The need for more doctors to develop quality health care in under- served and often miss-served minority communities of low-income families is of grave concern for Black medical professionals. An already existing problem of a Black and Latino doctor shortage coupled with recent anti-affirmation action legislation has worsened the problem.

According to the American Association of Medical Colleges, of the 737,764 total number of physicians in the United States in 1998, only 13 percent were non-white.

The issue of doctor-to-patient ratio is extremely important, said Dr. Abdul Alim Muhammad, minister of health for the Nation of Islam. One doctor to every 250 people is acceptable, he said, declaring that the one doctor to every 2,000 in the Black community and one per 3,000 in the Latino community is a crime against humanity. "The doctor-to-patient ratio in Black America is not any different from in Ghana or Ethiopia. Healthwise, we are an underdeveloped people," Dr. Muhammad said.

The issue of the scarcity of minority doctors is viewed by leading health professionals as a direct result of pervasive and systematic educational disadvantages in many non-white communities across the country. In November 1991, the Association of American Medical Colleges launched an initiative called Project 3,000 by 2000, to address the worsening problem of minority under representation in U.S. medical schools. Since then, the project has made significant strides in its efforts to increase Black and Latino enrollment at medical schools. However, the anti-affirmative action movement, which began in 1996, has stunted progress.

The National Medical Association, which represents over 25,000 Black doctors, attributes an anti-affirmative action wave to a two percent reduction in medical school enrollment for Blacks between 1996 and 1997, a 7.1 percent decline in total minority matriculation in medical schools during the same period. By 1999 there was a 12 percent decrease in minority medical school admissions and enrollment. But probably the most alarming statistic is a 40 percent overall decline in the number of people from non-white racial and ethnic groups that applied to medical school.

"Students feel that it is useless to apply because they see how effective the political opposition to equal access to higher education is in this country," said Dr. Mark Nivet, director of Minority Affairs for the Associated Medical Schools, a consortium of the 14 New York state schools. The figures for Black and Latino doctors for New York state has been the same for the last 10 years, a flat 10 percent. Dr. Nivet said that at the end of 1996 the national number was 12.5 percent. "The way we have been gauging the numbers we should be at 13 percent and that is as short as you can get," he said.

This discouragement of medical students is of grave concern to Dr. Muhammad. "It is time for us to realize that we as Black people need to declare the shortage of Black doctors a national emergency," he said during a telephone interview.

One New York-based doctor who has heeded the call for health care improvement in the Black community of Harlem is Dr. Dennis Brown. As a physician�s assistant he saw a need to return to medical school in order to better serve the community of his youth. Today, the 49-year-old trauma specialist in the Harlem Hospital emergency room is challenging the status quo, bucking a high-paying physician�s job and dedicating his services and talents to his community.

Dr. Brown�s motivation and inspiration for working in the impoverished community is quite simple. "It was the idea of public service ... making a difference," he said. "There are too few of us who understand the need to be in the trenches. The need to be dealing with the very sick in our community is a very special calling. Gone are the days of the big bucks. People laugh at me when they see me jump into my beat-up old jeep. They think I have a Mercedes parked in my driveway. For 90 percent of us working in Harlem Hospital, it is about improving the health care of our people," he added.

Dr. Nivet, who says the need for doctors to return to their community is of the utmost importance, applauds the efforts of Dr. Brown. He also sees the need to organize communities around the issue of health care. "The information concerning the seriousness of our problem doesn�t flow to our community," Dr. Nivet said. "People aren�t informed of things like the Georgetown University Medical Center�s study which showed that minority cardiac patients are less likely than whites to receive appropriate treatment," he added. Nor is it widely-known that the Kaiser Family Foundation released a report which stated 12 percent of Blacks questioned, and 13 percent of Latinos felt that they had been discriminated against by health providers. Other studies have shown that Black and minority patients feel that their quality of care is not equal to that of whites.

"Good physicians need to understand how social, cultural and economic factors influence the health of their patients and the patterns in which they seek out health care and respond to medical services," Dr. Nivet said, adding that Blacks and Latinos must insist that affirmative action in medical school recruitment continue.

Dr. Nivet�s point is supported by statistics published in "The National Agenda for the Million Family March" released in February. According to the agenda, 1992 saw Black males die of heart-related diseases at a 46 percent higher rate than that of white males. For Black females the rate was a staggering 69 percent higher than white females.

Acknowledging the problem and implementing solutions are sometimes worlds apart. Doctors like Dr. Gerald Thompson, senior associate Dean of the College of Physicians and Surgeons, and Dr. Michael Harris, Ph.D., director of Minority Affairs, both at Columbia University, are providing guidance and mentoring for undergrads who may be considering a career in medicine. The Minority Affairs Department recently held a one-day conference to inform students about the benefits of working in medical-related professions.

Factors such as poor or inadequate schooling are the greatest barriers students face, according to Dr. Harris. "We even have students telling us of teachers that try to discourage them from not only medical school, but college altogether. I think we need to become activists�be in the street�get into people�s faces, talk about what must change in the education system," offers Dr. Harris. Schools like Columbia have been working with high school students for many years. New programs have been extended into junior high, and plans are being drawn to start working with elementary grades. The main areas of concentration will be science and math, according to Dr. Harris.

Dr. Thompson, however, would rather talk of the 20-year legacy of the conference and Columbia University�s continuing commitment to recruiting minority students into the medical profession. "I know there is ongoing concern because we are not appreciably increasing our numbers," said the well-respected educator and doctor. "We will meet our goals," he said confidently. "We want improvement in the quality of teaching particularly in science at the high school level."

The Association of Medical Colleges has reported that it is only half-way to the goal of recruiting 3,000 doctors. "We need to regroup, start working with students at the lower grades," said Dr. Nivet. "We must put pressure on the school system and the politicians."

Dr. Muhammad concurs. "It begins with understanding that we are a community that must be responsible for one another. As parents we must take a harder look at our children. We do not need another basketball player. We must demand from parents that their children enter the medical professions. It is no longer something that we ask�it is something that must be demanded."

(Corey Muhammad contributed to this report.)