Can increased access to community-based primary care and physician workforce diversity be achieved through support of U.S. international medical students and graduates: The Cuba experience

Increasing racial/ethnic diversity among the U.S. physician workforce is a national priority, yet the proportion of African American, Hispanic American and Native American physicians has remained low and static over time despite numerous interventions and initiatives. Additionally, we continues to face a dearth of primary care physicians and maldistribution in both rural and urban poor areas. Cuba's Latin American School of Medicine (ELAM) has created a novel opportunity for U.S. citizens, primarily racial/ethnic minorities, to attend medical school in Cuba at no cost with an explicit expectation of eventual practice in the U.S. in community-based primary care and in underserved areas. We propose to share our experiences post participation in a recent U.S. research delegation to Cuba and ELAM, placing our observations within the broader context of international medical graduates and physician workforce diversity.

Medical Education Cooperation with Cuba (MEDICC), a non-profit organization based in the United States, sponsored the research delegation and arranged a comprehensive agenda of activities to expose participants to several aspects of the Cuban health care delivery and medical education systems. The co-presenters were among 14 U.S. researchers, clinicians, and policymakers on the trip in November/December of 2010. Our data collection activities included site visits to community health centers, teaching hospitals and the schools of medicine and public health, meetings with key leaders in the Cuban health system, and ELAM students and leadership at the University.

The presentation will include a summary of the MEDICC December 2010 research program with a focus on experiences during actual site visits to several clinical and academic settings in Cuba, provide an overview of the Cuban health care training and delivery system, profile ELAM with emphasis on the experiences of and challenges for current ELAM students and graduates, and outline the implications of ELAM within the wider conversation of U.S. citizens who obtain medical training abroad and the goal of physician workforce diversity and accessible community-based care. This multimedia presentation will also include audiovisual content reflective of the delegation's recent trip and subsequent television interviews.

ELAM presents unique challenges and opportunities for policymakers interested in international medical graduates and physician workforce diversity. Furthermore, the tenets and organization of the Cuban medical education system may hold broader policy implications for the successful development of a robust primary care workforce in the U.S on the cusp of health care reform implementation and a demographically-shifting population.