By Anne Federwisch, OTR
Illustrations by Malcolm Garris
August 6, 1998

The demise of race-based admission policies at Texas universities hasn’t hurt minority enrollment in schools of nursing and allied health as much as originally feared. But the numbers weren’t very good to begin with.

"The class coming in for this fall is probably just as diverse as it would have been three or four years ago," said Sherry Sancibrian, MS, CCC-SLP, associate professor in the department of communication disorders the Texas Tech University Health Sciences Center in Lubbock.

The estimated 8 percent minority enrollment there wasn’t affected by the 1996 U.S. Circuit Court ruling in the Hopwood case, which banned affirmative action at universities in Texas and the rest of the court’s jurisdiction beginning with the 1997-98 enrollment. "We have a big problem not only in our program, but in the field in general of not having much diversity," Sancibrian said.

Varied impact

Other allied health programs have had an easier time attracting minority applicants, though not in the same percentages as in the Texas population as a whole. For example, the health information management program at Southwest Texas State University in San Marcos consistently is 25 to 35 percent minority, according to Sue Biedermann, RRA, the program’s chair. She said that because the program’s admission criteria never relied on race as a factor, it was not affected by the affirmative action ban.

"The impact of the Hopwood decision has been that there is less pressure for admissions based on ethnicity," said Barbara Sanders, PhD, PT, president of the Texas Physical Therapy Association. "At the same time, there are fewer resources and options available [to boost minority enrollment]." Despite the challenges, targeted recruitment has managed to maintain average minority enrollment in PT programs at about 20 percent, according to Sanders, chair of the PT department at Southwest Texas State University.

Yet some programs have suffered a loss of minority students. The number of non-white nursing students at Texas Tech dropped from 106 in 1996-97 to 70 in 1997-98. That corresponded to the discontinuation of the affirmative action Enhance program, which had boosted minority enrollment, said dean Pat Yoder-Wise, EdD, RN, FAAN. "That program no longer exists because of Hopwood," she said. Yoder-Wise expects this year’s minority enrollment to again hover between 15 and 20 percent.

As president of the Texas Nurses Association, Yoder-Wise sees the under representation of minorities as a formidable problem for RNs. "We can certainly teach cultural sensitivity and valuing alternative ways of dealing with health issues as well as spiritual beliefs. But when you are part of that culture and a professional, you have a very different kind of connection," she said. Yoder-Wise fears that some students may leave the state to take advantage of scholarships and other affirmative action programs in areas unaffected by Hopwood. "I think Texas is seeing some real brain drain."

Minority powerhouse

One school that has never had difficulty attracting the best and the brightest students of color is Texas Southern University College of Pharmacy and Health Sciences in Houston, which offers degrees in pharmacy, medical technology, respiratory therapy, health information management, and other fields. Enrollment is typically only about 10 percent white, said Don Lewis, JD, RPh, assistant dean for academic affairs. Since 1949, the school has educated 35 percent of the nation’s black pharmacists.

"We have always been designated as a special-purpose institution that served minorities and the disadvantaged," Lewis said. "Therefore, we don’t have the problems that some of the majority schools have as far as attracting [minority] students to our campus." Race alone has never been the determining factor for admission, Lewis said. "We try to look at the total student, particularly their communication skills. The school typically receives 400 applications for about 130 slots.

Different approach

Many schools and organizations are devising ways to diversify the professions without relying on affirmative action. The University of Texas Medical Branch at Galveston physician assistant program used a lottery of all applications meeting the basic entrance criteria, explained Raymond Lewis Jr., MSW, ACSW, associate dean for student affairs in the school of allied health. The 100 students chosen were interviewed, and 47 made the final cut.

The resulting class is 36 percent minority, with blacks making up 7 percent of enrollment and Hispanics 17 percent. That’s better than the incoming 72-percent white physical therapy class, which has no blacks and is only 11 percent Hispanic. Lewis said that the lottery may eventually be used in other programs in the school of allied health, such as PT, OT, medical technology, and respiratory care.

One reason for the low representation of minorities in the health professions is that professional programs admit students in the junior year of college—and minorities are underrepresented in college to begin with, Lewis said. He’s optimistic that a new Texas law will help remedy the situation; students who graduate in the top 10 percent of their high school class will be guaranteed admission to state-supported universities. "Hopefully, it will give us a better pool," he said. "I’ve got my fingers crossed." It will be two years before the first students covered by the new law will be juniors.

Long-term solution

Why wait until college to target minorities? The Robert Wood Johnson Foundation and the W.K. Kellogg Foundation, in conjunction with the Health Professions Partnership Initiative, last month awarded six grants to increase minority participation in nursing, medicine, and other health professions. One was awarded to the University of Texas Health Science Center at San Antonio. A requirement of the grant is that efforts focus on middle and high school curricula.

"The basic idea is that a lot of schools that minority kids go to are disadvantaged schools," said Herbert Nickens, MD, vice president for community and minority programs for the Association of American Medical Colleges, which oversees the Health Professions Partnership Initiative.

By improving the middle and high school curricula, more students will be prepared for the science-based health professions. "There are all these courses that if you don’t take them, you don’t have a prayer of going on to college or graduate work in a science-related field," Nickens said.

It’s quite a long-term solution, Nickens admits. "But in our analysis of the problem, we think it’s the only sensible thing to do."

Why diversify?

Diversity in health care is needed to serve a diverse population. "That doesn’t mean the simple-minded matching of Laotian nurses to Laotian patients," Nickens said. "It’s really the notion that if you teach and learn in diverse teams, then you get some sense that people really are different from each other and you can’t approach patients as if they all have the same background and values."

Even individual health professionals can help diversify the profession, Sancibrian said. "What I wish would happen is that the speech pathologists who are out in practice—particularly in the schools, where you are with children anyway—would mentor some minority children. Let them know what a neat job you have."

By they time they reach college age, it may be too late.

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