Outreach Points Underrepresented Students to Careers in Medicine
Q&A with Tour for Diversity in Medicine President Kameron Matthews, M.D., J.D.
April 26, 2023, Michael Devitt — Increasing workforce diversity has been a passion for Kameron Matthews, M.D., J.D., for decades.
Matthews is the chief health officer of Cityblock Health, a value-based health care network that provides integrated physical, behavioral and social services for Medicaid, dually eligible and lower-income beneficiaries in the Northeast. When she’s not in the office, however, she dedicates most of her free time and energy to a long-time passion: the Tour for Diversity in Medicine, an organization she co-founded in 2012 (and where she continues to serve as president) that encourages underrepresented minority high school and undergraduate college students to pursue careers in health care.
It’s vital work. Just this month, a groundbreaking study in JAMA Network Open confirmed what many people in health care have suspected for years: having more Black primary care physicians in a community improves the lives of Black people throughout that community. The study, which analyzed physician practice information and health outcomes in more than 1,600 counties over 10 years, found that in counties with more Black physicians, Black residents had higher life expectancies, lower all-cause mortality rates and smaller disparities in mortality rates compared with white residents.
“Black representation levels likely have relevance for population health, supporting the need to expand the structural diversity of the health workforce,” the authors wrote.
AAFP News spoke with Matthews about her work recently in conjunction with National Minority Health Month. The conversation has been edited for length.
Give our members a little backstory on the Tour for Diversity in Medicine.
As a medical student, I definitely had some visibility into the shortcomings of outreach efforts to other underrepresented minority students and really wanted to try to solve that problem. We thought, how are they being able to connect with mentors? How are they able to attend premedical enrichment programming if, indeed, they weren’t connected to an academic medical center or hospital, or had a mentor already?
Part of the reason why we founded the Tour was to address the issue of connection and outreach. We literally were on the phone one night, and decided that we’d get on a bus and go find these students and do a college bus tour.
That’s exactly where it came from, even the name. We wanted to tour campuses and do it in reverse — bring the physicians and dentists to them, particularly with the focus of seeking out an audience that wasn’t necessarily connected to resources in the same way as some of the students that attend conferences like the Student National Medical Association. We purposefully sought campuses that didn’t have a local SNMA chapter, so we went to a lot of historically Black colleges and universities and Hispanic-serving institutions. Over time, we started adding community colleges, as well.
Part of our objective was to expand our concept of diversity through the actual methodology for outreach, which is to stop going to the same schools that medical schools have been recruiting from for decades. The thought was that if we’re going to diversify medicine, we need to think more diversely about where these students are coming from. We wanted to frame a curriculum that was not just sharing information about how to become a physician, but to also motivate them, particularly for our Black and Brown students who may be first-generation college students or who may have never seen a Black or Brown physician before. We wanted to motivate them by sharing our stories, showing them that we exist, and hopefully help them think about stepping on a path that maybe wasn’t seen as an opportunity previously.
What was the first school you went to, and what was the experience like?
Hampton University in Virginia. It was lovely. It immediately allowed us to reassess how we would come onto campus. We did a debriefing after that very first stop, and we realized that we had been prepared to offer a more formal curriculum: This is how you apply, this is what your personal statement should be like, interactive workshops, mock interviews and things like that. We had it very structured, but throughout the day, a lot of the students continued to just blow past the structure with their questions and really ask us more personal questions: What happened when you did this or that? How did you deal with making a mistake? How did you deal with paying for medical school?
They really wanted to get more personal, and so we purposefully adjusted how we would approach the presentation. We’d share information with them on a slide and answer those detailed questions about the application process, but more than anything we wanted to share our stories so that they could have that same motivation. They could see that it’s OK to make mistakes, that we had been told as well by prior advisers that maybe we should think about a different career, that we didn’t all score highly on the first, second or maybe even third time taking the MCAT — in other words, that we were human. That’s really what they were seeking on that first day, and it blew our minds because we were expecting it to be such a formal day, and we immediately pivoted. Every stop, since then and for the next 10 years, has really been about making sure they know who we are and showing that we’re human.
Five years ago, you told AAFP News that you wanted to reach students who weren’t even thinking about a career in medicine. How has the Tour made a difference for those students?
We definitely continue to outreach beyond just the typical pre-medical audience. We’re seeking out students in their first year of college, post-baccalaureate students, high school seniors and juniors, just to share information around health care. We are purposefully dedicated to an effort called Health Professions Week, which targets younger students where we’re able to share our personal stories and decisions to go into medicine, to hopefully provide that influence when they hadn’t been considering medicine previously.
We promote osteopathic and allopathic medicine, podiatric medicine, pharmacy and dentistry — we’re really thinking about the terminal degrees within health care. We’re trying to reach those underrepresented students, mainly African Americans, Latinos and Native Americans. A lot of times their advisers, unfortunately, try to influence them by saying that they don’t have strong enough academic records to consider one of these degrees or that they should consider other fields. We really like to become a part of that discussion around career choices early as possible, so that we can counter that unfortunate trend for these students.
We hear that all the time — virtually and in-person from students — “Well, my adviser told me I’m not good enough, or my grades aren’t good enough.”
The one story that I remember most vividly was of a young Black man, a freshman with a 3.9 G.P.A. He was basically on a path to perfection, and his adviser told him that he wasn’t good enough. It’s disappointing that we still need to counter that, but that’s the reason why we are purposefully targeting students even before they are considering medicine, to try to steer them and continue to motivate them past how advisers might be trying to deter them.
And you’re right there in front of these students as a living example of the opposite of what the adviser is saying.
That’s exactly what I mean. We have mentors on the Tour that had to take the MCAT multiple times. Testing is very difficult, especially if you came up through a system that didn’t prioritize it and you didn’t develop those testing skills.
One of our mentors initially failed out of college, but he still comes back and is now a team doctor. So much of the barriers that these students need to overcome requires, as you said, for us to be in front of them and to speak from our experience. One of the phrases we often say is that your advisers are not your gatekeepers. They are not the ones that are determining not only your entry into medicine, but your success on that path, as well. Nor should the test be a barrier. You can succeed, and that’s the most important part — you can not just get in, but succeed in medicine, regardless of what negative experiences you may have had or academic weaknesses you might need to overcome.
A lot of recent evidence shows medical schools are becoming more diverse. How do you see this trend playing out for family medicine?
This trend makes me want to celebrate this generation.
I think the difficulties that we’ve seen over the past few years with the pandemic, the racial justice conversations that are continuing to plague the country and the health inequities that our communities are facing, not only during the pandemic, but clearly prior to it, are motivating these students.
I think they have a strong sense of justice and a strong motivation to help their communities, and they’re turning toward health care to do that. I want to celebrate, but also continually remind them that they are needed. We need them to continue on this marathon path into medicine.
I’m even more hopeful with this generation coming in, I think, for family medicine. More students that I talk to are recognizing the importance of primary care. I think we’ve been doing excellent messaging, not only in family medicine, but through larger public health conversations — for example, that the pandemic response needed to include primary care, and that vaccines and prevention and the like are critical services for the communities that these students are coming from. With them purposefully wanting to enter medicine with an eye on going back to their communities in providing service, I think family medicine is such a significantly important opportunity for them, and I think more of them will continue to choose family medicine.
I also chose it purposefully to be able to focus on health equity and serving my community. I’m a second-generation family physician. I grew up with it. My father practiced in suburban Philadelphia, where I grew up. He stayed at the hospital where he trained his whole career, became chair of his department and retired now about a year and a half ago.
I knew I wanted to do family medicine. I knew, hands-down, that I wanted to have that connection that he did with his patients. I didn’t want to just see them when they were ill, but also when they were well. I wanted to see them outside of the hospital. I wanted them to understand my ability to help at a community level, but I knew I didn’t want to do it in that suburban setting, so I differentiated from my father early and my career has really been focused more on practice areas, treating marginalized and minoritized communities from correctional medicine to federally qualified health centers to the VA, and now at a value-based primary care practice focused on Medicaid populations.
Family medicine was, for me, the best way to serve marginalized communities. It was out of an effort to address equity and to do so through a preventive mindset, as opposed to a reactive and hospital-based one.
You’ve been involved with the Tour for a little over a decade now. What has been the greatest achievement so far?
We have attempted to collect data. It’s not longitudinal — we know about the program’s impact and success in the immediate timeframe in which we connect with the students, but we look forward to having partners in the future to help us collect data and connect with these students in the long term.
Anecdotally, the success of the Tour for me has been the number of students that I’ve met, whether it’s at an SNMA conference or applying to become a mentor on the Tour, who attended the program and speak to its impact on them. They talk about their perspective and careers, and how the motivation that they received during our programming, when they met us at Hampton or South Carolina State, really set them on the path to wanting to go all the way. I think that’s success.
We truly have sought to, through single-day programming, make an impact by steering them in a direction. We recognize they need more longitudinal relationships — mentoring, research, shadowing opportunities — and so our one stop on their campus isn’t necessarily enough to sustain them on that path. We recognize that, but our goal is to actually get them to take that first step. Again, anecdotally we have large numbers of students that some of the mentors have stayed in touch with over the years, or ones that me at conferences or other meetings, to celebrate our efforts. So that to me is extreme success.
Where do you see opportunities for advancement on the Tour?
We have advanced our programming over the years, and I think we can continue to head in that direction. Initially, we started with just the college curriculum; we now have a high school curriculum that I would love to run as frequently, if not more frequently, for the very reasons we spoke of, in terms of reaching star students earlier along their path.
During the pandemic the past couple of years, we expanded our programming to medical students. We’re recognizing that we offer, based on our experiences, an amount of motivation to continue to push them through medical school because that is an equally difficult time while they’re already on that path. We need them to stay on that path.
Through a program that we started in partnership with the SNMA and the Latino Medical Student Association, every summer we set students up in pairs with physicians around the country to do mock interviews and potentially form mentoring relationships. That’s been extremely successful, and the Academy definitely is going to be a partner as we continue that program in years to come. We also are thinking about how we can provide more small-group mentoring opportunities, and I’ve had conversations with the AAFP about how we could offer that to Academy members as a way to connect with students around the country through virtual group mentoring. It’s not as hands-on or time-consuming, and it’s an opportunity to connect with diverse students, arguably, from around the globe. This has been a successful model that we rolled out with another academy and we’re going to repeat that in the near future with family physicians as well.
We think of our advancement opportunities as expanding our audience and expanding the different ways they can connect and think about individual specialties like family medicine, and hopefully travel to additional states and back to states that we’ve visited. Our program has been quite successful; we just need to make sure that these students currently in school can benefit as well.
What challenges is the Tour facing?
I think with any grassroots effort or nonprofit organization, it’s about succession planning and making sure that we can continue to have strong partners like AAFP and SNMA as we all continue to evolve. Making sure that I find additional leaders to join us not just as mentors, but to help us design further advancements and continue this program into additional states; that’s one of the areas that I’m working on now. I’m thinking about how we can sustain this program, and not just as something I’m working on as an individual, but how we institutionalize it.
Those are active conversations that I’m eager to continue to push forward. I don’t really see any challenges, though, with what I consider our bread and butter — our programming. Students have been attending our virtual programs over the past couple of years during the pandemic at very high numbers. We continue to hit the mark with our messaging. We continue to be as visible as possible on social media. They can watch us on Instagram. We definitely know we need to spread to TikTok. We’re not there yet, but there’s more to come. I think the more that we can reach additional students with unique programming and webinar topics and the like, I don’t see any challenges with reaching the students that we know need to be joining us in medicine.
What final thoughts do you want to share?
I’m excited about the future of family medicine and of health care in general because of this generation. I strongly encourage family physicians around the nation and around the globe to really be thinking about their own succession plan and how we actually help the future.
I definitely would love to invite any family physicians to join us as we do our outreach to fourth-year students and as we come to different states around the country to meet us on campus and to meet the students that we’re reaching. Mentoring is critical, and we need family physicians from every walk of life to take part in this so that we can really display the full potential of family medicine.
We tend to have a lot of involvement from our academic family physicians, and it would be great to think about private practice, or my former space in FQHCs, or correctional medicine, or the military services and the like, which have been strong partners for us. Family physicians are everywhere, and we need to display that as much as possible.
I continue to encourage physicians from all walks of life to get involved with mentoring and students. We need them to be part of this larger effort and to stand beside those of us who are in academia in trying to train the next generation.