
    \4\  AACOM, Academic Recognition Program, available at https://
www.aacom.org/programs-events/programs-initiatives/academic-
recognition-program

    Moreover, AACOM's Council on Diversity and Equity (CDE) promotes 
evidence-based practices and programs to foster a culture of diversity 
and inclusion at our COMs. \5\ CDE initiatives have included the 
creation of a free online course focused on unconscious bias for 
healthcare and medical research professionals, medical students and 
medical educators and a collaboration with the Council of Osteopathic 
Medical Admissions Officers to increase DEI outcomes in recruitment by 
creating a more inclusive environment for applicants and matriculants.
---------------------------------------------------------------------------
    \5\  AACOM, Council on Diversity and Equity, available at https://
www.aacom.org/medical-education/councils-committees/council-on-
diversity-and-equity

    Last month, AACOM joined the Federation of Associations of Schools 
of the Health Professions in a statement encouraging academic freedom 
around diversity, equity and inclusion in schools of health 
professions. \6\ Creating a diverse, equitable, and inclusive academic 
health community is essential to patient care and a core competency of 
health professions education.
---------------------------------------------------------------------------
    \6\  FASHP, Statement on Ensuring Academic Freedom and Diversity, 
Equity, and Inclusion in Associations and Schools of Health 
Professions, available at https://www.aacom.org/docs/default-source/
advocacy/public-statements/fashp-academic-freedom-and-inclusion-
statement.pdf--sfvrsn=f2fc996f--3

    COMs are leading the effort to increase diversity in the physician 
---------------------------------------------------------------------------
workforce:

          In 2020, the Oklahoma State University Center for 
        Health Sciences College of Medicine (OSU-COM) at the Cherokee 
        Nation became the nation's only tribally affiliated medical 
        school. Currently, 11 federally recognized tribes are 
        represented in OSU-COM's student body and the school's Tribal 
        Medical Track prepares students to serve as primary care 
        physicians in tribal, rural, and underserved areas throughout 
        Oklahoma.

          The Maryland College of Osteopathic Medicine at 
        Morgan State University (MDCOM) is on track to become the first 
        new medical school at a Historically Black College and 
        University (HBCU) in 40 years. As one of only five medical 
        schools at an HBCU, MDCOM will strengthen and diversify the 
        physician workforce and improve healthcare access for the 
        underserved populations served by its students and graduates.

          The Cleveland Clinic Physician Diversity Scholars 
        Program is a partnership with the Ohio University Heritage 
        College of Osteopathic Medicine (OUHCOM). The program takes a 
        proactive approach to building diversity by giving first-year 
        URM students a unique opportunity for growth and engagement. 
        Those selected to participate in the 4-year program are matched 
        with a Cleveland Clinic health system physician with whom they 
        will have an opportunity to develop a mentor/scholar 
        relationship. The program is designed to complement each 
        scholar's curriculum at OUHCOM while offering purposeful and 
        meaningful interaction with underrepresented minority community 
        populations in a healthcare context. The Physician Diversity 
        Scholars program is open to all underrepresented minority 
        medical students at OUHCOM, Cleveland.

          The University of the Incarnate Word School of 
        Osteopathic Medicine's Anti-Racist Transformation in Medical 
        Education (ART in Med Ed) project is a 3-year project funded by 
        the Josiah Macy, Jr. Foundation to replicate the Icahn School 
        of Medicine and Mount Sinai's change-management strategy at 11 
        partner medical schools in the United States and Canada. The 
        project aims to develop the capacity of medical schools to 
        dismantle systemic racism and bias in their work and learning 
        environments and promote shared learning on how to dismantle 
        racism within and across medical schools.

                      AACOM Policy Recommendations
    Osteopathic medicine has a blueprint for success to address the 
crisis in our Nation's health care workforce, raise the number of Black 
Americans in the medical field, increase access to primary care and 
improve health outcomes for underrepresented Americans. We respectfully 
offer several recommendations for the 118th Congress to ensure a well 
trained and culturally diverse healthcare workforce for the Nation:

          Implement policies that leverage all available 
        physicians by ensuring that DOs and MDs have equal access to 
        federally funded GME programs. At least 32 percent of residency 
        program directors never or seldom interview DO candidates, and 
        of those that do, at least 56 percent require them to take the 
        USMLE (the MD licensing exam), in addition to the osteopathic 
        medical exam, COMLEX-USA. \7\ The demands of medical school are 
        arduous, and osteopathic students should not be subjected to 
        the additional 33 hours and $2,235 (as well as prep costs and 
        time) that is required to take the USMLE. Increased financial 
        and academic demands disproportionately impact underfinanced 
        and underrepresented populations and frustrates efforts to 
        diversify the healthcare workforce. Congress should pass 
        legislation that ensures all federally funded GME programs 
        accepts DOs and the COMLEX-USA.
---------------------------------------------------------------------------
    \7\  National Residency Matching Program, 2022 Program Director 
Survey, available at https://www.nrmp.org/match-data-analytics/
residency-data-reports/education debt, which can be a financial burden 
after graduation, during training, or in medical residency. Robust loan 
repayment and forgiveness programs decreases financial barriers for URM 
students and increases health equity.

          Provide permanent funding for the Teaching Health 
        Center Graduate Medical Education (THCGME) Program. This vital 
        program trains students in outpatient settings, such as Rural 
        Health Clinics, federally Qualified Health Centers and tribal 
        health centers. THCGME Program training sites prioritize care 
        for high-need communities and vulnerable populations, with more 
        than half located in medically underserved communities. 
        Permanent robust funding is needed to strengthen the THCGME 
        Program and establish a healthy, stable infrastructure for 
---------------------------------------------------------------------------
        physician training in outpatient settings.

          Increase funding for the Title VII and Title VIII 
        programs. These programs support the training and education of 
        health practitioners to enhance the supply, diversity, and 
        distribution of the health care workforce. Title VII and VIII 
        programs offer a lifeline to medical students facing financial 
        barriers and underserved communities afflicted by physician 
        shortages. Specifically, the Health Careers Opportunity Program 
        (HCOP) helps develop a diverse health workforce by investing in 
        K-16 health outreach, pipeline, and education programs through 
        partnerships between health professions schools and community-
        based organizations. Studies show that pipeline programs, such 
        as HCOP, increase the number of underrepresented students 
        enrolling in health professions schools, lead to heightened 
        awareness of factors contributing to health disparities, and 
        attract health professionals more likely to treat 
        underrepresented patients.

          Provide sustained funding for loan repayment and 
        forgiveness programs, such as the Public Service Loan 
        Forgiveness (PSLF) Program and National Health Service Corps 
        (NHSC), which incentivize physicians to practice in rural and 
        medically underserved areas and help alleviate student debt 
        obligations. Medical students take on significant

          Expand funding and support for community-based 
        training models, including clinical rotations in underserved 
        communities. According to the Health Resources and Services 
        Administration's (HRSA) Advisory Committee on 
        Interdisciplinary, Community-Based Linkages, there is a growing 
        trend toward providing care in smaller community-based clinics 
        instead of academic hospitals. As the provision of care has 
        shifted to community-based settings, so has the training of 
        medical students. Clinical training in these community-based 
        settings expose medical students to the unique healthcare needs 
        of rural and underserved populations and prepare them to serve 
        those communities after graduation. However, over three-
        quarters of all medical schools report concerns with the number 
        of clinical training sites and the quality and supply of 
        preceptors, especially in primary care. To support this trend 
        toward less expensive and less centralized care, Congress must 
        modify existing funding streams and establish new programs to 
        support community-based training. With underserved communities 
        suffering the most from physician shortages, Congress should 
        fund a new program within HRSA that creates a consortium of 
        osteopathic medical schools, rural health clinics and federally 
        qualified health centers to increase medical school clinical 
        rotations in underserved community-based facilities.
                               Conclusion
    On behalf of the 64 osteopathic medical school campuses and the 
35,000 medical students they serve, thank you for your consideration of 
our views and recommendations. Again, we are eager to be a resource as 
you examine and consider solutions to the nation's healthcare 
challenges. For questions or further information, please contact David 
Bergman, JD, Vice President of Government Relations, at 
[email protected].
                                 ______
                                 
                   American Federation of Teachers,
                                      Washington, DC 20515,
                                                      May 10, 2023.
Senator Bernie Sanders, Chairman,
Senator Bill Cassidy, Ranking Member,
U.S. Senate Committee on Health, Education, Labor, and Pensions,
Washington, DC 20510.

    Dear Chairman Sanders and Ranking Member Cassidy:

    Thank you for your continued focus on healthcare staffing issues. 
The American Federation of Teachers is the nation's fastest-growing 
union of nurses, representing more the 200,000 nurses, technicians, 
therapists and physicians in hospitals nationwide. The AFT has had a 
standing committee on healthcare equity for many years, so the topic of 
this field hearing--``How Can We Improve Health Workforce Diversity and 
Address Shortages?--is of particular interest to our members.

    As our Nation's hospitals remain understaffed and the demand for 
healthcare professionals rises, there is an opportunity to make 
considerable progress toward greater workforce equity, which is a key 
component of truly focusing on health equity as the nation's population 
continues to diversify. When healthcare professionals reflect the 
populations they serve and operate with a deeper cultural sensitivity 
to their patients' life situations, patient outcomes improve. This, in 
turn, increases the comfort level of patients seeking care, who want to 
trust that their health needs will be acknowledged and addressed.

    For numerous reasons, minority healthcare workers are 
underrepresented; and as the complexity of the positions and the 
salaries increase, the diversity of the workforce decreases. For 
instance, people identifying as Black or African American make up 13 
percent of the U.S. population, but they make up only 7 percent of 
nurse practitioners, a higher-paying role requiring more formal 
education than other nursing positions. This clearly demonstrates a 
lack of racial equity in the nursing profession, but it also 
demonstrates an opportunity to ``right the ship.''

    The AFT encourages the Committee to deploy new strategies to 
increase diversity in the healthcare workforce, such as addressing 
racism in healthcare workplaces; developing program models that expand 
career outreach programs in communities of color that are 
underrepresented in healthcare jobs; developing a workplace equity 
score that tracks healthcare facilities' workforce diversity numbers, 
and how many workers from underrepresented communities successfully 
advance along the career pathway to higher-paying positions; and 
regularly reviewing equity in compensation differences based on gender, 
race, sexual orientation, disability and all other protected classes.

    In addition to these strategies, we must address staffing 
challenges through improved working conditions, by addressing workplace 
violence and instituting safe patient-to-nurse staffing standards. 
Instead of doing so, hospitals have turned to staffing agencies--
domestic and international. Both types of agencies reduce capacity in 
home states and nations and ignore the underlying issues that have 
produced shortages. Passing the Nurse Staffing Standards for Hospital 
Patient Safety and Quality Care Act (S. 1113) and the Workplace 
Violence Prevention for Health Care and Social Service Workers Act (S. 
1176), as well as taking the actions described in this letter, Congress 
can alleviate staffing shortages, diversify the workforce and improve 
healthcare outcomes, instead of watching hospitals attempt to apply 
piecemeal temporary solutions.

    Another impediment to workforce equity is the student debt crisis. 
A 2019 analysis of data from the U.S. Department of Education found the 
average graduate of an associate degree in nursing program held $19,928 
in student debt. For graduates with a Bachelor of Science degree in 
nursing, the average debt was $23,711, and for graduates with a Master 
of Science degree in nursing, the average was $47,321. Nurses of color 
are more likely to have student loans and more likely to have higher 
loan balances, according to national debt statistics. Compared with 
their white peers, Black borrowers, for example, have higher total debt 
burdens and higher monthly payments. Four years after graduation, 48 
percent of Black borrowers owe 12.5 percent more than their original 
balance, while 83 percent of white borrowers owe 12 percent less than 
their original balance.

    No effort to recruit diverse talent into the healthcare workforce 
can be complete until the cost barriers for accessing and completing 
higher education and training programs are addressed. Targeted 
financial aid and loan repayment programs should be expanded, including 
the National Health Service Corps and the Nurse Faculty Loan Program.

    Thank you for considering our views on this important subject. The 
AFT stands ready to help you pass legislation to address healthcare 
staffing shortages.

            Sincerely,
                                          Randi Weingarten,
                                                         President,
                                   American Federation of Teachers.
                                 ______
                                 
     federation of association of schools of the health professions
Lack of Men of Color Graduating From the Health Professions Declared a 
                       Crisis by Association CEOs
    Washington, DC-The Federation of Associations of Schools of the 
Health Professions (FASHP) has declared the low number of historically 
underrepresented men of color (HU MOC) graduating and entering the 
health care professions a national crisis. Representing CEOs of 
national academic health professions associations, FASHP has released a 
addressing this critical issue, and is calling on local and national 
educational, health care, governmental and community leaders to raise 
awareness regarding this critical issue and to identify barriers and 
provide resources to dramatically increase the number of men of color 
graduating from the health professions.

    ``We must urgently join forces with P-16 education, government, 
health care, corporations and other leaders to remove pathway barriers 
and adopt robust strategies that facilitate a significant increase in 
the number of historically underrepresented men of color entering and 
graduating from dental, pharmacy, veterinary medicine, social work and 
other health professions schools.'' said Dr. Karen P. West, Secretary 
of FASHP and President and CEO of the American Dental Education 
Association (ADEA).

    Similar disparities exist across the academic health professions. 
For example:

          Of 6,665 2021 U.S. dental school graduates, 3,223 
        (48.4 percent) were men (American Dental Association). Of 
        those, 431 (6.46 percent) were HUMOC (263 Hispanic/Latino men, 
        147 Black/African American men, 18 American Indian/Alaska 
        Native men and 3 Native Hawaiian/Other Pacific Islander men).

          Of 21,051 2021-2022 U.S. medical school graduates, 
        10,268 (48.8 percent) were men (Association of American Medical 
        Colleges [AAMC]). Of those, 1,251 were HU MOC (664 Hispanic/
        Latino men, 565 Black/African American men, 13 American Indian/
        Alaska Native men, and 9 Native Hawaiian/Other Pacific Islander 
        men).

          The 2021 graduating class of veterinary medical 
        students included only 0.6 percent Black/African American men, 
        1.4 percent Hispanic/Latino men, and 0.2 percent American 
        Indian/Alaska Native men.

    In pursuit of greater collective action, FASHP is establishing a 
coalition with associations across the academic health professions, 
health care institutions and health professional organizations to 
tackle the longstanding problem of the low numbers of HUMOC at health 
professions schools. FASHP plans to expand its work to galvanize P-16, 
governmental, health care, corporate, foundation, health care research, 
community and other leaders to develop short-and long-term strategies 
with focused action plans.
                       FASHP Member Organizations
    American Association of Colleges of Nursing

    American Association of Colleges of Osteopathic Medicine

    American Association of Colleges of Pharmacy

    American Association of Colleges of Podiatric Medicine

    American Association of Veterinary Medical Colleges

    American Dental Education Association

    Association of American Medical Colleges

    Associat;on of Chiropractic Colleges

    Association of Schools Advancing Health Professions

    Association of Schools and Colleges of Optometry

    Association of Schools and Programs of Public Health

    Association of University Programs in Health Administration

    Council on Social Work Education

    PA Education Association
                            Liaison Members
    Association of Accredited Naturopathic Medical Colleges

    American Council of Academic Physical Therapy

    American Occupational Therapy Association

    American Physical Therapy

    Association American Psychological Association
              FASHP Men of Color in the Health Professions
    Systematic racism and the oppression of people of color have 
resulted in significant underrepresentation of men of color (MOC) in 
the health professions Men of color refer to any individual who 
identifies as a man and is a underrepresented racially/ethnically in 
the health professions. MOC area disproportionately underrepresented in 
the health professions at all levels compared to other racial/ethnic 
and/or gender counterparts. A continued lack of awareness, 
marginalization and unconscious bias has led this issue to reach crisis 
proportions. This crisis is reflected in absolute numbers in academic 
institutions, in the representation of health professionals, in the 
elevation to leadership positions, and in health outcomes across the 
health professions.

    The underrepresentation of MOC in the health professions extends 
well beyond the specifics of low numbers and has significant 
consequences for public health, education, social justice and 
historically underserved communities. MOC area disproportionately 
under-recruited and retained throughout the K-16 and graduate education 
pathway, creating a national workforce shortage of a diverse health 
professions sector. Failure to adequately address the 
underrepresentation of MOC in the health professions will perpetuate 
and worsen education and health disparities, particular1y for 
underserved communities.

    Entities of health professional practice, research, education and 
policy have the individual and collective ethical and moral 
responsibility to prioritize increasing the presence of MOC in the 
health professions as an essential part of effecting positive 
structural and systemic change to improve educational and health 
outcomes for all.

    The historic and ongoing crisis of underrepresentation of MOC in 
the health professions has urgent ramifications, and it calls for 
intentional collaborative efforts to address it by the healthcare 
professions. their partners and stakeholders, in partnership with the 
communities they serve.
                                 ______
                                 
                        morgan state university,
  Maryland College of Osteopathic Medicine at Morgan State University,
    David K. Wilson, Ed.D., is the 10th inaugurated president of Morgan 
State University--Maryland'sPreeminent Public Urban Research 
University.

    Barbara Ross-Lee, DO, President, proposed Maryland School of 
Osteopathic Medicine at Morgan State University (MDCOM.) Three-time 
Medical School Dean, Legislative Assistant to Sen. Bill Bradley, NIH 
Advisory Committee on Women's Health, and U.S. HHS National Advisory 
Committee on Rural Health.

    John Sealey, DO, Founding Dean, proposed Maryland School of 
Osteopathic Medicine at Morgan State University (MDCOM.) Cardiothoracic 
surgeon, Former Chief of Surgery and Medical Director, Associate Dean 
of Clinical Education ARCOM, Regional Dean KCOM, DIO of Authority 
Health's Residency Program, and Graduate Medical Education (GME) 
Expert.

    Subject: Chairman, Sen Sanders Discussion Roundtable addressing the 
crisis regarding health care workforce, raising the number of Black 
Americans in the medical field, increasing access to primary care, and 
ideas on improving health outcomes for Black Americans.
                      Favorable--Written Testimony
    Morgan State University is the preeminent public urban research 
university in Maryland, known for its excellence in teaching, intensive 
research, effective public service and community engagement. Morgan 
prepares its students for diverse opportunities to succeed in the fast-
changing, competitive world they enter upon graduation.

    We are delighted to announce the establishment of the proposed 
Osteopathic Medicine School at Morgan State University, a pioneering 
institution dedicated to training the next generation of osteopathic 
physicians. This significant initiative is our response to the growing 
health care workforce shortage in our region and nationwide.

    The shortage of health care workers, especially in underserved 
rural and urban communities, is a significant challenge we face. Our 
proposed Osteopathic Medicine School addresses this pressing issue by 
providing the opportunity for quality education and training to 
students who aspire to have a career in osteopathic medicine.

    Osteopathic medicine is a distinct branch of medical practice in 
the United States that emphasizes a holistic approach to patient care. 
With the training provided by our institution at Morgan State 
University, we will equip students with the necessary skills to 
approach healthcare from a disease-centered perspective and a human 
health-centered one, focusing on preventive care.

    We are proud and excited to announce the opening of the Maryland 
College of Osteopathic Medicine at Morgan State University in the Fall 
of 2024, marking a significant moment in history. This will be the 
first time in 50 years that a Historically Black College or University 
(HBCU) has opened a medical school.

    Establishing our medical school is a critical step in our ongoing 
commitment to address our communities' historical shortage of health 
care professionals. Furthermore, this visionary undertaking is a much-
needed step toward increasing diversity in the medical field, as HBCUs 
have a long-standing tradition of training Black professionals and 
leaders.

    Our graduates will join the health workforce with a unique 
perspective that places emphasis on viewing the patient in their 
entirety rather than just their symptoms. This approach is crucial in 
addressing health disparities and providing well-rounded care in 
communities of color impacted by health disparities.

    We understand that the road to resolving the health care workforce 
shortage is long, and our institution is just one piece of a much 
larger puzzle committed to drilling down on the following issues that 
we deem crucial in determining the mission of the proposed Maryland 
School of Osteopathic Medicine at Morgan State University:

          1. The U. S. is projected shortage of between 37,800 and 
        124,000 physicians within the next 12 years, according to The 
        Complexities of Supply and Demand; Projections from 2019 to 
        2034 (PDF), a report released by the Association of American 
        Medical Colleges. This shortage accounts for primary and 
        specialty care physicians. The AAMC reports that physician 
        shortages hamper efforts to remove barriers to care.

          2. In 2010, the Sullivan's Commission report classified this 
        as a crisis in Care due to the lack of representation for 
        underrepresented minorities. This crisis was declared not only 
        Physicians but all health professions if this crisis persists.

          3. The more recent IOM report states an increasing the number 
        of minority health professionals is a key strategy to eliminate 
        health disparities. The data in the IOM report states that 
        cultural differences, a lack of access to health care, combined 
        with high rates of poverty and unemployment, contribute to 
        racial disparities in health status and health outcomes.

          4. As the U.S. Population grows more diverse, half of all 
        Americans are projected to belong to a minority group by 2044. 
        In the absence of work-force strategy, the problem is going to 
        get worse. Of the 200+ medical schools, only four are 
        considered Historically Black Colleges and Universities (HBCUs) 
        and contribute substantially to the number of minority 
        physicians practicing in the field. Creating a diverse 
        physician workforce can improve health outcomes and reduce 
        health disparities.

          5. Approximately 25 percent of medical student are currently 
        enrolled in medical schools. The profession's strong base in 
        primary care contributes to addressing physician shortage in 
        medical underserved regions. The proposed Maryland College of 
        Osteopathic Medicine at Morgan Stage University is planned to 
        continue the tradition of Osteopathic Medicine as the first 
        Osteopathic Medical School at an HBCU and as the first Medical 
        School at an HBCU in 50 years. MDCOM is educating high-quality 
        diverse physicians for specialties to practice in racially and 
        culturally diverse communities.

    The Maryland College of Osteopathic Medicine, and its affiliation 
with Morgan, represents yet another example of Morgan's enduring 
commitment to Baltimore and the region as an anchor institution 
producing leaders in a variety of industries.

    We believe that by investing in the education and training of 
future osteopathic physicians, we are investing in the health and well-
being of all communities.

            Respectfully Submitted,
                                       Dr. David K. Wilson,
                                                         President,
                                           Morgan State University.
                                 ______
                                 
    [Whereupon, at 11:27 a.m., the hearing was adjourned.]

                                   [all]