The Educational Pipeline for Health Care Professionals: Understanding the Source of Racial Differences

While the representation of black students in medical schools rose dramatically from approximately 2 percent in 1965 to more than 7 percent in 1975, gains in the representation of blacks among health professionals have slowed, with blacks currently representing slightly more than 8 percent of first year medical students in the U.S. The underrepresentation of black Americans in the healthcare professions may have direct implications for the health outcomes of minority patients, underscoring the importance of understanding how individual characteristics, student achievement, and undergraduate experience differentially affect the completion of graduate training in the health sciences by race. We specify a model of individuals’ postsecondary decisions including college enrollment, college type, and baccalaureate degree completion, jointly with the decision to enter a health care occupation that requires an advanced degree. We estimate the parameters of the model with maximum likelihood using data from the National Longitudinal Study class of 1972. Our estimates highlight the importance of factors operating prior to post-baccalaureate study, such as pre-collegiate achievement, in explaining the differential representation by race in the health professions. Without accounting for the impact of college type on the likelihood of completing a bachelor’s degree, blacks appear to be somewhat more likely to pursue a career in the health professions. In contrast, blacks are less likely to pursue a career in the health professions once we account for the impact of college type on the race-specific likelihood of baccalaureate degree completion. Our results emphasize the importance of jointly examining the full chain of educational decisions in understanding racial differences in representation within professional healthcare occupations. ∗We would like to thank Michelle Bucci and Elizabeth Katz for excellent research assistance.