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Community Colleges and the Healthcare Workforce

Over the past year, President Obama has unveiled plans to increase the US college graduation rate with the goal of becoming number one in the world for college graduates (1, 2, 3). Key to the president’s plan are strategies to increase graduation and transfer rates for community colleges. This would apply to public and private institutions receiving federal support that meet thresholds for attrition and graduation rates, below which institutions would be penalized either with reduced (or lost) federal funding or, in severe cases, loss of accreditation (3).

Obama’s plan has implications for states like Arkansas, which need a more educated and skilled workforce. It also could affect how, and who, is trained to provide healthcare to our state’s increasingly diverse population.

Community colleges’ role in producing the US workforce is huge and is expected to grow. Community colleges play a vital part in the higher education pipeline – serving both public and private 4-year colleges and universities. In Arkansas, about a third of slightly more than 170,000 students in college in 2013 attended one of the state’s 22 community colleges (4). Nationally, community college attendance runs a little higher – at about 41 percent, compared to 57 percent at 4-year institutions (5).

Thus, community colleges have a tremendous impact, not only on the number but also the make-up of the applicant pools that apply to, are admitted and matriculate through graduate and professional schools. This includes the health professions.

To understand the growing importance of community colleges in higher education and health professions training in particular, an important question is: Who attends community colleges? Because many are from low- to middle-income families, minority and first-generation college students are more likely to stay at home and attend a 2-year college, then transfer to a 4-year institution. While whites and students whose parents are college-educated are less likely to attend a community college, more minority, first generation and low income students are starting their college education at a 2-year school to keep costs down.

For the past decade, the US has been undergoing a fairly rapid demographic shift. Today racial and ethnic minorities make up 31 percent of the US population (5). It is estimated that by 2050 there will be no real minority or majority in the US, and people of color will be in the majority (5). As our nation becomes more diverse, the ability of the health care system to provide culturally competent and equitable healthcare will become even more critical – and more dependent on the growing number of students attending our community colleges.

The literature is replete with studies that show the value of a racially and ethnically diverse healthcare workforce in improving access to care and patient compliance (6). Students from diverse backgrounds are more likely to be committed to primary care and providing care to the underserved. According to a study by Talamantes et al, among medical students who had attended community college there is a significantly greater intention to work in underserved communities and pursue a career in primary care. The study, which used data from the AAMC matriculating student questionnaire, also found that a third of all Latinos matriculating into medical school in 2012 had first attended a community college then transferred and about a third of all medical school applicants, in fact, had at some point used the community college pathway (7).

Community college students come from varying backgrounds, and with more than 40 percent of US college students attending a community college, that path should not be viewed only as an option for those who may need to remediate or as an educational avenue for the non-traditional student but as a current an indispensable part of the mainstream educational system.

However, many community college students do come from disadvantaged backgrounds. As they pursue an education, they may have to overcome barriers due to limited finances and having to work to supplement the family income, parents who are not college-educated, or having attended poorly equipped schools at the primary and secondary levels. The admissions process at select universities, colleges and professional schools needs to take into account the very long distance traveled by students who have persisted and overcome such difficulties. These former community college students should not viewed negatively, but rather positively. Those making admissions decisions should make sure that they are not discounting the academic achievements of those who took the community college pathway, in particular under-represented minority students, due to their attendance at what is perceived as a less “academically rigorous” institutions rather than select and research-intensive universities (8).

Unfortunately, due to multiple variables, some student-related and some system-related it has been estimated that only 37 percent of community college students eventually transfer to 4- year institutions (9). Reforms are needed to improve the 2-year college system (10).

Although community colleges have existed for many years over the past decade we have reached a “tipping point” at which based on several factors, most prominent of which is affordability, an increasing number of students must begin their educational process at community colleges. I do agree with the idea of free tuition at the community college level; it does seem to be a natural extension of the K-12 public and private school system. However, the extension must come with aggressive improvements to the current system of 2-year institutions. This should include a revamping of faculty advising especially in the pre-health arena (STEM), more stringent faculty evaluations and hiring practices, more aggressive monitoring of attrition and graduation rates, and more need-based financial aid and scholarship support in the form of Pell grants that specifically target minority and disadvantaged students, as well as mechanisms to hold students accountable to obligations for loans and class attendance. These basic reforms will strengthen the community college system so that it better serves us all. The community college pathway is solidly entrenched in our higher education system and will continue to expand and in so doing will require a much needed influx of funds along with increased educational and social support.

References:

  1. Obama Presses for Free Community College and Tax Reform. Chronicle of Higher Education. January 21, 2015. Kelly Field.
  2. Tennessee’s Task: Turn ‘Free Community College’ From a Rallying Cry into a Success. The Chronicle of Higher Education. Eric Kelderman, March 6, 2015.
  3. Under Pressure from New Performance Funding Systems, State Universities Raise Admissions Standards, New Study Finds. The Community College Research Center. Teacher College, Columbia University, NEW YORK, NY (Nov. 11, 2014).
  4. Comprehensive Arkansas Higher Education Annual Report, December 1, 2014. Arkansas Department of Higher Education. Retrieved 3/26/2015 from http://www.adhe.edu/SiteCollectionDocuments/Comprehensive%20Report/2014/Research%20and%20Planning/05-StudentEnrollment.pdf.
  5. US Department of Commerce. United States Census Bureau. Quick Facts. 2012.
  6. Cooper LA, Roter DL. Patient-Provider Communication: The Effect of Race and Ethnicity on Processes and Outcomes of Healthcare. In Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Institute of Medicine: Washington, D.C., National Academies Press, 2002.
  7. Talamantes E, Mamgione CM, Gonzalez K, Jimenez A Gonzalez F and Moreno G. Community College Pathways: Improving the U.S. Physician Workforce Pipeline. Academic Medicine, Vol. 89, No. 12. 1649 – 1656.
  8. Saguil A. and Kellermann AL, The Community College Pathway to Medical School: A Road Less Traveled. Academic Medicine, Vol. 89, No. 12 1589-1592.
  9. Adelman, C. The Toolbox Revisited: Paths to Degree Completion From High School Through College. Washington, D.C.: U.S. Department of Education, 2006.
  10. Continuous Improvement for College Completion: Arkansas Builds a System-Level Strategy for Community College Student Success. Achieving the Dream, Inc. The Winthrop Rockefeller Foundation. February 24th, 2014.