*91 C. Practice Location and Populations Served

      Thousands of communities across the United States have been designated as “Health Professionals Shortage Areas” (HPSA) by the Health Resources Services Administration of the United States Department of Health and Human Services. While these communities are by no means exclusively minority, they are disproportionately minority relative to percentage of population. In California, for instance, there is evidence that physician supply is inversely related to the concentration of African Americans and Latinos in the service area. This troubling inverse correlation appears to exist even after adjusting for community income level, and it exists in both rural and urban pockets of the state.

      This chronic access problem is not limited to California and is not limited to the African American and Latino communities. Simply stated, many minority communities have a chronic undersupply of health  care professionals, and this reality has an adverse impact on access to health  care and contributes to racial and ethnic disparities in health status.

      Although the Court in Bakke correctly noted the dearth of empirical data examining the practice patterns of minority physicians, researchers in the more than quarter century since Bakke have carefully examined practice patterns of minority physicians. The findings have been quite consistent and noteworthy: minority physicians are more likely to practice in underserved communities, and more likely to serve minority communities. Minority physicians have higher percentages of patients who are low income, covered by Medicaid, and sicker.

       *92 For instance, a 1985 study by Keith et al. of medical school graduates from the class of 1975 demonstrated that African American, Latino, and Native American physicians were almost twice as likely to be practicing in a HPSA as non-minority physicians, and were far more likely to be caring for patients of their own race or ethnicity. African American patients comprised 56% of the patient load of African American doctors and 8-14% of the caseload of non-African American physicians. Latinos comprised 30% of the caseload of Latino physicians, and 6% of the caseload of non-Latino white physicians.

      A 1996 study by Komaromy et al. focused on practice patterns of physicians in California and reached similar conclusions. African Americans comprised 52% of the caseload of African American physicians, and 9% of the caseload of non-African American physicians. Likewise, Latinos comprised 54% of the caseload of Latino physicians, and 20% of the caseload of non-Latino white physicians. This study controlled for the racial makeup of the community where the physicians practiced, and the findings nonetheless were quite stark and statistically significant.

      This study also showed that minority physicians cared for more poor people than non-minority physicians. African American doctors reported that 45% of their patients were Medicaid recipients; Asian physicians reported 30%; Latino physicians reported 24%, and non-Latino white physicians reported 18%.

      Both the Keith and Komaromy studies examined whether these practice patterns described above were by choice. Komaromy, for instance, examined minority graduates at the University of California-San Francisco, one of the most selective medical schools in the country. Graduates of UCSF have many career choices, and the researchers found that minority graduates at UCSF had substantially similar practice preferences to minority graduates elsewhere.

      A 1987 study of California physicians by Davidson and Montoya again confirmed that minority physicians care for higher percentages of Medicaid patients than non-minority doctors and see higher percentages of minority patients *93 than non-minority doctors. In this study, 32% of the minority physicians reported having Medicaid caseloads of greater than 40%, as opposed to 10% for non-minority physicians. Almost 60% of non-minority physicians reported having Medicaid caseloads of less than 10%, as opposed to 33% of minority physicians.

      In a 1995 study, Moy et al. analyzed data from a national survey that had over 15,000 respondents and found that minority physicians were more likely to provide care to racial and ethnic minority patients, poor people, and people who were sicker. Medicaid patients were 2.62 times as likely to receive their care from a minority physician as from a non-minority physician. Patients of minority physicians were much more likely to report being in poor health and having visited an emergency room than patients of non-minority physicians.

      More recently, the Association of American Medical Colleges (AAMC) released a report entitled “Minorities in Medical Education: Facts and Figures 2005.” This is the thirteenth edition of this critical compilation of data regarding minorities in medical education. In this report, the AAMC documented the findings of its 2004 Medical School Graduation Questionnaire. In this questionnaire, 21% of 2004 graduates reported that they intend to practice in an underserved community. There are noteworthy racial differences: 50% of African Americans, 41% of Native American/Alaska Natives, and 33% of Latino graduates reported an intent to practice in an underserved community, while 18.4% of white graduates reported such intent.

      The studies described herein are by no means the only bodies of research documenting the practice patterns of minority physicians. Many other studies have reached the same conclusion. In dismissing the access rationale put forth by the state, the Court in Bakke noted that there was insufficient evidence that a race-*94 conscious admissions program in question was “likely to have any significant effect on the problem” of improving access to health care in underserved communities. A quarter century later, there is a robust body of research demonstrating that increasing racial and ethnic diversity in the health professions will improve access to health care for underserved, poor, and minority communities.